Understanding Cannabis Use in Pediatric Healthcare: From Ancient Remedy to Modern Medicine:

Although cannabis in pediatric medicine may seem like a modern development, its therapeutic use dates back decades. Notably, clinicians in the late 20th century explored cannabis-derived compounds to alleviate symptoms in children undergoing chemotherapy. These early efforts, while limited in scope, opened the door to today’s more evidence-based investigations into cannabinoids and their potential roles in pediatric healthcare.

When healthcare professionals hear "cannabis" and "children" in the same sentence, it often raises eyebrows-and rightfully so. While cannabinoid-based medicines have been cautiously prescribed in pediatric settings for nearly five decades, any consideration of their use in children must be approached with rigor, nuance, and a commitment to safety.

A Brief History: Not as New as You Think

The medical use of cannabis spans millennia, but its modern pediatric applications began in earnest during the late 1970s. At the time, physicians began investigating Δ⁹-tetrahydrocannabinol (THC), a psychoactive compound in cannabis, for its potential to alleviate severe chemotherapy-induced nausea and vomiting in children. These early trials were small and preliminary, yet they showed promise that THC-based medications might offer symptom relief when other anti-nausea drugs failed.

While these historical studies laid an early foundation, the modern era of pediatric cannabis research began in the early 2000s when desperate parents started experimenting with artisanal cannabidiol (CBD) oils for children with treatment-resistant epilepsy and autism spectrum disorders. Stories of dramatic seizure reduction captured widespread media attention, but the lack of standardized products and rigorous research left many healthcare providers uncertain about safety and efficacy. This grassroots movement eventually catalyzed a broader shift in pediatric cannabis research—from urgent clinical experimentation with whole-plant cannabis to evidence-based, targeted therapy focusing primarily on CBD, a non-intoxicating compound that has become the cornerstone of legitimate pediatric cannabis medicine today.

Understanding Cannabinoids: THC vs. CBD

Before moving on, it’s important to take a moment and distinguish between the two primary cannabinoids used in pediatric care:

THC (Δ⁹-tetrahydrocannabinol) is the main psychoactive component of cannabis. It can alter perception, mood, and cognition, and while it has therapeutic potential, its effects on the developing brain require particular caution, especially in children.

CBD (cannabidiol), by contrast, does not produce a "high" and is generally better tolerated. It has shown the most promise in pediatric neurology, particularly for certain rare forms of epilepsy.

Though both are cannabinoids, their pharmacological profiles, legal status, and clinical applications differ substantially. Treating them interchangeably risks overlooking important safety and efficacy considerations.

The Evidence Revolution: From Anecdotes to Clinical Trials

What we're witnessing today is a transformation from scattered case reports to robust clinical science. A comprehensive 2025 living systematic review by Chhabra and colleagues represents a watershed moment, analyzing 276 studies that span the spectrum from randomized controlled trials to large-scale caregiver surveys. This body of evidence provides the clearest picture yet of how cannabinoids are being used in pediatric care and what we can—and cannot—confidently say about their benefits and risks.

Where the Evidence is Strongest: Pediatric Epilepsy

The most compelling data exists for drug-resistant epilepsy in children. Seven high-quality randomized controlled trials have consistently demonstrated that pharmaceutical-grade CBD (≥98% purity, dosed at 2-50 mg/kg/day) reduces monthly seizure frequency by approximately 30-50% in rare but severe epilepsy syndromes like Dravet syndrome and Lennox-Gastaut syndrome.

This evidence was strong enough to convince regulatory agencies in the United States, Europe, and Australia to approve purified CBD (Epidiolex) for these specific conditions. For healthcare professionals working with pediatric patients, this means you may encounter children who are already taking CBD under medical supervision, and many families report meaningful improvements in seizure control.

Historical Context: Chemotherapy-Induced Nausea

Though now overshadowed by modern antiemetics like ondansetron (Zofran), early studies of THC-based medications in children undergoing chemotherapy remain an important part of the therapeutic narrative. Between 1979 and 1995 Nine crossover studies found that THC-based medications (including nabilone and dronabinol) outperformed the anti-nausea drugs available at that time. These studies highlighted the potential of cannabinoids in settings where conventional therapies failed.

However, it is important to note that these findings were context-specific, and the psychoactive properties of THC require particularly careful consideration in pediatric populations.

Emerging Applications: Promising but Preliminary

Evidence for other pediatric conditions is developing but remains less certain. Recent studies have explored cannabinoids for:

• Autism spectrum disorders: Results are mixed, with one double-blind trial showing no difference from placebo for aggressive behaviors, while other studies suggest improvements in irritability, sleep, and caregiver stress.

