Cannabis Edibles and Young Children: A Dangerous Combination! – PediaCast 546
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Show Notes
Description
- Dr Christopher Gaw and Dr David Kling visit the studio as we explore the dangers of cannabis edibles in young children. THC-infused gummies, brownies and cookies are widely available… and severe toxicity can result from ingesting just a handful. We hope you can join us!
Topics
- THC-Infused Edibles
- Cannabis Toxicity in Young Children
Guests
Links
- Emergency Medicine at Nationwide Children’s Hospital
- Pediatric Edible Cannabis Exposure and Acute Toxicity: 2017-2021 (Pediatrics)
- Toxic Tetrahydrocannabinol (THC) Dose in Pediatric Cannabis Edible Ingestions (Pediatrics)
- Cannabis (marijuana): Acute Intoxication (UpToDate)
- Poison Center Hotline: 1-800-222-1222
Transcription
Announcer 1: This is PediaCast.
Announcer 2 Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 546 for October 11th, 2023. We're calling this one "Cannabis, Edibles, and Young Children, a dangerous combination." I Want to welcome all of you to the program.
So, we have a very important public service announcement for you today. And in our usual PediaCast fashion, we're going to expand on that message by exploring the who, what, when, where, why, and how of accidental poisoning with THC-infused edibles in young children.
0:01:14
Now, most of you know that THC is the primary mind-altering chemical in marijuana. And as products that contain THC become more common and widespread, children have an increased opportunity for exposure that was really unheard of just a few years ago.
Accidental ingestion of THC in kids, particularly less than six years of age, is really on the rise, like 1000% increase over the last few years. And one big reason for this is the creation and distribution of edibles containing THC. And, of course, these come in the form of gummy, candies, brownies, cookies, along with many other forms of baked goods.
0:02:02
And we all know that young children are curious. They love putting things in their mouths and are particularly fond of sweet treats like gummies, brownies, and cookies. So, it really makes sense that we are seeing a rise in young children presenting to emergency departments with a THC or cannabis or marijuana toxicity. But what may surprise you is just how dangerous these ingestions can be for young kids and how little milligram-wise is needed to cause severe effects.
And here's a spoiler alert. But I think it's important to disclose this up front because it's so important and sheds light on why we are spending time on this topic. And that is that it just takes one pouch of gummies to have a toxic, a life-threatening effect on a toddler. And so, it's really, important to keep cannabis edibles completely away from young children.
0:03:04
Of course, we'll explore much more along the way, and we will drive that point home several more times because it's really, really important.
We'll also talk about how THC affects the body, what exactly does it do, kind of at the cellular level, what signs and symptoms does it cause, when do these signs and symptoms become life threatening, and how is THC toxicity treated, and what are best practices for preventing these poisonings in the first place. We will answer these questions and many more. And of course, we have a couple of terrific guests to help us on our journey.
Dr. David Kling is a Pediatric Emergency Medicine Fellow at Nationwide Children's Hospital. And Dr. Christopher Gaw is a Pediatric Emergency Medicine attending, also at Nationwide Children's.
Before we get to them, let's cover our usual quick reminders. Don't forget, you can find us wherever podcasts are found. We also appreciate when you review the podcast wherever you listen to podcasts so that others who come along looking for evidence-based child health and parenting information will know what to expect.
0:04:08
We are also on social media. You'll find us on Facebook, Instagram, Threads, and LinkedIn. Simply search for PediaCast.
We also have a contact link at pediacast.org if you would like to suggest a future topic for the show.
And then I do want to remind you, the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.
Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pediacast.org.
So, let's take a quick break. We'll get Dr. Christopher Gaw and Dr. David Kling settled into the studio. And then we will be back to explore the dangers of cannabis edibles in young children. It's coming up right after this.
[Music]
0:05:24
Dr. Christopher Gaw is an emergency medicine physician at Nationwide Children's Hospital and an assistant professor of Pediatrics at the Ohio State University College of Medicine. Dr. David Kling is a Pediatric Emergency Medicine Fellow at Nationwide Children's.
