541 - High Stakes: Child Welfare Reporting in Child Injury from Marijuana-Related Products

Publication Number: 541.5541

Erin H. Sieke, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Shenel Heisler, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Kevin C.. Osterhoudt, Poison Control Center at Children's Hospital of Philadelphia, Philadelphia, PA, United States

Background: The sociopolitical climate around marijuana use is changing in the United States, contributing to increasing reports of pediatric marijuana ingestions to poison centers. Bias exists in child protective services (CPS) reporting, but no guidelines exist to outline indications for CPS reporting in pediatric patients presenting with toxic injury from marijuana.

Objective: This project seeks to describe demographic, clinical, and psychosocial factors associated with CPS reporting in cases of marijuana intoxication.

Design/Methods: This retrospective cohort studied children ages 1 mo – 6 years presenting to a tertiary children’s hospital between 7/1/2021 and 6/30/2024. Cases were identified to have THC exposure based on at least one of: 1) a Poison Control Center report, 2) Urine Drug Screen positive for cannabinoids, and/or 3) ICD-10 codes. Charts were reviewed for demographics, clinical characteristics, and documentation of CPS reporting. Draft criteria for CPS reporting were then applied. Descriptive statistics and X2 testing were used to characterize factors associated with CPS reporting.

Results: 139 patients were identified with a mean age of 2.7 years ± 1.5 years. Cases increased significantly each year. An exposure source was identified in 95 cases (68%), with the majority being from gummi candies (n=56, 57%). Social work was consulted in 85% (n=118), and a report to CPS was made in 78% of cases (n=108). Of cases, 63 (45%) were discharged from the ED, 53 (38%) were admitted to the wards, and 23 (17%) to the ICU. White children were less likely to have a CPS report (n=25, 64%) compared to black children (66, 84%), p=0.02, despite no difference in hospitalization or ICU level care (p=0.6). In 54% of cases (n=75), THC exposure was reported at time of ED presentation, after UDS result in 22% (n=31), and no known source was identified in 24% (n=33). Disclosure at presentation was associated with decreased rate of CPS reporting, p< 0.01. Analysis of indications for CPS reporting identified only 53 cases (38%) that met draft criteria, including: 19 cases with ICU level care, 4 cases in which a caregiver’s response to exposure placed child at risk of secondary injury, 1 case in which a caregiver’s own intoxication led to supervisory neglect resulting injury to child, and 33 cases with no plausible exposure pathway provided by caregiver (Table 1).

Conclusion(s): A CPS report was filed in the majority of cases of marijuana intoxication in young pediatric patients. Bias exists in CPS reporting for children, and evidence-based guidelines are necessary to provide a framework to decrease disparities.

Figure 1: Case Identification of Marijuana Exposure in Pediatric Patients
THC Data Source_11-4-2024.pdfThis figure describes how cases were identified for chart review. Cases were identified by Poison Control Center Report, Urine Drug Screen positive for cannabinoids, and/or ICD-10 codes T40.7 or F12.9 and all derivatives. Each method identified unique cases, with expected overlap between methods.

Table 1: Draft Criteria for CPS Reporting in Young Children with Marijuana Injury
Table 1 Reporting Criteria Revised.pdfCriteria for CPS Reporting in young children with toxic exposure to marijuana were developed in expert consultation with a pediatric toxicologist and child abuse pediatrician. These criteria were then applied to identified cases. 96% of those meeting criteria received a CPS report, while 67% of those who did not meet any of the criteria received a CPS report.