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Are Our Children at Risk?

 

 

Kim M. Lane, PhD.; L.C.S.W.; C.C.S.

6/6/2010

 

 

 

 


 

 

Are Our Children at Risk?

America runs on Dunkin”Reality is this slogan is not far from the whole truth.It is estimated that 80-90% of Americans consume caffeinated products daily (Plotnik & Kouyoumadjian, 2007; Naoshi & Hirofumi, 2007).Many adults begin their day with a dose of hot or cold caffeine to increase their alertness…a wake up boost.In fact, caffeine (in a reasonable dosage) is linked to increasing alertness (Ruxton, 2009).Coffee is the caffeinated beverage of choice for most adults.However, caffeine is not just the drug of choice for adults any longer.

It seems that our children and adolescents need a daily wake up boost as well.Did you know that 3-8 oz.

cups per day is considered moderate consumption, according to the National Institute of Health (NIH) (Wheeler,

2010).By the way, a medium Dunkin Donuts coffee comes in a 20oz. foam cup.Children and adolescents are

consuming a colossal amount of caffeine in their daily diets; they are consuming soft drinks or soda along with

newest craze of energy beverages. The multibillionaire dollar business of energy drinks is making way for additional

sources of higher potency caffeine known as infused snacks.Is the daily intake of caffeine causing alarm for our

children today?

Given the invasion of caffeinated beverages and snacks in our society today, it is clear that we need to address the level of consumption and explore the health risks among the stages of development.To answer the above question, an extensive literature review of resources no older than 5 years was conducted.

Introduction.In 2008, Richard Church, a toxicologist with University of Massachusetts Medical School, tracked 4,600 nationwide calls made to the poison control centers in 2005 (TheBostonChannel, 2008).After his investigation, he reported that half of the calls involved someone under the age of 19 regarding caffeine intoxication (2008).In addition, the regional poison control center at Children’s Hospital in Boston acknowledges receiving dozens of similar calls from parents and school nurses (2008).The concerns were isolated as to the intoxication and poisoning of caffeine.Specifically, the Oklahoma City Poison Control Center reports that a typical call involves a teen or college student that has taken too many tablets to stay awake to cram for tests (LifeWhile, 2008).In 2006, the Control Center received 31 calls regarding caffeine poisoning of which 5 calls directly related to energy drinks (2008).The Control Center reported an increase in calls regarding caffeine poisoning for the next two years with 80 calls at the end of 2008 (2008).Children and adolescents are the marketing targets for such energy drinks and caffeine snacks (Luebbee & Bell, 2009).

It is a biological fact that the human brain continues to develop until 25 years of age (Plotnik & Kouyoumadjian, 2007). What effects does caffeine have on the human brain?It is estimated that 80-90% of Americans consume caffeine every day (Plotnik & Kouyoumadjian, 2007; Naoshi & Hirofumi, 2007).The average American devours over 280 mg a day and an estimated 30% consume over 500mg a day (Naoshi & Hirofumi, 2007).According to the Food and Drug Administration, the average American consumes 37 gallons of soda a year.And we all have experienced the long lines at the Dunkin Donut drive through in the mornings.In fact, this author’s office overlooks a Dunkin Donuts where the traffic never ends from 7 a.m. to 5 p.m. It seems that caffeine has become the number one drug consumed in America.

How are children and adolescents obtaining caffeine? Energy drinks have become a teenage addiction (Hartevelt, 2009). To prove that it is not just teenagers…the other day while waiting for a youth soccer game to begin, two children had just returned from the local corner store with a large Red Bull to drink before the game.One little person said that they wanted to feel “jazzed” for the game.Now these Red Bulls have 80 mg in 8.3 ounces.The Red Bulls that these approximately 9 year olds were drinking were 16 ounces.Each can sells for over $3.00.One would ask how a 9 year old gets over $3.00.Was this school lunch money?If this was the first thing in the morning, children would be loading the bus for a day of educational activities. I do not know these children but one must wonder what the day has in store for these young minds as they attend school, interact with others, and keep themselves safe throughout their time away from us, their protectors.

Caffeine is a drug. This drug is a legal stimulant that is readily available to our children. The drug has no classifications controlling its restrictions based on age or means of consumption.Caffeine is contained in herbal supplements as well.

In 2004, the Nutrient Data Laboratory (a division of the USDA) analyzed 54 products that were in the marketplace (USDA, 2010).The results yielded 27 products with over 200 mg; while of the remaining 27 products, 65% contained less than 100mg of caffeinated ingredients (2010).The study tracked caffeine, guarana, yerba mate, kola nut, and cocoa (2010).In addition, products that contained all three (caffeine, guarana, and yerba mate) contained equal or exceeded the equivalent of three (3) cups of coffee (2001).It is critical to read the labels thoroughly.