Both have a passion for supporting children and families impacted by unexpected emergencies, including the accidental ingestion of edible products containing THC, which is the primary mind-altering chemical in marijuana. That is what they are here to talk about, cannabis edibles and the dangers they pose to young children.
But before we jump into that conversation, let's give a warm PediaCast welcome to our guests, Dr. Christopher Gaw, and Dr. David Kling. Thank you, guys, so much for visiting with us today.
0:06:06
Dr. Christopher Gaw: Thank you so much for having us on the podcast.
Dr. David Kling: Thank you. Excited to be here today.
Dr. Mike Patrick: We really appreciate you guys getting up early and sharing your expertise with all of us. David, I wanted to just ask you really quick. I mentioned that you are an Emergency Medicine Fellow. What exactly is a fellow and what is your role in the emergency department?
Dr. David Kling: Yeah, so a fellow is actually a subspecialty of Pediatrics. So, I am pediatric-trained and now I'm doing a subspecialty in Pediatrics and Pediatric Emergency Medicine. So, I kind of help residents and also the attendings in the emergency part and take care of the children.
Dr. Mike Patrick: Great. And then you are a third-year fellow and Pediatric Emergency Medicine Fellowships are three years. So, you will be an attending and taking care of kids and teaching residents and fellows yourself and medical students of course, too.
Dr. David Kling: That is correct, yes.
0:06:59
Dr. Mike Patrick: Great. All right, let's jump right into our topic. I think a great place to start is with some definitions because there's actually a lot of terms, I feel like that have nuanced meanings. But that people sort of use interchangeably sometimes.
And the first of those would be THC. What exactly does that stand for and what does it mean?
Dr. David Kling: Yeah, so THC stands for tetrahydrocannabinol. And like you mentioned earlier, this is the main psychoactive ingredient in cannabis or marijuana. And this is kind of what gives people that high when they use marijuana.
Dr. Mike Patrick: Okay. And so, this type of chemical is called a cannabinoid. And there are other ones which we will mention here in a minute. But what are some other terms that is associated with marijuana and THC that folks may hear?
Dr. David Kling: Maybe some people might encounter what's called Delta-9 THC. This is kind of one of the most common forms of THC. And then again, this is something that people might encounter on packaging and things.
0:08:02
Other names like we've already kind of mentioned is cannabis, which is actually the name of the plant itself or also known as marijuana. Some other terms people might be familiar with or hear are things like bud, ganja, grass, pot, weed. Those are all again, synonyms for THC.
And then, of course, different formulations that they come in. So, it can be smoked as like a joint, blunt and bowls or bongs. And then it can also be ingested as edibles, like we are focusing on today.
I would like to just say that it is a little bit different than CBD, which is the cannabidiol, which is something also from the cannabis plant, but doesn't have that psychoactive effect.
Dr. Mike Patrick: And so, THC is a cannabinoid that crosses into the blood brain barrier, gets into the brain, has an effect inside the brain or the central nervous system. But there are other cannabinoids and as you mentioned, CBD is one of them.
0:08:56
And then there's also CBG and there's CBN. And those are less studied and well known, although none of these things are studied to a high degree because they've just really been legal to use here in the last decade or so in the United States. And so, there hasn't been this big body of research. But I'm sure that as we move forward, there will be much more on that.
Chris, I want to bring you in and ask so what does THC and these other cannabinoids, what do they do in the body?
Dr. Christopher Gaw: I think the best way to understand how they interact with your body is to actually use a separate example, just to kind of illustrate. So, if you think about your brain, your nervous system, even other parts of your body, there are specific receptors across your body that can bind specific substances.
And if you think of a compound that maybe most people or some people have heard about called serotonin. It's a substance that is in neurotransmitter that can affect mood, that binds to serotonin receptors. So, when you hear about a drug like an SSRI that works by changing the amount of serotonin that can bind to those receptors.