• Cerebral palsy-related spasticity: A small trial of nabiximols (1:1 THC:CBD spray) did not achieve statistically significant spasticity reduction.

• Chronic and neuropathic pain: Limited to case series reporting modest pain relief.

While media coverage of these applications may encourage families, healthcare professionals should understand that the clinical science supporting these uses is still evolving.

Safety Profile: What We Know

Across studies, the safety profile is becoming clearer. The most frequent side effects include:

• Drowsiness

• Diarrhea

• Reduced appetite

• Occasional liver enzyme elevations (particularly when CBD is combined with valproic acid)

Rare but serious events (status epilepticus, severe pneumonia, psychotic reactions) have been reported, primarily in cases involving high-THC products.

Practical Implications for Healthcare Professionals

When families mention cannabis use for their children, consider these key points:

1. Ask specific questions: Pharmaceutical-grade CBD prescribed by a neurologist is vastly different from an over-the-counter tincture that might contain significant THC.

2. Set objective measures: Establish clear, measurable goals so families can assess whether perceived improvements translate into functional gains.

3. Monitor and communicate: Document any side effects you observe and share them with the child's medical team. Long-term safety data remain limited, making real-world reporting crucial.

4. Stay informed: This is a rapidly evolving field. The evidence base is "living"—meaning it's continuously updated as new research emerges.

Looking Forward

For healthcare professionals, the key message is nuanced: cannabinoids represent a promising adjunct therapy for specific, well-defined pediatric conditions, particularly drug-resistant epilepsy. However, they do not replace established, evidence-based treatment approaches.

As research continues to evolve, healthcare providers who understand both the potential benefits and limitations of cannabinoid therapy will be best positioned to guide families through informed decision-making. The ancient medicine of cannabis is finally getting the modern scientific scrutiny it deserves—and the results are helping us separate fact from fiction in pediatric care.

For healthcare professionals seeking to deepen their understanding of cannabis in medical practice, PTCannabisInfo offers evidence-based educational resources and continuing education opportunities designed specifically for rehabilitation professionals and other healthcare providers.

References

Chhabra, M., et al. (2025). Cannabinoids for Medical Purposes in Children: A Living Systematic Review. Acta paediatrica (Oslo, Norway : 1992), 10.1111/apa.70140. Advance online publication. https://doi.org/10.1111/apa.70140

Devinsky, O., Cross, J. H., Laux, L., et al. (2017). Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. New England Journal of Medicine, 376(21), 2011–2020.

Devinsky, O., Patel, A. D., Cross, J. H., et al. (2018). Effect of cannabidiol on drop seizures in the Lennox-Gastaut syndrome. New England Journal of Medicine, 378(20), 1888–1897.

Fairhurst, C., et al. (2020). Efficacy and safety of nabiximols cannabinoid medicine for paediatric spasticity in cerebral palsy or traumatic brain injury: A randomized controlled trial. Developmental Medicine & Child Neurology, 62(9), 1031–1039.

Herman, T. S., Einhorn, L. H., Jones, S. E., et al. (1979). Superiority of nabilone over prochlorperazine as an antiemetic in patients receiving cancer chemotherapy. New England Journal of Medicine, 300(23), 1295–1297.

Sallan, S. E., Cronin, C., Zelen, M., & Zinberg, N. E. (1980). Antiemetics in patients receiving chemotherapy for cancer: A randomized comparison of delta-9-tetrahydrocannabinol and prochlorperazine. New England Journal of Medicine, 302(3), 135–138.

Silva, E. A. D. J., Medeiros, W. M. B., Santos, J., et al. (2024). Evaluation of the efficacy and safety of cannabidiol-rich cannabis extract in children with autism spectrum disorder: Randomized, double-blind, placebo-controlled clinical trial. Trends in Psychiatry and Psychotherapy, 46, e20210396.

Sun, N., Cunha, N., Amar, S., & Brown, S. (2022). Synthetic cannabinoid for the treatment of severe chronic non-cancer pain in children and adolescents. Canadian Journal of Pain, 6(1), 225–231.

Thiele, E. A., Marsh, E. D., French, J. A., et al. (2018). Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet, 391(10125), 1085–1096.

Thiele, E. A., Bebin, E. M., Bhathal, H., et al. (2021). Add-on cannabidiol treatment for drug-resistant seizures in tuberous sclerosis complex: A placebo-controlled randomized clinical trial. JAMA Neurology, 78(3), 285–292.