Caffeine has several positive attributes to our diet.It may even be used for medicinal purposes with certain diseases.Caffeine has been proven to stimulate the central nervous system, first at the cortex and medulla, and finally the spinal cord at higher doses (Bolton & Null, 2005). Mild cortex stimulation appears to be beneficial resulting in more clear thinking and less fatigue (Bolton & Null, 2005). Caffeine has been shown to improve attention in a study which simulated night driving (2005).Caffeine is known to produce more rapid, clearer flow of thoughts, increases the capability of a greater sustained intellectual effort and more perfect association of ideas (2005; Ruxton, 2009).

How much caffeine is okay?The Diagnostic Statistical Manual IV-TR (DSM IV-TR) states that 250 mg may cause caffeine intoxication.The symptoms of caffeine intoxication mirror symptoms of generalized anxiety, attention deficit hyperactivity disorder, along with several other disorders.Caffeine intake may cause sleeping troubles, irritability, restlessness, heart palpations, muscle and body tremors, anxiety, and headaches.Now, caffeine has benefits as well.In fact, it has been used to suppress appetite, stimulate energy levels for airplane pilots and weight loss programs, and reduce migraine symptoms.Since caffeine is absorbed in the stomach repetitive use may cause gastric irritation (Bolton & Null, 2005).

Caffeine reaches its peak anywhere from 30 to 90 minutes after consumption but one needs to consider the amount of caffeine and body type. Caffeine is often absorbed directly from the stomach. Caffeine has a physiological half life. In adults, the time ranges from 1 to 3.5 hours (Ruxton, 2009).However, these actual numbers vary according to the source. Though, children excrete caffeine faster given their metabolism. Since infants do not metabolize at the same rates as adults it could take up to four (4) days (Bolton & Null, 2005; Rogers, 2009). According to Wheeler, high doses of 750 milligrams over the course of days can produce a tolerance requiring an increase use to sustain effect (2010).

Another concern resulting from the consumption of caffeinated beverages is dehydration.There are mixed reviews on the effects of dehydration caused by caffeine intake.According to Ruxton, two recent studies suggested that caffeine only presents a risk at high levels of intake of greater than 2 cups of tea or 6 strong cups of coffee per day (2008).Children are at greater risk for dehydration than adults (D’Anci, Constant, & Rosenberg, 2006).In fact, the symptoms of dehydration may be mistaken for low energy: confusion, irritability, decrements in cognitive performance, and lethargy.A frequent fix to such feelings of low energy often have people thinking of an energy or caffeinated drink.

It is critical that a person monitor their specific types of beverages consumed throughout the day given the cumulative effect of caffeinated products on the kidneys and liver.Once an energy drink or 16 oz coffee is consumed in a day, there is a risk of caffeine intoxication if the second drink has caffeine as well.Depending on the amount consumed a person may suffer symptoms of vomiting and extreme headaches (LifeWhile, 2008).The National Institute of Health reports symptoms of caffeine poisoning as trouble breathing and diarrhea (Carrillo & Benitez, 2000; LifeWhile, 2008).As mentioned earlier, the Poison Control Centers are receiving an increased amount of calls from teens and young adults (TheBostonChannel, 2008).

The advice from the Food and Drug Administration (FDA) is the key to caffeinated beverages is moderate consumption.In addition to this advice is education and mindful consumption. According to literature a daily amount is less than 250 mg a day (DSM IV).

Food and Drug Administrative Response. Caffeine amounts are often unlabelled or include substances that are herbal but contain caffeine. In some cases, caffeine is listed and the herbal supplement but not added together for the total amount.In addition, few include warnings about potential health risks of caffeine intoxication.Energy drinks are often marketed as “dietary supplements” which negates the 71 milligrams per 12 ounces standard.The FDA website explains why we, as individual consumers, need to be more diligent and responsible for what we consume. The Nutrition Facts Panel on food labels is required dietary information on most food and beverage products.However, caffeine is not a nutrient because it is a natural chemical found in several items (FDA, 2010).Only if caffeine is added is it required on the Nutrition Facts Panel.Caffeine is considered safe up to the level of 0.02 (200 parts per million) (2010).

Guarana is a rain-forest vine with fruit that contains caffeine from South America (Finnegan, 2003; Johannes, 2010).You will recognize this ingredient in many energy drinks.According to Finnegan, 1gram of Guarana is the equivalent of 40 mg of caffeine (2003).Therefore, in determining the amount of stimulant in a beverage one must consider both ingredients.Naoshi and Hirofumi recommend that companies and businesses market caffeinated products with the following considerations in mind: (a) clearly indicate the caffeine content indicating higher quantities and precise quanitity for safe consumption; (b) warn that such products should be avoided by infants/children; and (c) clearly state the health risk factors for large quantities and long term use (2007). There should be an aggressive public campaign that educates consumers about the symptoms of excessive use of caffeine and the remedies for such physical signs.

