A systematic review of 14 studies found that benzodiazepines were the most commonly reported effective treatment for pediatric CHS, followed by topical capsaicin and haloperidol, while traditional antiemetics were frequently ineffective.
Emergency clinicians treating adolescents with CHS, parents of teens who use cannabis, and pediatricians recognizing this increasingly common presentation.
Traditional antiemetics often ineffective
What the researchers found
Benzodiazepines were the most frequently reported effective treatment for pediatric CHS, followed by topical capsaicin cream and haloperidol. Nine of 14 studies described IV fluid resuscitation and hot bathing as supportive measures. Seven cases reported that traditional antiemetics were ineffective for CHS. Treatment approaches were highly heterogeneous across studies.
Why it matters
As adolescent marijuana use increases, pediatric CHS is becoming more common in emergency departments. Knowing that traditional antiemetics often fail while benzodiazepines and capsaicin may work can help clinicians avoid ineffective treatments and reach for appropriate alternatives faster.
The numbers in context
14 studies included; benzodiazepines most effective; topical capsaicin and haloperidol also effective; 9/14 studies used IV fluids and hot baths supportively; 7 cases reported traditional antiemetics ineffective
How the study worked
Systematic review searching PubMed, Scopus, CINAHL, Web of Science, and Cochrane Library. 14 studies met inclusion criteria describing management strategies for pediatric CHS.
What this study cannot tell us
Only 14 studies, mostly case reports and small series. No randomized controlled trials. Heterogeneous treatment protocols prevent direct comparisons. Publication bias likely favors reporting successful treatments.
How to read the evidence
Systematic review of available literature, but based mostly on case reports and small series without controlled studies.
When this study was published
Published in 2021; pediatric CHS management remains largely based on expert opinion and case data.
The bigger picture
The failure of standard antiemetics in CHS highlights that its mechanism differs from ordinary nausea and vomiting. CHS appears to involve cannabinoid receptor desensitization and TRPV1 pathway dysfunction rather than the serotonin or dopamine pathways targeted by typical antiemetics.
Questions still open
- What is the optimal first-line treatment protocol for pediatric CHS? Could TRPV1 agonists other than capsaicin be effective? Why do some patients respond to benzodiazepines while others need haloperidol?
Common questions
Why don't regular anti-nausea medications work for CHS?
What should parents know about CHS in teens?
Read the original research
Management of Pediatric Cannabinoid Hyperemesis Syndrome: A Review.
The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 26(4), 339-345
Citation
Reinert, Justin P; Niyamugabo, O'Neill; Harmon, Kiersi S; Fenn, Norman E. (2021). Management of Pediatric Cannabinoid Hyperemesis Syndrome: A Review.. The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAG, 26(4), 339-345. https://doi.org/10.5863/1551-6776-26.4.339
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