Accidental Ingestion of Marijuana in Babies and Toddlers More Than Doubled in 2021

The number of babies and toddlers who screened positive for marijuana in the Emergency Department (ED) at Cook Children’s more than doubled in 2021 from the previous year.

Data collected from the ED in 2021 show 29 patients between ages 0-3 whose urine tested positive for a molecule called tetrahydrocannabinol (THC), the cannabis plant’s main psychoactive ingredient. In 2020, there were 13 patients from that age group with marijuana detected in urine. In 2019, the count was eight.    

The rise in accidental ingestion by babies and toddlers reflects concerns nationally about the danger posed by edibles – cookies, brownies or candy infused with marijuana – or other products such as vaping fluids. The same way a crawling or cruising child might swallow a button on the floor or a coin on a coffee table, a marijuana product can wind up in the mouth of a curious youngster.      

Kyle Brady, D.O., a pediatric hospitalist at Cook Children’s, cited a recent case in which a toddler ate an older sibling’s marijuana gummies. The toddler had trouble waking up and was hospitalized until the drug’s effects wore off.

“It was scary for everyone involved,” Dr. Brady said. “It is something we’re seeing more of.”

In the data from the Cook Children’s ED over the past three years, most of the babies and toddlers with THC in their urine spent at least 24 hours in the hospital to recover. Dr. Brady said signs of marijuana intoxication can include altered mental status, sleepiness, impaired coordination, hypermobility, high heart rate and trouble breathing. If admission to the hospital is needed, the medical team will monitor the patient’s vital signs and fluids, protect the airway, and be on guard for worsening symptoms, he said.   

“It’s all supportive care and giving the body time to clear the metabolite,” Dr. Brady said. “The severity depends on how much they ingested. The main thing for hospitalization is to make sure their body can clear it in an appropriate time.”

Jamye Coffman, M.D., serves as medical director of the Cook Children’s C.A.R.E. Team, which stands for Child Advocacy Resources and Evaluation. The scope of the C.A.R.E. Team includes examinations for pediatric patients suffering from drug exposure. Exams are conducted following a referral from Child Protective Services, law enforcement agencies or a medical provider.

Dr. Coffman said marijuana intoxication typically causes one of two extremes: lethargy or agitation.

 “Over the last year or two we’ve seen more of those kids coming through the Emergency Department,” she said. “Sometimes we have to do fluids or hydrate them. But for the most part, it’s waiting and watching and making sure that it gets out of their system at least enough to where they can go home.” 

The U.S. Centers for Disease Control and Prevention (CDC) reports that edibles pose a greater risk for poisoning or injury compared to smoked marijuana. The CDC cites the longer-lasting and unpredictable effects of edibles, in which the strength of the ingredients might not be known. 

“Children, adults, and pets can mistake marijuana products, particularly edibles, for regular food or candy. Consuming marijuana can make children very sick. They may have problems walking or sitting up or may have a hard time breathing,” according to the CDC website. “Since marijuana use has been legalized in some states, accidental marijuana poisonings in children have increased, sometimes requiring visits to the emergency room or hospitalization.”

Dr. Coffman identified three particular concerns:

The legalization of recreational marijuana has made edibles more accessible even in states like Texas where it remains illegal.

The concentration of THC has become increasingly potent in recreational marijuana and much higher than the levels in prescribed medical marijuana.  

Candy and baked goods infused with marijuana are attractive to children, who don’t realize they’re eating a substance that could harm them.

“To a 2-year-old, a cookie is a cookie is a cookie, or a brownie or a gummy or a lollipop or whatever. They’re going to get into it,” Dr. Coffman said. “We’ve had kids have gummy parties. They think it’s just regular candy. That one edible can have a huge amount of THC.” 

Dr. Brady said when a patient shows up in the emergency room with sleepiness or suspicious symptoms, the doctors have to work to eliminate other possible causes such as traumatic brain injury. Once a patient is admitted to Cook Children’s with the diagnosis of marijuana intoxication, Dr. Brady said, the medical team waits and watches until the patient's body can eliminate the drug. Supportive care is provided as necessary while the intoxicating effects wear off.  

In 2021, there were 540 patients in the Cook Children’s Emergency Department who tested positive for THC in the urine screens. The vast majority were 12 years or older.

Unlike a young child who ingests marijuana accidentally, the adolescents generally present with different medical issues caused by purposeful and chronic use, Dr. Brady said. Prolonged use can lead to coughing, lung injury, seizures and repeated bouts of severe vomiting, a condition known as cannabinoid hyperemesis syndrome. And then? Severe vomiting may result in dehydration and bleeding of the esophagus with extreme marijuana use. Dr. Brady says he’s seeing more teenage patients with marijuana-induced vomiting.

Dr. Coffman also has witnessed an upward trend in marijuana-related cases in her 22 years at Cook Children’s. She pointed out that any amount of drug will have a much greater impact on a child’s small body than on an adult. With infants and toddlers, the risk of intoxication usually comes from resin, vaping cartridges, beverages or edibles that were unintentionally left within reach by a family member, caregiver or houseguest.

“If the children are crawling age and they can pull up on furniture, if you leave something out or it drops on the floor, or it gets between cushions on a couch, they can find it. They’re low to the ground. If it’s down there, they’re going to find it.”

She sometimes encounters parents or caregivers who are reluctant to disclose how the child was exposed to marijuana. Others are more forthcoming with information. “It’s nice that they do tell us, because then it gets us down the right path of diagnosis and treatment faster instead of waiting for the test results to come back,” Dr. Coffman said.  

Keeping Kids Safe from Ingestion

First, never consume or smoke marijuana around children. The American Lung Association warns that people who are exposed to secondhand marijuana smoke can have detectable levels of THC in their systems.

Other recommendations… Keep product packages securely sealed, locked away and stored where children can’t discover or reach them. Dr. Coffman emphasized there should be absolutely no access because there’s no safe amount of marijuana for children unless prescribed by a physician.

“It is a dangerous substance for little kids, and people need to be aware that it’s dangerous,” she said. “I’ve had some parents say, ‘Well, it’s just herbal.’ No, it’s beyond being just herbal. It can actually be dangerous.”

From Dr. Brady: “You have to treat it like you would any kind of medication, keeping it locked up, keeping it out of sight and out of reach, and making sure it is truly a childproof container. That is the best thing you can do.”