0:10:09
Also, in your body are receptors that are called cannabinoid receptors. And these exist in your brain, in your central nervous system and in other parts of your body, like certain types of muscles. And your body actually makes its own type of substances called endocannabinoids that bind naturally to those cannabinoid receptors. But THC, being an external substance, can also bind to those receptors. And those receptors or that binding is really what creates those psychoactive effects, those effects of being high that people often talk about.
Dr. Mike Patrick: So how we feel each day is really a complex interaction of chemicals in our brain. And I love that example that you gave where we have drugs that we use in medicine all the time, that either bind your receptors and activate them or bind and prevent your natural chemicals that you're making from binding to those same receptors because this chemical is bound to it.
0:11:07
And in this case, I think folks would find it interesting to know that we make our own type of cannabinoid. And so, we already have the capacity to sort of feel high, I guess, but at a much lower level because we're not making nearly as much of that as when you ingest THC. And then, there's so much of it activating all of those receptors at once. And so, we get really an exaggerated response of that high feeling and that's why we have that.
There also are cannabinoid receptors in the immune system. And again, this is really not well studied. So, you hear all sorts of claims that cannabis can do this and that. And there's all sorts of medical benefits of cannabis and to some degree that may be other receptors in the body, but we just don't really know yet. Correct?
0:11:59
Dr. Christopher Gaw: Yeah, that's exactly right. We are just beginning to kind of uncover that and really dig into that type of research. We know that, especially when we talk about CBD, there may be some opportunities to kind of better understand how that interacts with the immune system, how that interacts with mood. And so that research is just starting to come out.
And then there are certain compounds that are approved for increasing appetite, specifically in cancer patients or HIV patients, that kind of leverage these cannabis compounds. And so, that's probably where the most understanding that we have is with cannabis compounds is really increasing appetites in special patient populations.
But again, the world is still wide open in kind of understanding all these other effects that cannabis, THC, CBD might have on the body.
Dr. Mike Patrick: So there certainly can be positive effects. And it's interesting because probably, anecdotally, people have heard that if you smoke marijuana or now eat edibles that you have increased hunger. And so, there's kind of that stereotype of someone who has used these substances and then they're running to Taco Bell.
0:13:18
And so, from those anecdotes, then we can say, "Well, let's see if that's really true and do a study." And then it starts to get incorporated into clinical medicine at that point.
So, it's all very interesting and, as you said, the world's wide open here for future research. And I think ten years from now we'd probably be having a very different conversation. So, we'll see what the future holds.
So traditionally, I think when most people have thought about marijuana in the past, we think about smoking it. And so, that the THC and other cannabinoids entering our body through the lungs.
But now, we have these edibles. And tell us a little bit more about those, David. What exactly are edibles and how do they deliver THC?
0:14:06
Dr. David Kling: Yeah, so edibles are anything that you can actually consume or ingest, so eating or drinking. And typically, what happens is they take the cannabis plant and cook it down to its oil form and use that oil and incorporate it into various food products.
So that can be candy. It can be baked goods, cookies, brownies. It can even be involved with chips or even something that you drink. So that obviously provides kind of a variety of options there.
And like you mentioned, this is of course different than the traditional smoking, but it does produce the same effects. And it's important to note, because you are ingesting it, your body has to kind of absorb that through your GI tract and that provides kind of like that delayed effect and onset. So that typically happens maybe an hour or two after consuming the edible.
Dr. Mike Patrick: And that's important because there's some feedback if you're smoking a product and that chemical is getting into your bloodstream right away, you're going to have that feeling and know, "Hey, I probably don't need anymore." Hopefully, you think that.
0:15:08
But if you do an edible and it's going to take an hour or more before you have onset, you may eat more than you really wanted to eat. And so, then toxicity or bad effects, even in adults, can occur if you over consume because you don't have that feedback right away.
Dr. David Kling: Yeah, exactly. Kind of think about it when someone consume alcohol, the effect doesn't happen immediately. It is delayed. So same thing applies here.
Dr. Mike Patrick: And then Chris, why is this a particular problem then, edibles with containing THC? Why is it a particular problem for the pediatric population?
