Introduction

The growing legalization of medical cannabis across the United States has ushered in a new era of accessibility and normalization—but with it comes an unsettling and often overlooked consequence: accidental cannabis exposure in infants and young children. As edibles, oils, and concentrates become commonplace in homes, so too do emergency room visits involving toddlers who have unwittingly ingested high-potency THC products disguised as harmless treats. This alarming trend is not hypothetical—it is unfolding in real-time in pediatric emergency departments across the nation.

While cannabis is widely perceived as relatively safe for adults, the same cannot be said for children, whose developing brains and small bodies are acutely vulnerable to the drug’s psychoactive effects. In fact, even a single gummy or cookie laced with THC can lead to serious, sometimes life-threatening, consequences for a young child. The subtle presentation of symptoms, coupled with the hesitation or unawareness of caregivers to disclose cannabis in the home, makes these cases diagnostically challenging and clinically urgent.

In this detailed case study, we explore the real-world emergency treatment of an 18-month-old boy who arrived at the hospital unresponsive, later determined to have THC in his system. His story serves as a stark reminder of the public health risks that accompany cannabis use in households with children. Through an in-depth analysis of his clinical presentation, the diagnostic process, treatment pathway, and larger epidemiological implications, this article aims to offer a definitive resource for clinicians, journalists, bloggers, and public health educators seeking to understand and prevent pediatric cannabis exposures.

Clinical Vignette

An 18-month-old boy was rushed to the pediatric emergency department (PED) after being found unresponsive at home. Emergency medical services reported that although the child was breathing independently and maintained normal vital signs, he was difficult to awaken. No external signs of trauma were visible, and initial observations indicated altered mental status and abnormal motor activity, including upper extremity rigidity and intermittent tremors.

Upon arrival, the patient was placed in the resuscitation bay. A multidisciplinary team promptly began a comprehensive workup: complete metabolic panel, venous blood gas, cerebrospinal fluid (CSF) analysis, and neuroimaging with a CT scan. Toxicology screening, including a standard 7-drug urine panel, was performed. Empirical treatments included IV fluids at 60 mL/kg, 2 mg intravenous naloxone (with no observable effect), and a broad-spectrum antibiotic (ceftriaxone) in case of meningitis.

Initial glucose levels were normal at 120 mg/dL. The family, who arrived shortly after the child, denied access to any substances in the home, though they reported the recent use of over-the-counter cold medications and ibuprofen. Later, after the urine drug screen returned positive for delta-9-tetrahydrocannabinol (THC), the child’s grandmother acknowledged the presence of cannabis products in the household. The patient’s condition improved within six hours, and he was safely discharged following observation.

Diagnostic Approach and Key Observations

Initial Differential Diagnosis

In pediatric cases of altered mental status, differential diagnoses are broad and include:

Toxic ingestion (e.g., household chemicals, medications)
Seizure disorders
Central nervous system infections
Metabolic disturbances
Head trauma or non-accidental injury

The clinical team took a systematic approach, ruling out metabolic, infectious, and traumatic causes through laboratory testing and imaging. The child’s sedation, motor rigidity, and fluctuating pupillary responses initially suggested a neurotoxic or centrally acting sedative agent.

Urine Drug Screen Confirmation

The presence of THC was confirmed in the urine sample collected roughly four hours after initial presentation. Notably, delta-9-THC is the primary psychoactive compound in cannabis, and it can be detected in urine for hours to days post-exposure depending on dose and metabolism.

Symptomatology Consistent with Cannabis Toxicity

Common signs of cannabis ingestion in children include:

CNS depression (lethargy, stupor, coma)
Muscle rigidity or ataxia
Tremors
Vomiting
Tachycardia or bradycardia
Hypotension in severe cases

The infant's altered mental status, rigidity, and tremors aligned with this presentation.

Epidemiology and Legal Context

Cannabis Legalization and Increased Risk

Cannabis is now legal for medical use in 47 U.S. states and the District of Columbia, and for recreational use in 24 states as of 2025. This widespread legalization has unintentionally increased the risk of pediatric exposure. In homes where cannabis is consumed, storage practices often do not meet child-safety standards. Edibles pose a unique risk due to their resemblance to regular snacks and candies.

Pediatric Exposure Trends

A recent study utilizing U.S. poison center data from 2000–2020 revealed a dramatic spike in cannabis exposures in children aged 0 to 5 beginning in 2014, with an even steeper rise starting in 2020, corresponding with COVID-19 lockdowns. From 2017 to 2020 alone, monthly cannabis exposure reports nearly doubled. Canada has reported similar findings following its own legalization timeline, especially after permitting the sale of cannabis edibles.

Edible Cannabis: The Hidden Danger

Why Edibles Are Especially Risky

Cannabis edibles—ranging from gummies to brownies to soda—are often marketed in brightly colored, enticing packaging. In one survey, 8% of edible products imitated popular non-cannabis snack brands, making them indistinguishable to children. These products may contain up to 500 mg of THC per package, far exceeding the threshold for intoxication in adults, let alone children.

