Cannabinoids intoxication in children: a five-year retrospective study in Palermo Pediatric Hospital (Italy)

Background Acute cannabinoid intoxication in children is an emerging clinical concern, often presenting with predominant neurological manifestations and posing diagnostic challenges in emergency settings. Although most cases are related to accidental exposure, the contributing contextual factors are not always clearly defined, and epidemiological and clinical data remain limited. This study aimed to characterize the neurological features, clinical presentation, and management of pediatric patients with acute cannabinoid intoxication. Methods We retrospectively reviewed clinical records of children aged 0–16 years admitted to the Pediatric Emergency Department of the “Giovanni Di Cristina” Children’s Hospital in Palermo, Italy, between September 2019 and March 2025. Data collected included demographic characteristics, clinical and neurological presentation, vital signs, diagnostic investigations, treatments, and outcomes. Acute cannabinoid intoxication was confirmed by urine toxicology screening for tetrahydrocannabinol (THC), with additional confirmation by blood testing. Results Eighteen cases of acute cannabinoid intoxication were identified, with a mean age of 2.8 years; most exposures were accidental and occurred in children younger than 2 years. Neurological involvement was prominent, with lethargy and irritability as the most frequent presenting features, often reflecting altered levels of consciousness. Additional manifestations included tachycardia and, less commonly, other neurological signs. Most patients required only supportive care; however, one child developed severe neurological and respiratory impairment requiring intensive care and mechanical ventilation. No deaths were reported. Conclusions Accidental pediatric exposure to cannabinoids may represent a relevant and even life-threatening clinical and child protection concern, often associated with inadequate caregiver awareness. It frequently presents with neurological symptoms ranging from mild alterations in consciousness to severe central nervous system involvement. Prompt recognition and toxicological screening may be useful for diagnosis and management. Preventive strategies, including caregiver education and improved awareness among healthcare professionals, are important to reduce the risk of pediatric exposure and to support child health protection.