Primarily, it is the manufacturers responsibility with the oversight of the Food and Drug Administration to ensure a consumer has the information for safe consumption through the Generally Recognized As Safe (GRAS) oversight, or the FDA has given the seal of approval (FDA, 2010).This website contains a list of approved caffeinated alcoholic beverages that are considered safe for consumption:(http://www.fda.gov/Food/FoodIngredientsPackaging/ucm190448.htm).

The Food and Drug Law Class of Michigan’s School of Law compiled the most thorough document requesting more specific labeling so consumers could make informed decisions before consumption (2006).This document was an appeal for more stringent guidance that cites the health risks and consequences of continued use.The petitioners (Food and Drug Law Class) requested that the FDA consider a regulation to require all products containing caffeine to display a prominent label which provides for, (1) the potential addiction to caffeine, and (2) the potentially adverse effects on health from the consumption of caffeine (2006).Additional oversight was suggested for the acknowledgement of a recommended daily amount of consumption.

According to the Food and Drug Law Class of Michigan (2006) and Branstedt (2007), the U.S. Food and Drug Administration does not place sales or labeling restrictions on such products.However, Australia and New Zealand require “enhancing mental performance” and “not recommended for children” be labeled (Branstedt, 2007).A minimum legal age for energy drinks would be too difficult to enforce but schools at least should be banned from selling them (Hartevelt, 2009).As many parents admit they are not fully aware of what children as consuming.

Why do children need a boost?Gordon cites a study conducted by Danice Eaton, a researcher with the U.S. Centers of Disease Control and Prevention in Atlanta, where an extreme lack of sleep for teenagers and the reasons for the lack of sleep were discovered (2010).The study discovered that 69% of high school students get less than 7 hours of sleep at night (2010).The optimal level for this age group is nine hours or more (2010).The reasons for the reduction of sleep hours will not be surprising to many parents: teen employment, social activities, caffeine consumption, and early school start times (2010). Specific to this article the interest lies in the caffeine consumption.What we know for facts is that energy drinks have become a multibillion dollar a year business in the last several years.It is suspected that a fair amount of the sells comes from children, teenagers, and young adults.Unfortunately, there is no substantial research to collaborate these thoughts.

Yes, our children are at risk but so are people of all ages.Before the risks are pointed out, it is important to note that each person should sit back to assess the pattern and level of consumption of all caffeinated products that may consume.There is a sense of self-medicating with such products.

Given that 80-90% of Americans consume caffeine daily, the risks of continued use need to be pointed out.The average daily consumption for children under the age of 18 years of age is drastically increasing.Here are the risks to specific areas: (a) central nervous system (CNS):agitation, anxiety, headache, insomnia, muscle tremor, seizures, restlessness and sensory disturbances; cardiovascular: cardiac arrhythmia, circulatory failure, palpitations, and tachycardia; and (b) gastrointestinal: abdominal pain, diarrhea, nausea, and vomiting.In adults, an oral dose of 1 mg/kg produces peak plasma drug concentration (Carrillo & Benitez, 2000).Tolerance will develop over repeated consumption of caffeinated products.Toxicity is a factor when developing a tolerance to caffeinated consumption.The lethal dose to adults is estimated to be at about 5 to 10 mg (2000).Such doses have not been determined while considering a child’s body.

A daily comsumption of as little as 100mg of caffeine may lead to physical dependence (Luebbee & Bell, 2009).For example, a 12 year old girl weighing approximately 66 pounds who drinks 1-12 ounce can of Diet Coke (47 mg of caffeine) digests an equivalent dose to a 144 pound adult who consumes 2.5- 12 ounce can of Diet Coke.Daily consumption may increase dependence and increase tolerance for children and adolescents. According to the two studies, children and adolescents may demonstrate the negative signs of depression with regular (more than 3 times a week) ingestion of caffeine (Arciero & Ormsbee, 2008; Luebbee & Bell, 2009). The depression like symptoms may result from the heightened heart rates and increases in blood pressure from caffeine ingestion then add activity or a sports event to the mix.The buildup of tolerance sneaks up on children and adolescents because often the withdrawal symptoms occur while sleeping (Attwood, Higgs, & Terry, 2007).

The National Collegiate Athletic Association (NCAA) has been responsible to examine the effects of caffeine on sports performance.In 2006, the NCAA’s maximum dose allowed was 15 µg/mL urine levels allowed (Bramstedt, 2007). This equals an ingestion of 6 cups of coffee or 1 large Red Bull prior to the event.Remember children have a slower metabolism (compared to adults) therefore the effects may be more pronounced.In addition, there is a greater lactic acid concentration with caffeine ingestion resulting in an increase in resting condition (Davis & Green, 2009).Health concerns my entail anxiety, increased heart rate, inability to reach state of rest, and nausea.The activity level of children and adolescents is reflective in the response to consuming caffeine: the more active the less vulnerable to the presser responses (Arciero & Ormsbee, 2008).

