? This living systematic review represents a necessary effort to consolidate evidence on pediatric cannabinoid use, yet several important limitations merit consideration before applying findings to clinical practice. The heterogeneity of study designs, patient populations, and cannabinoid formulations makes direct comparison difficult, and many included studies likely lack the methodological rigor of randomized controlled trials, particularly regarding long-term safety outcomes in developing brains. Publication bias toward positive findings and the evolving regulatory landscape surrounding cannabis research means that evidence quality varies considerably across therapeutic indications. Clinicians considering cannabinoid therapy in pediatric patients should focus on conditions with the strongest evidence base (such as treatment-resistant epilepsy), maintain realistic expectations about effect sizes, and engage in shared decision-making that acknowledges both potential benefits and the genuine gaps in our understanding of neurodevelopmental safety in children and adolescents.