Editor’s Note: A Sunday post? I know, not our typical cadence. But this one is important – and timely. As you dig into your Halloween candy stash, we’re talking about a different kind of edible that kids may find. Dr. Priya Shah returns to HipPEMcrates to discuss unintentional THC ingestions in children, what ED clinicians need to know, and how we can help families prevent them. ~JB
As children search for Halloween candy, could they come across a THC stash instead? Gummies, chocolates, and even chips containing tetrahydrocannabinol (THC) can look like familiar snacks. A child may eat several – or even the whole package – before anyone realizes an exposure occurred.
In my TEDx talk, I discuss why these ingestions are predictable and preventable. For ED clinicians, Halloween is a timely reminder to recognize toxicity, ask about access, and make storage counseling part of the visit.
THC edible (left) and ordinary candy (right)
Credit: Upstate New York Poison Center, from Dr. Shah’s TEDx slides.
Why this belongs on your differential
National poison control centers report a 27x increase in edible cannabis exposures in children younger than 6 years old, from about 200 cases in 2017 to >5,500 cases in 2025. Nearly 98% of ingestions occur in a residential setting.
We are seeing this dramatic increase regardless of whether marijuana has been legalized at a state level for recreational and/or medical use, making this a national issue.
Recognize the presentation
Think about THC in a young child with unexplained lethargy, ataxia, hypotonia, mydriasis, or decreased responsiveness. Changes in heart rate and drops in blood pressure may occur. Severe poisoning can cause respiratory depression, seizures, or coma. In a systematic review of >3,500 children 12 years old or younger, 6% were intubated and 18% were admitted to an ICU.
Symptoms can be delayed. After an edible ingestion, onset may take one to four hours, so remember that an initially well-appearing child may still become symptomatic. And the effects can last for many hours; in the systematic review, mean length of stay was 27.1 hours.
Estimate the dose, but don’t always trust it
Five gummies containing 10 mg of THC each total 50 mg, or approximately 3.3 mg/kg in a 15-kg child.
In a retrospective study of 80 children younger than 6 years, higher estimated doses were associated with severe and prolonged toxicity. A threshold of 1.7 mg/kg identified severe toxicity with 97.3% sensitivity in that cohort.
However, this is a risk estimate, not a safe-dose cutoff. In fact, a study found that fewer than 1 in 5 unregulated products have an accurately labeled THC dose. A lower reported dose should not override a concerning examination or determine discharge.
Ask about possible exposures
Some THC products use copycat packaging that resembles familiar snacks. A small warning label offers little protection to a preschooler who sees a favorite treat.
The FDA and FTC have warned sellers about specific delta-8 THC products packaged to look like ordinary candies, cookies, and chips.
Examples of unregulated THC-containing products.
Credit: North Carolina Secretary of State’s Office / FDA, from Dr. Shah’s TEDx slides.
Ask about possible exposures not just in the home, but also in other caregivers’ homes, cars, and purses/bags. When possible, obtain the product name, time of possible ingestion, amount missing, and possible co-ingestants. A package photo is useful; remember to distinguish THC per ‘serving’ from THC per package.
Manage the child and reassess the diagnosis
- Stabilize first. Assess airway, breathing, and circulation, check a bedside glucose, and support ventilation when needed. There is no specific antidote; treatment is supportive.
- Interpret urine testing in context. A positive cannabinoid screen supports exposure but does not establish timing or severity. Cannabinoids can remain detectable after acute effects have resolved.
- Keep the differential open. Consider hypoglycemia, trauma, infection, seizures, and other ingestions. Target additional testing to the history and examination, and broaden the evaluation when the findings or clinical course do not fit.
- Call Poison Control early. Use 1-800-222-1222 for product-specific advice, observation planning, and disposition support.
Disposition depends on recovery
Persistent altered mental status, respiratory compromise, or an uncertain clinical course warrants continued monitored care; severe cases may require intensive care. Before discharge, reassess for return to age-appropriate baseline, stable breathing and vital signs, ability to drink and move safely for developmental age, and reliable caregiver supervision.
A reported dose or elapsed observation time alone is insufficient. Individualize observation periods with Poison Control, particularly when timing, product contents, or co-ingestants are uncertain.
Use the visit to prevent the next exposure
Make the storage message concrete:
- Keep edibles in their original packaging and inside a locked container, out of children’s reach and sight.
- Store edibles separately from ordinary food and candy.
- Include visitors and other caregivers in the conversation; a product in a guest’s bag can be accessible to children even when the family does not use THC.
Tell families to call Poison Control promptly after a suspected ingestion, even without symptoms. If a child cannot be awakened, has trouble breathing, or has a seizure, call 911.
🎥 Watch the TEDx Talk
Dr. Priya Shah on pediatric THC edible exposures →
Supporting references
1. Tweet MS, Nemanich A, Wahl M. Pediatric edible cannabis exposures and acute toxicity: 2017–2021. Pediatrics. 2023;151(2):e2022057761. doi:10.1542/peds.2022-057761. PubMed
2. US Food and Drug Administration. FDA, FTC continue joint effort to protect consumers against companies illegally selling copycat delta-8 THC food products. Published July 16, 2024. Accessed October 16, 2026. FDA
3. Amirshahi MM, Moss MJ, Smith SW, Nelson LS, Stolbach AI. ACMT position statement: addressing pediatric cannabis exposure. J Med Toxicol. 2019;15(3):212–214. doi:10.1007/s13181-019-00708-z. Full text
4. Johnson-Arbor K. My child ate a cannabis edible. National Capital Poison Center. Accessed October 16, 2026. Poison Control
5. Children’s Hospital Colorado. Marijuana effects on children. Accessed October 16, 2026. Children’s Colorado
6. Pepin LC, Simon MW, Banerji S, Leonard J, Hoyte CO, Wang GS. Toxic tetrahydrocannabinol (THC) dose in pediatric cannabis edible ingestions. Pediatrics. 2023;152(3):e2023061374. doi:10.1542/peds.2023-061374. PubMed
7. American College of Medical Toxicology. ACMT position statement revision: preventing cannabis exposures in children. Accessed October 16, 2026. ACMT
8. Shah, P. Kids Are Getting Into Candy Stashes…Meant for Adults. Published Jun 10, 2024. Accessed October 16, 2026. PolicyLab
Dr. Priya Shah, MD, is a Pediatric Emergency Medicine fellow at Children’s Hospital of Philadelphia. She can be reached at shahp17@chop.edu.
