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Brittain Robinson, MD
Nick Watkins, MD

The legalization and commercialization of cannabis products, particularly in edible forms such as gummies and cookies, have contributed to a rise in pediatric marijuana ingestions. These products are often indistinguishable from non-THC-containing snacks, making them especially hazardous for young children. The COVID-19 pandemic introduced additional risk factors including increased time spent at home, limited supervision, and elevated caregiver stress. This study aimed to examine changes in ingestion trends before and during the pandemic, and to assess demographic characteristics and clinical outcomes among affected pediatric populations.

We conducted a retrospective observational study of pediatric emergency department (ED) visits for marijuana ingestion between January 1, 2016, and December 31, 2023, at a tertiary children’s hospital in the United States. Cases were included if marijuana ingestion was documented in ICD-10 codes, toxicology reports, or discharge diagnoses. The cohort was divided into pre-COVID and COVID-era groups using March 11, 2020, as the point of data inflection. Trends over time were assessed using linear regression; group comparisons used chi-square testing and one-way ANOVA.

A total of 2,304 cases were identified, with 1,423 (61.7%) occurring during the COVID era. The proportion of ED visits attributed to marijuana ingestion rose from 0.20% in 2016 to 0.70% in 2023 (p = 0.0019). The 0–5-year age group experienced the sharpest increase, from 3.6% of cases pre-pandemic to 10% during the pandemic—representing a 1466% rise with a P value of <0.001. Floor admissions (p = 0.0037) and discharges (p = 0.0016) significantly increased, while ICU admissions remained stable. Disparities were evident: African American children and those covered by Medicaid were disproportionately represented among the cases.

Pediatric marijuana ingestions have increased substantially in recent years, particularly among young children during the COVID-19 era. While most exposures resulted in floor admission or discharge, the rising frequency highlights a growing burden on emergency and inpatient services. Public health interventions—including caregiver education, safer product packaging, and clear labeling—are essential. Addressing racial and financial disparities is also critical to ensure equitable prevention efforts.

1. Analyze trends in pediatric marijuana ingestion before and during the COVID-19 pandemic.
2. Identify demographic disparities associated with these ingestions.
3. Discuss implications for public health interventions aimed at reducing pediatric marijuana exposures.

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Amy Thompson, MD, MS
Elizabeth Lendrum, MD
Brandon George, PhD, MS
Wendy Pomerantz, MD, MS

With cannabis legalization, concentrated and edible forms have become widely available, leading to increased unintentional ingestions in children. These toxic ingestions raise concerns for neglect and often prompt social service involvement, yet data on health equity in managing such cases is limited. This study examined sociodemographic factors and the incidence of social work (SW) consultation, child protective services (CPS) reporting, and safe disposition planning (SDP) among young children with unintentional cannabis ingestions.

A retrospective cohort study at two level 1 trauma centers analyzed pediatric emergency department (PED) records of children aged 0-6 who tested positive for THC from June 2016 to September 2024

Among 266 cases, most children were under age 2 (58.3%), male (52.3%), white (47.0%), English-speaking (98.9%), non-Hispanic (91.7%), and publicly insured (71.4%). Ingestions increased over time, with 51.8% occurring in the last two years (2023-2024). Edibles (51.1%) from a primary guardian (40.2%) were the most common source. Most cases (83.5%) were triaged as high-risk, with 41.7% evaluated in a trauma bay. Hospital admission was common (82.0%), with 25.2% of admitted children requiring critical care. SW (95.5%) and CPS (80.1%) were involved in most cases. No significant relationship was found between deprivation index and SW (p=0.520), CPS (p=0.405), or discharge disposition (p=0.144–0.256).

The rising incidence of pediatric cannabis ingestion highlights significant toxicity risks to young children and an increasing burden on pediatric healthcare systems, with high utilization of social service evaluation regardless of socioeconomic status.

1. Cannabis ingestions in young children are rising post legalization.
2. Cannabis ingestions in young children are highly toxic and require high resource utilization.
3. Cannabis ingestions in young children commonly prompt social work consultation and child protective service reporting, regardless of socioeconomic status.