Children are more susceptible due to their lower body mass and immature metabolism. After ingestion, THC is absorbed slowly but efficiently via the gastrointestinal tract, with peak effects often delayed for 1 to 2 hours. This delay can make diagnosis more difficult and increase the risk of repeated dosing or misattribution of symptoms to other causes.

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Clinical Course and Management

Typical Symptom Duration

In a systematic review, the duration of symptoms from cannabis ingestion ranged from 6 to 48 hours. This wide range reflects the variability in THC concentration and the child's metabolism. In the case of this 18-month-old boy, the symptoms resolved within 6 hours, which is relatively short and may suggest a smaller dose or more rapid clearance.

Supportive Treatment as the Standard of Care

There is no specific antidote for THC intoxication. Management is generally supportive and includes:

Monitoring airway, breathing, and circulation (ABCs)
IV fluids for hydration and perfusion
Glucose monitoring in cases of poor oral intake
Ongoing neurologic assessment

In more severe cases, respiratory depression may necessitate intubation. ICU admission is typically reserved for patients with persistent CNS depression, hemodynamic instability, or respiratory compromise.

Avoiding Unnecessary Testing

Pediatric cannabis ingestion can mimic other serious conditions, prompting extensive testing such as CT imaging or lumbar punctures, particularly when no ingestion history is provided. This increases healthcare costs and may expose children to unnecessary procedures. Clinicians are urged to include cannabis toxicity in their differential diagnosis to streamline care when relevant risk factors are present.

Public Health Implications

Prevention and Education

This case illustrates the critical need for public education on safe cannabis storage. Health care providers should counsel parents and caregivers to:

Keep cannabis products locked and out of reach of children
Avoid consuming edibles in front of children
Store products in child-resistant packaging
Dispose of cannabis waste discreetly and securely

Packaging Regulations and Policy Considerations

There is growing advocacy for standardizing THC packaging to eliminate branding that mimics popular snacks. Regulators are urged to:

Mandate bland, non-attractive packaging
Limit THC concentration per unit
Require clear THC labeling and warnings
Enforce child-resistant containers

Role of Poison Centers

Poison control centers play a vital role in both clinical management and public education. Available 24/7, these centers guide healthcare providers and caregivers in real-time, helping reduce unnecessary ER visits or escalating care when needed. The national poison center number—800-222-1222—should be made widely available, especially in homes where cannabis is used.

Lessons Learned and Recommendations

For Healthcare Providers

Maintain a high index of suspicion for cannabis ingestion in young children presenting with altered mental status.
Incorporate urine toxicology testing early in the diagnostic process.
Minimize invasive testing when cannabis exposure is suspected and confirmed.
Provide discharge counseling on poisoning prevention.

For Caregivers

Always treat cannabis products like prescription medications—keep them secure and away from children.
Be honest with emergency personnel in cases of suspected ingestion; timely information can prevent unnecessary procedures.
Seek medical help immediately if a child becomes unusually drowsy, unresponsive, or shows abnormal motor behavior.

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Conclusion

The case of the 18-month-old boy who unintentionally ingested THC highlights the urgent need for increased vigilance, education, and regulation surrounding cannabis products—particularly in homes with children. As legalization continues to expand across the country, pediatric exposures are expected to rise unless proactive public health measures and parental awareness efforts are implemented. This case serves as a critical reminder that cannabis, while legal in many states, is not without risks—especially for young and vulnerable populations.

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FAQs

There is currently no specific antidote for cannabis poisoning. Treatment is primarily supportive and may include IV fluids, monitoring of vital signs, and observation until symptoms resolve. Most patients recover without the need for intensive medical intervention.
Cannabis allergies are managed similarly to other plant-based allergies, with treatment focusing on antihistamines, corticosteroids, or inhalers for respiratory symptoms. In severe cases, such as anaphylaxis, epinephrine may be required. Avoiding exposure to cannabis is the most effective preventive strategy.
Yes, newborns exposed to cannabis in utero may exhibit withdrawal-like symptoms, such as irritability, tremors, poor feeding, or sleep disturbances. These symptoms tend to be mild and temporary but require monitoring and supportive care. Long-term effects are still being studied.
There is no way to "neutralize" a cannabis overdose, but symptoms can be managed with rest, hydration, and reassurance. In medical settings, treatment focuses on monitoring and supportive care until the effects wear off. Severe cases may require hospitalization, especially if respiratory depression or altered consciousness occurs.
A cannabis allergy may cause skin rashes, itching, hives, red or watery eyes, nasal congestion, or asthma-like symptoms. Some individuals may experience more severe reactions, including anaphylaxis. Symptoms can appear after touching the plant, inhaling pollen, or consuming cannabis products.

Case Study: Treating Infants for Cannabis Exposure

Introduction

Clinical Vignette