A network of experts in reproductive and children’s environmental health


A Resource for Health Professionals 

The use of and exposure to marijuana in pediatric populations has risen over the past several years as more states legalize the substance for recreational use. Health professionals are encouraged to follow the guidance below to help navigate discussions with patients and families.

PEHSU Fact Sheet on Marijuana and the Impact on the Pediatric Population (including Perinatal and Adolescent) - Guidance for Healthcare Providers (2018)

 What is Marijuana? posted on Aug 1, 2019
 Products and Methods of Use posted on Aug 1, 2019
 Epidemiology posted on Aug 1, 2019
 Clinical Symptoms posted on Aug 1, 2019
 Laboratory Testing posted on Aug 1, 2019
 Treatment posted on Aug 1, 2019
 Why should we be concerned about adolescent use? posted on Aug 1, 2019
 What are the concerns of maternal use during pregnancy and breastfeeding? posted on Aug 1, 2019
 Strategies for Prevention posted on Aug 1, 2019
 How can we prevent adolescent marijuana use? posted on Aug 1, 2019
 What are ways we can prevent mothers from using marijuana during pregnancy and post-delivery? posted on Aug 1, 2019

To download this page as a fact sheet, click here.

Additional Resources for Health Professionals



PEHSU Resources


  1. Gloss D, Vickrey B. Cannabinoids for epilepsy. Cochrane Database System Rev. 2012;6.
  2. Devinsky O, Cross JH, Laux L, Marsh E, Miller I. Trial of cannabidiol for drug-resistant seizrues in the Dravet Syndrome. NEJM. 2017;376:2011-2020.
  3. FDA warning on CBD. https://www.fda.gov/newsevents/publichealthfocus/ucm484109.htm. Last accessed Aug 28, 2018.
  4. Busse F, Omidi L, Timper K, Leichtle A, Windgassen M, Kluge E, Stumvoll M. Lead poisoning due to adulterated marijuana. N Engl J Med. 2008;358(15):1641-2.
  5. Horth RZ, Crouch B, Horowitz BZ, Prebish A, Slawson M. Notes from the Field: Acute Poisonings from a Synthetic Cannabinoid Sold as Cannabidiol - Utah, 2017-2018. MMWR Morb Mortal Wkly Rep. 2018;67(20):587-588.
  6. National Survey on Drug Use and Health. https://www.samhsa.gov/data/sites/default/files/NSDUH-DetTabs-2016/NSDUH-DetTabs-2016.pdf
  7. Wang GS, Roosevelt G, Le Lait MC, Martinez EM, Bucher-Bartelson B, Bronstein AC, Heard K. Association of unintentional pediatric exposures with decriminalization of marijuana in the United States. Ann Emerg Med. 2014 Jun;63(6):684-9.
  8. The Monitoring the Future Survey. http://monitoringthefuture.org/pubs/monographs/mtf-overview2017.pdf
  9. http:/www.samhsa.gov/data/sites/default/files/HSDUHresults/PDFWHTML2013/Web/NSDUHresults2013.pdf
  10. Grotenhermen F. Pharmacokinetics and pharmacodynamics of cannabinoids. Clin Pharmacokinet. 2003;42(4):327-60. Review.
  11. Wang GS, Roosevelt G, Heard K. Pediatric marijuana exposures in a medical marijuana state. JAMA Pediatr. 2013 Jul;167(7):630-3.
  12. Wilson KM, Torok MR, Wei B, Wang L, Robinson M, et al. Detecting biomarkers of secondhand marijuana smoke in young children. Pediatr Res. 2017;81(4):589-592.
  13. Fried PA, Watkinson B, Gray R. Fried PA, Watkinson B, Gray R. Neurocognitive consequences of marihuana--a comparison with pre-drug performance. Neurotoxicol Teratol. 2005 Mar-Apr;27(2):231-9.
  14. Fergusson DM, Horwood LJ, Beautrais AL. Cannabis and educational achievement. Addiction. 2003 Dec;98(12):1681-92.
  15. Horwood LJ, Fergusson DM, Hayatbakhsh MR, Najman JM, Coffey C, Patton GC, Silins E, Hutchinson DM. Cannabis use and educational achievement: findings from three Australasian cohort studies. Drug Alcohol Depend. 2010 Aug 1;110(3):247-53.
  16. Hooper SR1, Woolley D, De Bellis MD. Intellectual, neurocognitive, and academic achievement in abstinent adolescents with cannabis use disorder. Psychopharmacology (Berl). 2014 Apr;231(8):1467-77.
  17. Medina KL, Hanson KL, Schweinsburg AD, Cohen-Zion M, Nagel BJ, Tapert SF. Neuropsychological functioning in adolescent marijuana users: subtle deficits detectable after a month of abstinence. J Int Neuropsychol Soc. 2007 Sep;13(5):807-20.
  18. Pope HG Jr, Gruber AJ, Hudson JI, Cohane G, Huestis MA, Yurgelun-Todd D. Early-onset cannabis use and cognitive deficits: what is the nature of the association? Drug Alcohol Depend. 2003 Apr 1;69(3):303-10.
  19. Arseneault L1, Cannon M, Witton J, Murray RM. Causal association between cannabis and psychosis: examination of the evidence. Br J Psychiatry. 2004 Feb;184:110-7.
  20. Fergusson DM, Poulton R, Smith PF, Boden JM. Cannabis and psychosis. BMJ. 2006 Jan 21;332(7534):172-5.
  21. Fergusson DM, Boden JM, Horwood LJ. Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis. Addiction. 2006 Apr;101(4):556-69.