Dr. Christopher Gaw: Yeah, I think there are two big issues or reasons why edibles cause a problem for children. So, the first is an edible looks like candy in most cases. It can look like a gummy; it can look like a lozenge.
0:16:02
As David had mentioned, sometimes, they look like other food types as well. And so, if kids are looking at these products, they get excited and they may be eating more than what they should in terms of a dose. And so then, let's talk about the dose aspect of that.
It's really a problem about dose and size because edibles are really potent, and kids are quite small compared to adults.
So, I like to give another example. When we give a medication like Tylenol to kid, your pediatrician tells you a specific dose, we adjust that dose based on their size and weight because giving an adult dose of Tylenol would be too much for children and could be toxic to them.
Technically, kids probably shouldn't be eating edibles, but that same principle applies though. For example, the serving size on most edible packaging that you can purchase in states that have legalized recreational cannabis, they'll list 5 to 10 milligrams as a serving. And remember, that is a serving size for an adult, someone who's over 100 to 150 pounds.
0:17:10
And so, kids are much, much smaller. And so, one-year-olds, we're talking probably is around 20 to 25 pounds. And so, even the dose from that one edible, which is meant for an adult, is a much higher dose on a child's body and can have much greater effects.
Dr. Mike Patrick: And if a child gets into a pack of gummies, for example, most kids don't stop eating gummies at one, right, like you eat the bag. And so, these bags can have 100 to 200 milligrams of THC, which is really going to be a crazy toxic dose for a child. And we've talked about the effects on the immune system and the effects on the brain, but we haven't really talked yet about what happens when you have way too much. And we will do that in a moment.
Before we get there, though, let's just talk about how common this is. I'm sure it was pretty much unheard of 10, 15 years ago and now it's actually pretty common, right? David? That is true.
0:18:11
Dr. David Kling: That is true. It's definitely becoming more common. And basically, a study recently showed us that from 2017 to 2021, there has been over 1000% increase in these cases and calls into poison centers specifically for these THC-containing edibles. And overall, they account for about 40% of all marijuana ingestions in all age groups. So, yes, it's definitely increasing.
Dr. Mike Patrick: Yeah. And the study that you mentioned was published in the journal Pediatrics, and it's called Pediatric Edible Cannabis Exposure and Acute Toxicity from 2017 to 2021. We do have a lot of science-y people in the audience, and so if this is something that you're interested in learning a lot more about, it's really a lot of epidemiology on edible ingestion. So, I'll put a link to that in the show notes so folks can find it easily.
0:19:07
It was interesting, some of the things that they found. And in addition to just how common it is, but also when you look at where edible ingestion occurs, like 98% is inside the home, which makes sense. But it just shows even more important why, if you have edibles in the house, that they really should be definitely out of the reach of young children.
And preferably something that you know that child cannot get into because kids often can climb up on chairs and counters. And so, we have to be really careful about that.
Study also found that of the children who present to an emergency department because they have eaten an edible, like a quarter of them get admitted to the hospital. So, I mean, it's actually a common reason why kids would, I mean, a high percentage of them would need to be admitted because the symptoms are so severe.
Are we seeing that here in Columbus as well, David?
0:20:08
Dr. David Kling: Yes, definitely. I recently worked over the past weekend and I easily saw at least two cases of this and kind of something maybe we'll talk about a little bit later. But just with the uncertainty of sometimes how much is consumed and of course the uncertainty of when as well, it's oftentimes safest just to admit the child to monitor them closely in the hospital.
Dr. Mike Patrick: Yeah, absolutely. And then what risk factors are associated with accidental THC ingestion? So, what kind of profile of a child might be more at risk for having this happen to them?
Dr. David Kling: Good question. So, like all unintentional ingestions, whether that be a THC edible or some other medication or a household cleaning product, typically it's the younger patients that are more likely to have these unintentional ingestions.
And studies have shown that typically majority of these cases occur in children under the age of six years of age.
