title: A 10-year review of cannabis exposure in children under 3-years of age: do we need a more global approach?
abstract: Pediatricians working in an emergency environment are confronted with children admitted to emergency departments for intoxication on a daily basis. We carried out a retrospective cohort study of children admitted to a pediatric emergency department due to unintentional cannabis exposure over a 10-year period from 2004 to 2014. Twenty-nine children under the age of 3 were admitted with a positive cannabis urine test. Eighty-seven percent of intoxications occurred at the family home. Resin was the main form of ingested cannabis (69%). The mean age was 16.5 ± 5.2 months, and mean weight was 11.1 ± 2.1 Kg. Sixty percent of admissions occurred between 2012 and 2014. More severe presentations, based on Poisoning Severity Score, occurred over the past 2 years. Four children experienced seizures before admission. Ten children (34%) had a decreased level of consciousness (GCS <12) and were admitted to a pediatric intensive care unit for 12-24 h. All of them had ingested hashish (resin). The majority (70%) of children suffering from neurological impairment were admitted in the last year, of whom three required assisted ventilation. There were no cases with major outcomes and no deaths. Parents were not assessed regarding their cannabis consumption.
  
  
  CONCLUSIONS
  This study supports the impression that accidental child poisonings with cannabis have been more serious than previously thought for 2 years. This observation may be explained by (1) the increased THC concentration in cannabis and (2) the widespread use in young adults, even after they become parents. Introducing an addiction team inside the PED could help to improve the care links with these parents. What is Known: • Cases of unintentional cannabis intoxication in children have been increasing for many years due to an increase of potency. What is New: • We highlight an increase in more severe presentations in children under the age of 3 occurring over the past 2 years, which will indicate the importance of assessing cannabis abuse in parents by a specialized addiction team.
authors.affiliation: Pediatric Emergency Department, Children hospital, CHU Toulouse, Toulouse, France.|University of Toulouse III, Toulouse, France; INSERM U 1027, Toulouse, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Claudet
authors.affiliation: Pediatric Emergency Department, Children hospital, CHU Toulouse, Toulouse, France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Le Breton
authors.affiliation: Pediatric Emergency Department, Children hospital, CHU Toulouse, Toulouse, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Bréhin
authors.affiliation: University of Toulouse III, Toulouse, France; INSERM U 1027, Toulouse, France. franchitto.n@chu-toulouse.fr.|Regional Poison Center, Purpan Hospital, CHU Toulouse, Toulouse, France. franchitto.n@chu-toulouse.fr.|Department of Addiction Medicine, Toulouse-Purpan University Hospital, 31059, Toulouse, France. franchitto.n@chu-toulouse.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Franchitto
mesh_terms: D002188:Cannabis / Q000506:poisoning*; D002675:Child, Preschool; D013759:Dronabinol / Q000652:urine*; D004636:Emergency Service, Hospital; D006801:Humans; D007223:Infant; D008385:Marijuana Smoking; D010290:Parents; D012189:Retrospective Studies
chemical_list: D013759:Dronabinol
keywords: Cannabis; Children; Emergency department; Parental addiction