  22. Swift W, Coffey C, Degenhardt L, Carlin JB, Romaniuk H, Patton GC. Cannabis and progression to other substance use in young adults: findings from a 13-year prospective population-based study. J Epidemiol Community Health. 2012 Jul;66(7):e26.
  23. Perez-Reyes M, Wall ME. Presence of delta9-tetrahydrocannabinol in human milk. N Engl J Med. 1982;307(13):819-20.
  24. Bertrand KA, Hanan NJ, Honerkamp-Smith G, Best BM, Chambers CD. Marijuana use by breastfeeding mothers and cannabinoid concentrations in breast milk. Pediatrics. 2018 [epub ahead of print]
  25. Day NL, Richardson GA, Goldschmidt L, Robles N, Taylor PM, Stoffer DS, Cornelius MD, Geva D. Effect of prenatal marijuana exposure on the cognitive development of offspring at age three. Neurotoxicol Teratol. 1994 Mar-Apr;16(2):169-75.
  26. El Marroun H, Hudziak JJ, Tiemeier H, Creemers H, Steegers EA, Jaddoe VW, Hofman A, Verhulst FC, van den Brink W, Huizink AC. Intrauterine cannabis exposure leads to more aggressive behavior and attention problems in 18-month-old girls. Drug Alcohol Depend. 2011 Nov 1;118(2-
  27. Fried PA, Watkinson B, Gray R. Growth from birth to early adolescence in offspring prenatally exposed to cigarettes and marijuana. Neurotoxicol Teratol. 1999 Sep-Oct;21(5):513-25.
  28. Fried PA, Watkinson B, Gray R. Differential effects on cognitive functioning in 13- to 16-year-olds prenatally exposed to cigarettes and marihuana. Neurotoxicol Teratol. 2003 Jul-Aug;25(4):427-36.
  29. Effects of prenatal marijuana exposure on child behavior problems at age 10. Goldschmidt L, Day NL, Richardson GA. Neurotoxicol Teratol. 2000 May-Jun;22(3):325-36.
  30. Noland JS, Singer LT, Short EJ, Minnes S, Arendt RE, Kirchner HL, Bearer C. Prenatal drug exposure and selective attention in preschoolers. Neurotoxicol Teratol. 2005 May-Jun;27(3):429-38.
  31. Smith A, Fried P, Hogan M, Cameron I. The effects of prenatal and current marijuana exposure on response inhibition: a functional magnetic resonance imaging study.Brain Cogn. 2004 Mar;54(2):147-9.
  32. Willford JA, Chandler LS, Goldschmidt L, Day NL. Effects of prenatal tobacco, alcohol and marijuana exposure on processing speed, visual-motor coordination, and interhemispheric transfer. Neurotoxicol Teratol. 2010 Nov-Dec;32(6):580-8.
  33. Crume TL, Juhl AL, Brooks-Russell A, Hall KE, Wymore E, Borgelt LM. Cannabus use during the perinatal period in a state with legalized recreational and medical marijuana: the association between maternal characteristics, breastfeeding patterns, and neonatal outcomes. J Peditr.
  34. Colorado Department of Public Health and Environment. Retail Marijuana Public Health Advisory Committee. https://www.colorado.gov/pacific/cdphe/retail-marijuana-public-health-advisory-committee Last accessed Aug 29, 2018
  35. WAC 314-55-105. http://apps.leg.wa.gov/wac/default.aspx?cite=314-55-105 Last accessed Aug 29, 2018
  36. Oregon Marijuana Packaging and Labeling. http://www.oregon.gov/olcc/marijuana/Documents/PackagingandLabeling.pdf Last accessed Aug 29, 2018.
  37. Colorado Department of Public Health and Environment. Marijuana. https://www.colorado.gov/pacific/cdphe/categories/services-and-information/marijuana. Last accessed Aug 29, 2018.
  38. Children’s Hospital Colorado. https://www.childrenscolorado.org/conditions-and-advice/marijuana-what-parents-need-to-know/. Last accessed Aug 29, 2018.
  39. Seattle Children’s. http://pulse.seattlechildrens.org/keep-kids-safe-legalization-marijuana/. Last accessed Aug 29, 2018.
  40. National Instistute on Drug Abuse. https://www.drugabuse.gov/publications/principles-substance-abuse-prevention-early-childhood/table-contents. Last accessed Aug 28, 2018.
  41. SAMHSA. https://www.samhsa.gov/atod/marijuana. Last accessed Aug 28, 2018.

The Pediatric Environmental Health Specialty Units (PEHSUs) are supported by cooperative agreement FAIN: NU61TS000296 with the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry (CDC/ATSDR). The U.S. Environmental Protection Agency (EPA) also provides support through Inter-Agency Agreement DW-75-95877701 with CDC/ATSDR. The American Academy of Pediatrics supports the PEHSUs as the National Program Office. The content on this website has not been formally disseminated by CDC/ATSDR or the EPA and should not be construed to represent any agency determination or policy. Use of trade names that may be mentioned is for identification only and does not imply endorsement by the CDC/ATSDR or EPA.

The information contained on this website should not be used as a substitute for the medical care and advice of your/your child’s primary care provider. There may be variations in treatment that your provider may recommend based on individual facts and circumstances.

Last updated: August 2021