0:21:08
And that most recent study that we talked about already actually showed that most commonly, even more specifically, was in kids around the age of two even. They're just very prone to exploring the world. They just want to know what's out there, what their parents are doing. And so, they obviously can unintentionally get into things that they shouldn't.
Other things to keep in mind too would be children that have maybe some developmental delays. Again, they might not have the same learning abilities and therefore might not know at various stages in their life when to not to do something. And so, that they can also be at risk for unintentional ingestions.
And again, I would like to just also emphasize the things that we have already mentioned is kind of other risk factors would be just the products themselves, how they're packaged and how they're marketed as well.
0:21:56
Dr. Mike Patrick: And so, what would be ripe for potential disaster is going to be if you have THC edibles inside the house and you have a two- or three-year old. And of course any age, but those are the highest risk or kids who are maybe older but have developmental delays. If you have that situation, then you need to be extremely careful to prevent toxic doses of THC in your toddler. So really, really important.
Chris, so what are then early signs and symptoms that would be associated with THC ingestion? So not quite to the toxic level yet, but what might we see in a child in terms of their behavior if they do ingest an edible.
Dr. Christopher Gaw: Yeah, and so I think one thing I want to emphasize to parents out there is you may not see an effect, even the early signs of symptoms right away, especially if a kid is eating it. So, you're not going to see it maybe in the first couple of seconds or minutes, but usually, you'll start to see some effects over the next few hours.
0:23:03
And they can be quite varied. Some of them are what I think most people associate when they think of someone who might be high from marijuana.
And so, there might be some behavior changes. Older kids can say that they might feel their heart beating faster. You might see a little bit of red eyes.
Some kids have some abdominal pain. Some kids have vomiting. And there can be a little bit of what we call neurologic effects. So, kids can just be a little bit more unsteady.
And so those are some of the early signs as the edible is starting to get absorbed into the body.
Dr. Mike Patrick: And then, what about toxic doses or what we would call severe cannabis toxicity? What might we see as that dosage level goes up in a child?
Dr. Christopher Gaw: Yeah, and so we typically see that kids are affected from a neurologic status. So, when we think about our kids being awake, alert, happy, running around, they can get really sleepy and sometimes can become completely unresponsive from severe THC ingestions.
0:24:11
There have been seizures reported from THC edible ingestions. And then, when we think about the cardiovascular system and the respiratory system, we can see potentially dangerous changes in heart rate or blood pressure. And some children may develop irregular breathing, slow breathing, and some children may even stop breathing altogether from a severe ingestion.
Dr. Mike Patrick: So, it really can be life threatening. And so, folks need to understand that what makes a parent feel good can actually kill their toddler. And so, we just have to be really careful about that. And if you suspect that your child may have eaten an edible is get your child to an emergency department if they just ate it. You may be watched for a while to see if there are issues with toxicity, but you want to be in a safe place where someone could help them breathe if they needed help breathing.
0:25:06
So, another term that I want to bring up is prolonged cannabis toxicity. Chris, what does that mean?
Dr. Christopher Gaw: And so I think in the simplest terms, it just means when the effects of cannabis last a long time. Now, how long is long? And there was a group of researchers who recently published a paper in Pediatrics as well out of Colorado, who measured a group of children who were exposed to cannabis edibles and tried to quantify the proportion that were affected by prolonged cannabis toxicity.
And so, they defined prolonged cannabis toxicity as lasting greater than six hours. And they chose that number because six hours is a reasonably long time where someone might need to be moved from an urgent care or an emergency department to a hospital for longer observation.
0:26:01
And they were seeing that kids, a significant proportion of kids met that six-hour mark or exceeded that six-hour mark. And they were seeing kids who had cannabis toxicity or THC toxicity lasting as long as 12 to 30 hours. And that often was seen, those longer times were often seen with children who ingested larger doses of THC or who developed severe toxicity.
Dr. Mike Patrick: And the article that you're talking about again for the science-y folks in the audience who would want to look it up, again, this one was also published in the journal Pediatrics. And it is called Toxic THC Dose in Pediatric Cannabis Edible Ingestions. And I'll put a link to that in the show notes as well, if folks want to explore that article in a little bit more depth.
