Legalization of marijuana for recreational use among adults could significantly increase access to the drug among youth and is a growing concern for pediatric health in the United States. In a January 2015 policy statement, the American Academy of Pediatrics (AAP) reaffirmed its opposition to legalization of recreational marijuana because of potential harms to youth. Alongside efforts to promote prevention and treatment, it advocated for decriminalization (reducing criminal penalties for marijuana possession) to reduce adverse effects of felony convictions on youth, especially minorities.1 Adolescents who regularly use marijuana are at elevated risk for cognitive decline, poor educational achievement, mental illness in adulthood, and injury and death caused by marijuana-impaired driving. Marijuana potency has more than doubled since the 1990s, amplifying concerns about children accidentally consuming dangerous levels of tetrahydrocannabinol (THC) when marijuana is added to candies and baked goods, as such products are easily mistaken for marijuana-free goods.2 Despite these risks, the movement to legalize marijuana is gaining momentum. Voters in 4 states (Colorado, Washington, Oregon, and Alaska) and the District of Columbia have passed laws legalizing recreational marijuana, and additional states may follow in 2016. When marijuana is legalized for recreational use by adults, it is essential that states develop stringent regulations to protect children and adolescents. Legalization normalizes marijuana and reduces perceived risks, a concern raised by the AAP.1 However, legalization with strong regulation potentially provides greater scope for protecting children than decriminalization policies, which on their own reduce criminal penalties without controlling marijuana supply and price. On its current trajectory, marijuana legalization will … Address correspondence to Brendan Saloner, PhD, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Room 344, Baltimore, MD 21205. E-mail: bsaloner{at}jhu.edu