? This living systematic review represents a necessary effort to synthesize the sparse pediatric cannabinoid evidence base, yet clinicians should recognize that the 37,189 citations screened likely yielded a relatively modest number of actual pediatric studies, reflecting how limited the rigorous data remains outside specialized domains like childhood epilepsy. The heterogeneity of cannabinoid products, dosing regimens, and measured outcomes across included studies complicates direct comparisons and generalizability, while publication bias may overrepresent favorable findings in this emerging field. Additionally, the exclusion of mechanistic animal studies and the challenge of disentangling cannabinoid effects from confounding variables such as underlying disease severity, concurrent medications, and family expectations all warrant caution in interpretation. Until more controlled pediatric trials are completed, practitioners should view cannabinoid use in children as a potentially evidence-supported option primarily for well-established indications like refractory epilepsy, while remaining transparent with families about the gaps in safety and efficacy data for other