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Rahul Shah, MD
Sharon Smith, MD
Mohsin Mirza, BS
Sumeet Kadian, BS, BA
Brendan Campbell, MD, MPH
Kevin Borrup, DrPH, JD, MPA
J. Leslie Knod, MD
Garry Lapidus, PA-C
Danielle Chenard, MPH
Steven Rogers, MD

Firearm related injuries are the leading cause of death in children older than one year of age. Safety counseling and prevention are cornerstones of injury prevention. Little is known about caregivers’ perceptions regarding safety counseling in the ED (emergency department) setting. This survey study sought to assess caregivers’ recollection of firearm safety counseling and who provided that counseling in the past two years. It further sought to determine whom they entrusted to provide this information, and their preferred modalities for future counseling. Secondary objectives included assessing the relationship between parental perspectives on who provided this counseling and how this counseling was provided based on presence of a firearm in the home.

A prospective cross-sectional survey was implemented at a single institution’s emergency department. Parents of children birth-18 years of age were recruited between November 2020 through May 2022, in a private ED treatment room and the survey was administered using a handheld tablet. Excluded were parents of critically ill/injured children (ESI level 1) or those presenting with a primary psychiatric complaint such as suicidal ideation.

A total of 820 of 1,181 of eligible caregivers were recruited (response rate of eligible caregivers: 69.4%). 24.1% of respondents recall receiving counseling on firearm safety within the last two years. 56.1% responded affirmatively that pediatricians ought to counsel parents/guardians on firearm safety. 17.4% reported having a firearm in their home, and these respondents were more likely to have received recent safety counseling. Police departments and pediatricians were the most trusted sources for information; with 58.3% and 55.5% of caregivers identifying them as a highly reputable source of such counseling respectively.

Just over half of caregivers in our convenience sample are following AAP firearm recommendations regarding safe storage of guns and ammunition. Caretakers who own a firearm are more likely to recall counseling on safety measures, equally as likely to believe their pediatrician should offer such counseling, and less likely to entrust their pediatrician to provide them with high-quality information when compared to caretakers who do not own a firearm. Pediatricians and police were viewed as trusted sources of information on firearm safety. In-person counseling was preferred while social media and online resources were not.

Attendees will be able to:
Review compliance of AAP firearm recommendations among firearm owners
(Just over half of caregivers in our convenience sample are following AAP firearm recommendations regarding safe storage of guns and ammunition.)

List trusted sources of firearm safety information among caregivers
(Police officers and pediatricians were among the most trusted sources of firearm safety information.)

Compare and contrast differences between caregivers who possess a firearm and those who do not with regards to firearm safety counseling preferences
(Caretakers who own a firearm are more likely to recall counseling on safety measures, equally as likely to believe their pediatrician should offer such counseling, and less likely to entrust their pediatrician to provide them with high-quality information when compared to caretakers who do not own a firearm.)

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Victor A Soupene, PhD, MS
Charles Jennissen, MD
Nicholas Stange, MD, MPH
Pam Hoogerwerf, BA
Cassidy Branch, MA
Marc Doobay, MPAS, MC

Firearm-related suicide and unintentional firearm injury rates are higher in the rural US compared to the urban US. While firearm safe storage programs and safety messaging have the potential to reduce such injuries, little is known about how to effectively engage rural populations with these interventions. The objective of this study was to identify factors related to firearm safety programming and messaging among parents in rural US households.

Rural parents participated in focus group sessions conducted in-person or online during 2024. Participants were recruited through emails to Iowa FFA club advisors who informed member parents, a mass email distributed to University of Iowa faculty/staff, and invitations distributed to 2024 Farm Progress Show attendees. Inclusion criteria were: (1) (1) residence in Iowa with active farming or ranching operations, (2) at least one child aged 10-19 years living in the home, and (3) at least one firearm in the household. The focus group moderator guide was used to identify primary themes, while sub-themes emerged organically during group discussions. Transcripts were analyzed using Dedoose qualitative analysis software. Three research team members independently coded the data; discrepancies were resolved through consensus in iterative review meetings.

A total of 32 participants took part in the focus groups, with most participants being female, holding at least a college degree, and identifying as non-Hispanic White. Trusted messengers for firearm safety messaging included law enforcement officers, Department of Natural Resources personnel, community members, and individuals directly impacted by firearm-related violence. Conversely, teachers, healthcare professionals, and celebrities were generally not perceived as effective messengers. Participants strongly advocated for age-specific messaging, recommending the use of realistic examples and impactful visualizations while avoiding redundant messaging. They proposed integrating new firearm safety messaging within existing community initiatives, such as school curricula, 4-H and FFA programs, and local firearm safety courses. Opinions on distributing firearm safety devices like locks and safes were mixed: some participants considered these practical tools for injury prevention, whereas others anticipated underutilization and thus perceived such efforts as potentially wasteful.

Effective firearm safety programming and messaging should account for the distinct preferences and values of rural populations. Tailoring interventions to reflect these nuances can enhance their relevance and impact. Strategies led by law enforcement—such as the distribution of firearm safety locks—may be particularly effective in these settings. Future research and program development should incorporate these findings to design firearm safety initiatives that resonate with rural communities and potentially reduce firearm-related injuries.

1. Describe the burden of firearm-related injuries in rural US populations.
2. Identify factors contributing to effective programming and messaging among rural US populations.
3. Discuss how these findings may inform future firearm safety interventions in the rural US.

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Timothy R. Thompson, BA
Hannah L. Hays, MD
Sandhya Kistamgari, MPH
Natalie I. Rine, PharmD, BCPS, BCCCP
Motao Zhu, MD, MS, PhD
Henry Xiang, PhD, MD, MPH, MBA
Gary A. Smith, MD, DrPH

Children under six years represent the highest percentage of caffeine-related exposures reported to US poison centers (PCs), and youth under 20 years account for more than two-thirds of exposures. Previous studies on this topic are limited to data before 2015 and do not exclusively focus on the pediatric population, despite a growing popularity of these products among youth. This study investigated the characteristics and trends of pediatric exposures to caffeine energy products reported to US PCs.

This is an observational study of single-substance exposures involving caffeine energy products among individuals <20 years old reported to US PCs from January 1, 2011, to December 31, 2023. Cases were identified using the National Poison Data System generic codes for caffeine and caffeine-containing energy drinks. Exposures involving coffee, tea, and caffeinated conventional soft drinks were not included because these are not considered energy products. Analyses included descriptive statistics, population-based rates, and odds ratios (ORs) with 95% confidence intervals (CIs).

There were 32,482 caffeine energy product exposures reported to US PCs, representing a 17.3% increase in the exposure rate during 2011-2023. Most exposures were among <6-year-olds (69.6%), males (56.7%), and involved liquid formulations (57.5%). Most (80.7%) were not treated in a healthcare facility; however, 1.6% were medically admitted. Teenagers 13-19 years old were more likely to be admitted (OR=12.74, 95% CI: 10.40-15.60) or have a serious medical outcome (OR=18.83, 95% CI: 16.88-21.01) than children <13 years old. Solid energy product formulations were more likely to be associated with a serious medical outcome (OR=1.98, 95% CI: 1.81-2.17) or medical admission (OR=5.23, 95% CI: 4.31-6.36) than other types of formulations. During the study period, exposure rates increased for liquid (34.5%) and powder/granules (632.9%) product formulations but decreased for solids (-51.5%). Among liquid formulation subcategories, the exposure rate for beverages increased by 46.5% and that for shots decreased by 86.1%.

Although most pediatric exposures to caffeine energy products reported to US PCs were associated with no or minimal clinical effects, serious medical outcomes and medical admissions occurred. The product formulations that drove the 17% increase in the exposure rate changed during the study period. Opportunities exist to reduce the adverse effects of caffeine energy products among the pediatric population.

1. Understand the major trends in single-substance exposures involving caffeine energy products in the <20 years old population.
2. Compare product types associated with exposures in the <6 years old, 6-12 years old, and 13-19 years old populations.
3. Differentiate product types associated with more serious medical outcomes and medical admissions.

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Marc Doobay, MPAS MC
Nicholas Stange, MD MPH
Pam Hoogerwerf, BA (Presenter)
Cassidy Branch, MA
Victor Soupene, PhD MS
Charles Jennissen, MD

Firearm-related deaths and injuries can often be prevented with safe firearm storage. The American Academy of Pediatrics (AAP) recommends clinicians discuss firearm storage with families as part of their injury prevention routine. The AAP also advocates through their Asking Saves Kids (ASK) campaign for parents/caregivers to ask about firearms and their storage in the homes where their children visit. Our study objective was to evaluate the attitudes held by Iowa parents on farms regarding healthcare providers asking about and discussing firearm storage and also about the ASK campaign.

Focus group sessions (in-person and on-line) were performed in 2024. Participants were recruited through emails to Iowa FFA club advisors who informed member parents, a mass email distributed to University of Iowa faculty/staff, and personal distribution of invites to 2024 Farm Progress Show attendees. Requirements included: (1) Must live on and actively farm/ranch in Iowa, (2) Must have at least one child between 10-19 years old, and (3) Must have at least one firearm in the home. Major themes were identified from the focus group moderator guide. Sub-themes were based on the conversations of subjects. Dedoose, a software package that facilitates qualitative analysis, was utilized to analyze transcript content. Additional coding was conducted by three research members, and coding discrepancies were discussed with a consensus achieved via an iterative process.