But one of the interesting things that came out of this study was really not only quantifying what constitutes prolonged cannabis toxicity, but also the degree of THC exposure. So, what big of a dose do you need to cause severe toxicity and or prolonged toxicity? And Chris, what did they find out in terms of the dose needed to do this?
0:27:15
Dr. Christopher Gaw: And so, the researchers did something really interesting where as they followed these patients, they kind of looked back with all of the data available. They asked the parents, they looked at the packaging and they figured out how much these kids ate.
And if you really think about it or what the data shows is that it's not that much. So, they found that the median or midpoint dose that leads to severe toxicity, some of those changes in your cardiovascular system, respiratory system and nervous system was around 5.4 milligrams per kilogram.
And then, for prolonged toxicity, they found that midpoint dose to be at 3.7 milligrams per kilogram. So really to summarize, it's about 4 to 5 milligrams per kilogram.
0:28:03
Now, obviously, we're in the United States, so we don't often talk about kilograms. So again, just thinking back to a typical one-year-old, a nice round number, a one-year-old is about 10 kilograms. So, 40 to 50 milligrams of a THC dose could lead to severe or prolonged toxicity.
And so, that is as few as four to five THC gummies. And you have to remember that most THC packages often have double that amount. They usually sell them in packs of 10 to 15 depending on the dose.
And that is well above what is a severe toxic dose to a child. And you've got to remember that kids are not eating one gummy. And so, they are likely going to be eating multiple gummies.
And they're not feeling the effects after that first one. And so, oftentimes, kids are eating multiple ones and well beyond the dose that an adult would be eating.
0:28:59
Dr. Mike Patrick: Yeah, absolutely. And so, I think I want to kind of rephrase that, because it's so important that folks understand that if your toddler gets into a pack of THC-infused gummies and eats that whole pack, that is likely at a minimum, double the severe toxic dose and would also create prolonged cannabis toxicity. And can very well be life threatening from just one pack of gummies in the house.
So again, if you have THC gummies or any other edibles in the home, and you have a toddler in the home, those do not make a good combination and it could kill your toddler. So, it's really important that we think about this and take it seriously.
So, Chris, what should parents do when they suspect or know that their child has ingested an edible? So, a parent's at home, they walk into a room and their toddler has a bag or a box open and putting one in its mouth. What should parents do in that situation?
0:30:04
Dr. Christopher Gaw: Yeah, and so I think a lot of parents might be concerned, might be worried. And I just want to emphasize that they can always reach out to the Poison Center.
And poison centers are available across the country. And we here at Nationwide Children's work closely with the Central Ohio Poison Center and they can call a toll-free hotline. It's available 24/7, and it's 1-800-222-1222.
And this hotline is staffed by trained poison specialists who can talk through what has happened, review any symptoms that the child might be having, and direct you to help whether that is watching at home versus going into an emergency department or seeking other forms of care.
I do want to point out that if you're worried or if a parent's worried that there are any of those severe symptoms that we've talked about, that they should go ahead and seek medical attention for their child right away or call 911.
0:31:06
Dr. Mike Patrick: Yeah, absolutely. And so again, that phone number 1-800-222-122. And have you guys heard the jingle, the poison-controlled jingle? 1-800-222-1222. You know what I'm talking about?
Dr. David Kling: Well, for me it was eighth-grade home ed class, they had us walking around the hallway singing the song and at the end of the last two, we would go choo-choo like a train.
[Laughter]
Dr. David Kling: It's been ingrained in my brain since then. And I realize not everyone knows the number, but I do.
Dr. Mike Patrick: Yeah, absolutely. Well, I'll tell you what, I'm going to play it as we exit the podcast so that folks who have not heard it before, just put it on replay and it'll be ingrained in your brain and then you'll never have an issue remembering that it's 1-800-222-1222.
