Clinical Takeaway
Cannabinoids have shown some benefits in treating certain medical conditions in children, but more research is needed to establish safety and efficacy. Studies include a mix of interventions and observations, highlighting the need for continuous monitoring and updates.
#6 Cannabinoids for Medical Purposes in Children: A Living Systematic Review.
Citation: Chhabra Manik et al.. Cannabinoids for Medical Purposes in Children: A Living Systematic Review.. Acta paediatrica (Oslo, Norway : 1992). 2025. PMID: 40437694.
Design: 5 Journal: 0 N: 2 Recency: 2 Pop: 3 Human: 1 Risk: 0
Methodological Considerations:
- Small sample — underpowered for subgroup analysis
Abstract: AIM: We developed a living systematic review (LSR) that will continuously map the safety and reported benefit data related to cannabinoid use for medical purposes in children. METHODS: MEDLINE, Embase, PsycInfo, and the Cochrane Library were searched from inception to April 2023. Studies involving at least one child < 18 years who was administered plant-derived or pharmaceutical cannabinoids as an intervention or treatment for medical conditions were included. RESULTS: Of 37 189 identified citations, 276 studies were included: 84 interventional, 131 observational, 54 surveys, and 7 qualitative studies. Among interventional and observational studies, common indications for cannabinoids in children were refractory epilepsy (n = 146 studies, 188 726 participants), cancer and cancer symptoms (n = 30 studies, 208 753 participants), and autism spectrum disorder (n = 18 studies, 1285 participants). Common cannabinoids identified in interventional studies were purified cannabidiol (CBD) (78.6%, n = 66 studies, 5235 participants) with dose range of 2-50 mg/kg/day, tetrahydrocannabinol (6%, n = 5 studies, 148 participants) with dose range of 2.5-10 mg/day (max dose of tetrahydrocannabinol in nabiximols 32.4 mg) and nabilone (6%, n = 5 studies, 267 participants) with dose range of 0.5-2 mg/day. In randomised controlled trials, purified cannabidiol was reported to reduce seizure frequency ranging between 30% and 50%. Common adverse events (> 20% studies) in studies enrolling children were somnolence, diarrhoea, vomiting, and decreased appetite. CONCLUSION: These findings will continue to be updated to inform practice and reveal knowledge gaps for future research.
What This Study Teaches Us
This living systematic review mapped 276 studies on cannabinoid use in children, finding that purified CBD dominates the research and shows a 30-50% seizure reduction in randomized trials for refractory epilepsy. The most common adverse events across studies were somnolence, diarrhea, vomiting, and decreased appetite, occurring in more than 20% of studies.
Why This Matters Clinically
If you’re seeing families asking about cannabis for their child’s epilepsy, autism, or cancer symptoms, you now have a baseline on what the evidence actually supports and what side effects to counsel about. This systematic review consolidates scattered literature that’s hard to navigate alone, which matters because cannabinoid use in children is rising and you need to know the safety and efficacy signal strength.
Study Snapshot
| Study Design | Living systematic review of 276 studies (84 interventional, 131 observational, 54 surveys, 7 qualitative) |
| Population | Children under 18 years receiving plant-derived or pharmaceutical cannabinoids for medical conditions; largest cohorts in refractory epilepsy (188,726 participants across 146 studies) |
| Intervention | Purified CBD (78.6% of interventional studies, 2-50 mg/kg/day), THC (6% of studies, 2.5-10 mg/day), nabilone (6% of studies, 0.5-2 mg/day) |
| Primary Outcome | Safety and reported benefit across indications; seizure frequency reduction in RCTs with CBD for epilepsy |
| Key Result | Purified CBD reduced seizure frequency by 30-50% in randomized controlled trials for refractory epilepsy; somnolence, diarrhea, vomiting, and decreased appetite were common adverse events |
Where This Paper Deserves Skepticism
This is a map of the literature, not an assessment of quality, so heterogeneity is baked in: the 146 epilepsy studies vary widely in design, population, dosing, and outcome measurement, which means that 30-50% seizure reduction figure could mask everything from robust RCT data to small case series. The abstract doesn’t tell us how many of those 276 studies were high-quality RCTs versus observational, and we don’t know the funding sources or risk of bias assessments. For autism and cancer, the participant numbers look large until you divide by study count, which suggests small individual trials and observational work rather than definitive evidence.
Dr. Caplan’s Take
I find systematic reviews like this useful for showing me what questions clinicians are actually asking about cannabinoids in kids and where the evidence density lives. The epilepsy signal is real and has genuine RCT support, which sets it apart from autism and cancer indications that mostly rest on observational data. That said, a 30-50% seizure reduction in refractory epilepsy is meaningful but not transformative, and it comes with trade-offs like somnolence and appetite suppression that families need to weigh carefully. This review’s real value is showing me where the gaps are and keeping me honest about what I don’t know.
Clinical Bottom Line
Purified CBD for refractory epilepsy in children has the strongest evidence base (30-50% seizure reduction in RCTs), while autism and cancer use rest primarily on observational data. Before prescribing, counsel families on common adverse effects and that this is a living review that will keep evolving as new evidence arrives.
Clinical Angles to Consider:
- Does this support a specific cannabinoid ratio or formulation for ASD?
- What behavioral outcome measures were used — are they clinically validated?
- How does this fit with existing behavioral and pharmacological ASD management?
| |
Have thoughts on this? Share it:
