Caffeine consumption in children and teens

• Introduction
• Prevalence of caffeine consumption
• Which foods and beverages provide children and teens with caffeine?
• How much caffeine do children consume?
• Recommendations for caffeine limits in children and teens
  • Maximum daily caffeine intake
  • Safe consumption of energy drinks
• Health risks associated with caffeine consumption in childhood and adolescence
  • Behavioural effects
  • Sleep disturbances
  • Bed wetting
  • Appetite suppression
  • Food preference, diabetes and obesity
• Health effects not associated with caffeine consumption
  • Increased hyperactivity
• Caffeine therapy
  • Apnoea of prematurity
• Caffeine overdose
• Tips for reducing caffeine intake in children

Introduction

Caffeine is a naturally occurring drug which stimulates the central nervous system and may increase an individual’s alertness and concentration. It is the only psychoactive drug (drug which affects the mind or mood) that is legally available to children and adolescents. While caffeine is generally considered safe for consumption in moderation by adults and children, concerns have been raised about the health effects of children consuming large quantities of caffeine.

Prevalence of caffeine consumption

A United States study reported that 57% of children 9 years and under consumed caffeine. In the US, 31% of 12-17 year olds report regularly consuming energy drinks. An Australian survey found that 27% of 8-12 year old boys consumed energy drinks in the two weeks prior to the survey.

Which foods and beverages provide children and adolescents with caffeine?

Canadian statistics indicate that children obtain their caffeine mostly from cola beverages (55%) and tea (30%). Chocolate also contributes a considerable proportion of the caffeine consumed by children (14%). Other sources, including medicines contribute only around 1% of children’s caffeine intake. A US based survey of children 9 years and under reported similar results. US children obtained 52% of their caffeine from carbonated beverages, 28% from tea, 2% from coffee and 18% from chocolate.

How much caffeine do children consume?

The 2007 Australian Child Nutrition Survey estimated the daily caffeine intake of Australian children for the first time. That survey reported increasing caffeine consumption with increasing age. Children aged 2-3 years consumed 3.4mg of caffeine daily and 4-8 year olds consumed 8.1mg of caffeine. Caffeine intake increased to 19.2mg in the 9-13 year age group and 41.7mg amongst 14-16 year olds. On average, boys consumed slightly more caffeine than girls.

Recommendations for caffeine limits in children and teens

Maximum daily caffeine intake

It is recommended that children and adolescents consume no more than 2.5mg of caffeine per kg of body weight per day.

Safe consumption of energy drinks

A recent trend which has created considerable concern amongst health professionals is the regular consumption of caffeinated energy drinks by children. Most energy drinks contain approximately 80mg of caffeine per 250ml can or about the same amount as a cup of coffee. However, some energy drinks contain as much as 300mg of caffeine. In Australia, legal loop-holes mean that energy drinks sold as “dietary supplements” can contain more than the 80mg of caffeine usually prescribed as the maximum caffeine quantity.

There are conflicting opinions about how much energy drinks can be safely consumed by a child. Some experts believe that only excessive consumption of caffeinated energy drinks poses a health risk, while others believe that even moderate consumption may be dangerous at a young age and that addiction or dependency is likely in children who regularly consume energy drinks. In some European countries(including Denmark, Norway, Sweden, Germany and Turkey) have banned entirely or placed restrictions on the sale of caffeine-containing energy drinks to children (under 15 years of age) due to concerns about the safety of children consuming the large amounts of caffeine these drinks contain. Australia has recently banned five brands of energy drink with a very high caffeine content (>320mg per litre). In the absence of research demonstrating the safety of caffeinated energy drinks in childhood, some experts recommend a cautious approach and that children should not consume these products at all.

Health risks associated with caffeine consumption in childhood and adolescence

Few studies have been conducted to investigate the effects of caffeine consumption in children over one year of age and there are no long term studies of the health effects of caffeine consumption in those agedsimilar effectsas caffeine consumption in adults. Then again, children are smaller than adults and will be more sensitive to the effects of an equal amount of caffeine because of their lower body weight.

Behavioural effects

Behaviour may be affected, particularly in children, as caffeine is a stimulant. Some teachers have noted that children who consume energy drinks are impulsive and disruptive in the classroom. Caffeine intake may also result in temporary side effects including irritability, restlessness, difficulty concentrating and sleepiness, particularly in the afternoon. This may in turn affect school performance.

Sleep disturbances

School children who consume >50mg of caffeine per day experience more wakefulness than those who consume ≤10mg per day.

Bed wetting

Children who consume caffeine may suffer from bed wetting. Guidelines recommend that children who wet the bed avoid caffeine.

Appetite suppression

Caffeine is an appetite suppressant and individuals who consume excessive amounts of caffeine may eat less. Caffeine containing beverages may also replace more healthy alternatives including milk, water and juice. This is a particular concern for children, whose nutrition may be affected even from consuming caffeine in moderation. Consumption of caffeine in the form of energy drinks may also lead to dehydration during sports and dental problems if the drinks also contain large quantities of sugar.

Food preference, diabetes and obesity

Caffeine affects parts of the brain which make an individual feel rewarded and/or addicted. It is therefore believed that caffeine consumption may influence the food preference of young people who regularly consume sugary caffeinated drinks. For example, young people who regularly consume caffeinated soft drinks may develop a preference for sugary drinks because they feel rewarded when they drink sugary caffeinated drinks. This has potential implications for a child’s nutritional status as energy drinks are high in calories and sugar (a 250ml can may contain up to 9 teaspoons of sugar). Regular or over-consumption may increase the risk of nutritional disorders such as obesity and diabetes. In addition, sugary caffeinated drinks which typically have no nutritional value (do not contain vitamins and other healthy micronutrients) may affect a child’s nutritional status if they are consumed as substitutes for nutritional beverages such as milk, water and juice.

Health effects not associated with caffeine consumption

Increased hyperactivity

Caffeine consumption in children with attention deficit hyperactivity disorder (ADHD) has been reported to increase hyperactive behaviour. However, a study of caffeine therapy in children with ADHD reported the opposite. Caffeine therapy reduced aggression, impulsivity and parent and teacher perceptions of the severity of symptoms of ADHD in children. (Please note this was conducted under medical supervision.)

Caffeine therapy

Apnoea (breathing difficulty) of prematurity

Caffeine is one of the drugs most commonly used for treating newborn babies in the intensive care unit. It has been used as a respiratory stimulant in this setting for more than 30 years. Caffeine therapy increases survival rates and improves neurological outcomes in premature infants. A large randomised controlled trial of infants born premature and weighing 500-1,250 grams at birth, reported that those treated with caffeine therapy were 23% more likely to survive without neurodevelopment disability after 18-21 months, compared to infants who did not receive caffeine therapy. Caffeine treated babies were 42% less likely to develop cerebral palsy and 19% less likely to experience a developmental delay. Caffeine therapy also reduced the length of time for which the preterm infants needed machine-assisted breathing.

Caffeine overdose

The effects of caffeine vary from person to person and are affected by size, weight and previous intake of caffeine. Caffeine overdose may occur in children following consumption of relatively small amounts of caffeine. While overdose in adults occurs following consumption of 5-10g of caffeine, children may experience the toxic effects of caffeine overdose following consumption of 1g of caffeine. Children who drink around seven cups of strong coffee (or 12 cans of energy drink) may experience caffeine overdose, which results in a range of symptoms and can be fatal.

Symptoms of caffeine overdose include:

• Tremors;
• Nausea;
• Vomiting;
• Irregular or rapid heart rate;
• Confusion;
• Seizures and/or
• Panic attacks.

Tips for reducing caffeine intake in children

In order to reduce caffeine intake in children, replace their coffees and other caffeinated beverages with calcium rich beverages such as coffee flavoured milk and decaffeinated cappuccino or café latte.

More information

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For more information on caffeine, including consumption by adults, children and pregnant women, as well as some useful tools, see Caffeine.

 

For more information on nutrition, including information on types and composition of food, nutrition and people, conditions related to nutrition, and diets and recipes, as well as some useful videos and tools, see Nutrition.

 

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