0:31:54
Now, David, this is going to be of interest, I think, to the healthcare professionals in the audience. You have a kid who comes in and they may be sleepy and then when they are awake, maybe they're irritable. They may be acting very strangely.
We may look at them and say that child looks intoxicated. What are other things, because parents don't always let you know that their child ate an edible. They may not even know that their child did. They just know that their kiddo is acting funny or very very sleepy and they bring them in.
So then what other things do we have to think about as physicians that could be causing that issue in that particular child?
Dr. David Kling: Definitely. And honestly, that is a very common scenario that we encounter. Oftentimes, we do not know that a child ingested some form of marijuana or THC. So, this would kind of constitute altered mental status or abnormal behavior.
And so, I like to think of that in kind of like five broad categories. The first one thinking about neurological conditions, thinking about did this patient have a seizure? And now are they just a little bit confused after a seizure?
0:33:03
Could they have had a stroke, for example? Or is there something else going on, like a mass or something growing in their brain that's contributing to how they are acting? Or is this a brain response to after an infection that can also occur?
Another broad category I think about is trauma. So specifically, asking families if there was any major head injuries or trauma to the head and thinking about could they have some type of brain bleed occurring.
Another category would be infection. So, asking families about if their child has been having any fevers because that could be a symptom of meningitis or encephalitis.
Other category would be metabolic. And so sometimes kids come in and they have low blood sugar or other electrolyte abnormalities and therefore are acting abnormal as a result.
And then, of course, the broad, big category of ingestions. And again, any ingestion can present with kind of abnormal behavior or altered mental status.
So yes, we are seeing an increase in THC ingestions. However, any other form of ingestion or medication can also contribute to those kinds of similar symptoms. Which is why, of course, it can be so scary because again, parents just know that my child's not acting normally, and we have to therefore kind of get into the history and do a thorough physical exam in order to figure out specifically what do we think is causing it.
0:34:19
Dr. Mike Patrick: Yeah, absolutely. And then what do you do to get to that diagnosis of THC toxicity? How is that diagnosed?
Dr. David Kling: So of course, we want to make sure the patient is stable and address anything that we need to immediately. If they're having issues with their breathing, we address that, of course, right away.
But then, we kind of do our best to ask a very focused history and do a very thorough physical exam to try to narrow it down. Because like I mentioned, we have a lot of different things that could be causing their symptoms. If we, through that process, have a suspicion that maybe ingestion is a source of their symptoms, we'll kind of start simple and just obtain some simple blood work, as well as obtain a urine drug screen and look for any signs that are pointing or supporting that diagnosis.
0:35:10
However, if a patient, again, is looking really sick and we're having to do a lot of different interventions to keep them stable, we might be doing a lot more initially with things such as like scanning their brain to look for any signs of trauma or masses or signs of infection, testing their spinal fluid for infection, getting more blood work to look for other sources and causes like I already mentioned.
So, really depends on the severity and how the patient is initially presenting and that will really guide our initial management and work up.
Dr. Mike Patrick: And then, Chris, once we discover that the issue is THC toxicity, where do we go from there in terms of treating these kids and maintaining life for them? Because it is life threatening.
Dr. Christopher Gaw: And so, what we have are a lot of different tools to help support these kids and treat these kids. But one thing I want to emphasize is there's no antidote for THC toxicity. So, this is not like an opioid overdose where we can give an antidote like naloxone.
0:36:12
So, we just have to wait for the THC to work its way out of a child's body. But during that time, we can support children and we can do that in multiple different ways. And so, for children who haven't ingested a toxic dose, they may just be watched closely, either in an emergency department or hospital setting, where we're keeping a close eye on their neurologic status and their vital signs.
For children who are more severely affected, who have severe toxicity, we may have to place an IV. We may have to give fluids. We may have to do some of that additional testing that David had mentioned to make sure that we're not missing other diagnoses.
And in very serious cases, we may be treating seizures with anti-seizure medications. Or we may have to place a breathing tube and breathe for a child if they're not able to breathe on their own due to the degree of that toxicity.