Conclusion. This article started with a question: Is the daily intake of caffeine causing alarm for our

children today? It is the hope of this author that the literature was able to demonstrate the health risks of daily

consumption of caffeinated beverages or snacks. Even if we were able to train children and adolescents to read the

labels before consumption, the warnings are not enough to detour the purchase or the ingestion.Ultimately, it is the

parent’s role or other influential adults to educate and mentor our young.

 

It is a proven fact that we need the U.S. Food and Drug Administration to step up their action as well.

Having stricter labeling would be helpful.Most importantly taking caffeine out of the hands of children would be

great.Limiting the use for adolescents would be very helpful but that enforcement is extremely complicated.The

restriction of consumption is similar to the issues we have with the purchasing of cigarettes and alcohol.

 

References

Arciero, P. & Ormsbee, M. (2008, December). Relationship of blood pressure, behavioral mood state, and physical

activity following caffeine ingestion in younger and older women. Applied Physiological Nutritional

Metabolism, 34. 754-762.

Attwood, A., Higgs, S. & Terry, P. (2007). Differential responsiveness to caffeine and perceived effects of

caffeine in moderate and high regular caffeine consumers. Psychopharmacology, 190. 469-477.

Bramstedt, K. (2007). Caffeine Use by Children: The Quest for Enhancement. Substance Use & Abuse, 42. 1237-

1251.

Bolton, S. & Bolton & Null, G. (2005). Caffeine: Psychological Effects, Use and Abuse. Retrieved

from http://www.garyBolton & Null.com/home/caffeine-psychological-effects-use-and-

abuse.html.

Carrillo, J. & Benitez, J. (2000, August). Clinically Significant Pharmacokinetic Interactions Between Dietary

Caffeine and Medications. Clinical Pharmacokinet, 39. 127-153.

D’Anci, K., Constant, F. & Rosenberg, I. (2006, October). Hydration and Cognitive Function in Children, Nutrition

Reviews, 64. 457-464.

Davis, J. & Green, J. (2009). Caffeine and Anaerobic Performance. Sports Medicine, 39. 813-832.

Finnegan, D. (2003). The health effects of stimulant drinks. British Nutrition Foundation Nutrition Bulletin, 28, 147-155.

Food and Drug Administration (FDA). (2010, May 17). Why isn’t the amount of caffeine a product contains

required on a food label? http://www.fda.gov/AboutFDA/Basics/ucm194317.htm.

Food and Drug Law Class (2006, January 15). Citizen Petition for New Labeling Requirements for Caffeine in

Food. http://www.fda.gov/ohrms/dockets/dockets/06p0039/06p-0039-cp00001-01-vol1.pdf.

Gordon, S. (2010). Two-thirds of Americans teens need more shut eye. Retrieved from

http:proquest.umi.com/pdqweb?index=5&sid=1srchmode=2&vinst=PROD.

Hartevelt, J. (2009, September 1). Caffeine drinks may be hurting teenagers: Canterbury university research.

The Press, ChristChurch, New Zealand, 6. 6-8.

Johannes, L. (2010, March 2). Health & Wellness: Aches & Claims: Can a caffeine packed plant give a boost?

Wall Street Journal. New York: NY.

Luebbe, A & Bell, D. (2009, August). Mountain Dew or Mountain Don’t: A pilot investigation of caffeine use

parameters and relations to depression and anxiety symptoms in 5th to 10th grade students. Journal

of School Health, 79. 380-387.

theBostonchannel. (2008, July 10). Caffeine behind 4,600 calls to Poison Control Center

(Video file). Retrieved from http://www.thebostonchannel.com/health/16844829/detail.html.

LifeWhile. (2008, December, 24). Energy Drinks Caffeine Poisoning Reports. Retrieved

from http:www.wmtw.com/print/18353025/detail.html.

Naoshi, G. & Hirofumi, U. (2007). Clinical importance of caffeine dependence and abuse. Psychiatry and Clinical

Neurosciences, 61, 263-268.

Plotnik, R. & Kouyoumdjian, H. (2007). Introduction to Psychology, 8th ed. Cengage Learning:NY

Roger, P. (2009, August). Caffeine-our favourite drug. Biologist, 56. 138-143.

Ruxton, C.(2009, November 4). Health aspects of caffeine: Benefits and risks.Nursing Standard, 24, 41-48.

USDA, (2010, April 30). www.USDA.gov.

Wheeler, R. (2010). Hooked on Caffeine? Retrieved from http://www.everydayhealth.com.

 

Article By: Kim M. Lane

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