Thirty-two parents participated. Some deemed it appropriate for clinicians to discuss firearm storage to help ensure children’s safety and to identify families needing safety information. However, others felt it only appropriate to ask about firearms if there were mental health concerns. A few stated providers were a trusted source and that it would be easier to have firearm safety conversations with them than others, and recognized firearms were another safety issue to be addressed. The majority had negative opinions regarding clinicians discussing firearms. Many would be surprised, offended, defensive, and even stop going to the provider if asked. Specific reasons included that it was an invasion of privacy and none of their business, it was not healthcare provider’s job/responsibility, being asked was threatening and made them feel targeted, and it would not be helpful for providers to ask. Regarding the ASK campaign, many stated they would be annoyed, that asking them was offensive like they didn’t trust them or were judging them as bad parents, and asking would not change their storage behaviors.

Most study participants were not comfortable with clinicians asking about firearm storage, and in many cases, felt it had nothing to do with their family’s health. Similarly, they had negative attitudes regarding being asked about their firearm storage by other children’s parents. Healthcare providers may encounter unique barriers when addressing safe firearm and ammunition storage with rural families.

Attendees will be able to:
1) State at least three positive things that some farm parents relayed to focus group moderators regarding healthcare providers discussing firearm storage with them.
2) Identify at least three negative things that some farm parents discussed said to focus group moderators regarding healthcare providers discussing firearm storage with them.
3) Discuss at least three opinions shared by some farm parents to focus group moderators about parents of their children’s friends asking them about their firearm storage.

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Lindsay Clukies, MD
G Hoganson, MD
N Agostin, BA, EMT
S Wiltrakis, MD
K Mueller, MD
S Morand, MD
D Jeffe, PhD

Firearm injuries are the leading cause of death among children and adolescents in the U.S. Despite this public health crisis, firearm-injury prevention education remains infrequent in pediatric care. Pediatric residents are uniquely positioned to provide such education to families but may lack the training, confidence, or comfort to do so. This study aimed to assess pediatric resident comfort discussing firearm safety and evaluate the underlying structure of a brief attitudinal questionnaire to guide development of a physician-led curriculum.

An anonymous electronic survey was administered to 112 pediatric residents at an urban, Level 1 trauma center in January 2024. The survey included six items about residents’ comfort discussing firearm access, secure storage, local resources, and firearm laws with families as well as interest in further training on these topics. Responses were scored on a 5-point scale from “Not at all” (1) to “Very much” (5); higher scores indicate greater comfort and greater interest. Principal component analysis (PCA) was conducted for data reduction and to examine the underlying structure of these items. Cronbach’s ? measured the internal-consistency reliability of items loading on resulting components.

Sixty-three (56% of 112) residents completed the survey, 58 (92.1%) of whom reported having cared for a patient with a firearm injury; yet only 31 (49.2%) reported being trained to discuss secure firearm storage. PCA yielded a 2-component solution, with five items each loading >.600 on the first component; the item about interest in further training loaded on its own component and was analyzed separately. The 5-item component measuring residents’ comfort discussing firearm-safety/injury-prevention had high internal-consistency reliability (Cronbach’s ? = 0.845), with a mean (SD) score of 2.4 (0.8) indicating low levels of comfort. Notably, residents’ mean interest in firearm-safety/injury-prevention training was 4.1 (0.9). Barriers to discussing firearm safety with families included having little comfort with the topic (25 [35.7%]) and knowledge about available resources (24 [38.1%]).

Despite extensive clinical exposure to firearm-related injuries, pediatric residents reported low levels of comfort discussing firearm-injury prevention with families. The strong internal-consistency reliability of the 5-item scale measuring comfort discussing firearm-safety with families and the barriers to having such family discussions provide preliminary evidence of the validity of this measure. Findings underscore the need for a structured curriculum to build residents’ competence and confidence in initiating firearm-safety discussions with families.

1. Describe the current comfort levels and training gaps among pediatric residents in discussing firearm-injury prevention with families.

2. Interpret the findings of a principal component analysis (PCA) used to evaluate a 6-item attitudinal survey measuring residents’ comfort and training interest in firearm safety counseling.

3. Identify key barriers to firearm safety counseling in pediatric care and explain how these findings can inform the development of a structured, physician-led curriculum.