0:37:07
Dr. Mike Patrick: So, this is really something we want to avoid. And so, that really brings us to probably the most important piece of information for parents out there. And that is, in what ways can we prevent accidental THC ingestion by children? Chris?
Dr. Christopher Gaw: And so, the way that I would think about a THC edible is it may look like food, it may look like candy, but it's not food, and it's not candy.
I would think about these products as similar to a medication and a potentially dangerous medication. So, we should be storing them safely. So, we should be putting these products out of reach of children, out of sight of children.
They should be kept in a child-resistant package or child-resistant container, and preferably in the original container so kids or adults don't get confused about the product.
And then, people should consider storing them behind a cabinet that is either closed and locked to make sure that kids don't have access to it.
0:38:06
And then when, using them, if an adult is using them, to be using them with caution and putting them back up so that they're not out for children to accidentally get in to.
Dr. Mike Patrick: Yeah, absolutely. Very very important. Well, I want to thank both of you for stopping by and helping us understand more about the dangers of cannabis edibles.
Before we go, David, can you tell us a little bit about Emergency Medicine at Nationwide Children's Hospital?
Dr. David Kling: Yeah, definitely. So, at Nationwide Children's Hospital, we have a wonderful emergency department. It's open 24/7, 365 days of the year.
We treat patients of all caliber from age 0 to 21 and with a variety of symptoms. So, it can be treating simple colds to treating more severe infections or other severe conditions, such as respiratory failure or severe traumatic injuries as well. We also have a location north of the city in Lewis Center.
0:39:03
Dr. Mike Patrick: And so, we do provide emergency services. And that is also where I work, and so I know both Chris and David very well. And not only do we provide care for sick and injured children, but there's also a big academic component to our division.
And Chris, what kind of research stuff do we have going on in emergency medicine?
Dr. Christopher Gaw: Yeah, so we work closely with other pediatric centers to conduct multi-center trials to improve the care of children. We also work closely with our partners in Emergency Medical Services, so our paramedics and EMS, to also improve care out in the communities before children come to us to the emergency department. So, there's a lot of exciting work going on in all of those areas.
Dr. Mike Patrick: Yeah, great. And we'll put a link to emergency medicine at Nationwide Children's Hospital in the show notes so folks can find that easily. We'll also have links to those two research articles that we talked about in the course of this conversation.
0:40:04
And then finally, especially for medical providers out there who would like to know more about cannabis acute intoxication in children, I'm also going to put a link to an up-to-date article that really goes into depth in terms of acute intoxication of cannabis in kids.
So, once again, Dr. Christopher Gaw and Dr. David Kling, both with emergency medicine at Nationwide Children's Hospital, thank you so much for stopping by and visiting with us today.
Dr. Christopher Gaw: Thank you again for having us.
Dr. David Kling: Yeah, thank you. It was wonderful talking with you this morning.
[Start Poison Control Center Jingle]
1-800-222-1222. 1-800-222-1222. If you think it might be poison, then the first thing you should do is call 1-800-222-1222.
Jingle Announcer: For poison emergencies or just questions, the Poison Control Center hotline is here 24/7 with the expert help you need.
If you think it might be poison, then you don't know what to do. Call 1-800-222-1222.
[End Poison Control Center Jingle]
0:41:05
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really appreciate that.
Also, thanks once again to our guests this week, Dr. David Kling and Dr. Christopher Gaw, both with Pediatric Emergency Medicine at Nationwide Children's.
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0:42:02
Also, don't forget about our sibling podcast, PediaCast CME. It's similar to this program. We do turn the science up a couple notches and offer free Continuing Medical Education Credit for those who listen.
And that includes physicians, of course, but also nurse practitioners, physician assistants, nurses, pharmacists, psychologists, social workers, and dentists. And since Nationwide Children's is jointly accredited by all of those professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements. Of course, you want to be sure the content of the episode matches your scope of practice.
Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.
Thanks again for stopping by, and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everyone.
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0:43:09
Announcer 2 This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.
