Long gone are the days when coffee was consumed primarily by adults starting their workdays. Today, with coffee shops on every corner offering innumerable choices of sweetened coffee drinks, kids as young as middle school age are heading off to school carrying cups of joe. Teens and preteens are hanging out in coffee shops where they’re ordering venti drinks containing shots of espresso blended with whipped cream and ample packs of sugar.
Parents may be concerned about this trend, worrying that their kids are overly caffeinated. How much caffeine is too much? Should they ban or limit kids’ caffeinated beverage consumption?
“Caffeine intake by children and teens has increased in recent years, mostly due to caffeinated sodas and energy drinks,” says Skylar Griggs, a registered dietician and clinical nutrition specialist in the Preventive Cardiology Division of Boston Children’s Hospital. While the Food and Drug Administration has not set caffeine recommendations for children and adolescents, she says, the American Academy of Pediatrics (AAP) warns that children should not consume caffeine on a regular basis and adolescents should consume no more than 100 mg of caffeine per day (which is about a half cup or 4 ounces of coffee). The adult limit is 300 to 400 mg daily. Despite this recommendation, Gregg notes that a new study reveals that about 73 percent of children and adolescents consume caffeine daily.
Normand A. Tanguay, M.D., chair of the Department of Pediatrics at Winchester Hospital, says his 12-year-old son returned from a week in Colombia and decided he wanted to drink coffee. Tanguay says he told his son: “We know from recent research that adolescent brains continue developing until well into their twenties. Caffeine is a neuro-active drug, and we don’t know the effect of caffeine on this brain development.” As a compromise, Tanguay says he agreed to let his son have a half cup of coffee with milk once a week on either Saturday or Sunday morning.
There’s a lack of research on the effects of caffeine in children, says Tanguay, but he points out that with a rise in the consumption of energy drinks, the amount of research being conducted is increasing.
“Further research is needed,” agrees Griggs, “but it is my opinion that children and adolescents should abstain from caffeine-containing beverages until they can make an adult decision, keeping in mind the risks and benefits.”
Dangers of Energy Drinks
Eric Sleeper, M.D., a pediatrician at Garden City Pediatric Associates in Beverly, says, “At higher levels, caffeine can raise blood pressure, heart rate and possibly lead to changes in heart rhythm. Caffeine can also cause symptoms of anxiety, irritability and insomnia.”
A big way that kids consume caffeine is by drinking soda. Energy drinks have about three times as much caffeine as soda.
The AAP has warned that energy drinks are dangerous for children, says Tanguay. He cites that in 2011, the AAP released a report published in Pediatrics stating their opposition to children consuming energy drinks, suggesting they pose health risks. A representative from the AAP testified before Congress about this issue.
Rebecca Chase, a pediatric nurse practitioner at Riverside Pediatrics in Newburyport, says she once treated a young teen who had been hospitalized the night before for a fast heartbeat. “The ER never asked him about what he drank,” says Chase. “I soon discovered that he had had an energy drink after camp the previous two days in a row. He was surprised to find out that his symptoms were from the energy drinks and relieved to hear that his heart was OK. He had been up at night worrying there was something seriously wrong with him.”
Parents concerned about kids having too much caffeine should look for signs of their kids feeling jittery, nervous or anxious, upset stomach, headaches, difficulty concentrating or sleeping, and an increase in heart rate and blood pressure, says Chase.
“Energy drinks are scary, and I think they should be banned from the shelves, especially when teens are being hospitalized for irregular heartbeats and elevated blood pressure,” says Paige Katzenstein, a registered dietician with Cambridge Health Alliance. “Parents need to know how much caffeine is in the drinks chosen by their preteens and teens, and to have a conversation with them about it.”
Other Health Risks
Frequent use of caffeinated beverages can lead to dependency and can decrease a child’s appetite, notes Sleeper.
Also, kids who drink caffeinated beverages are probably not drinking as much water or milk as they need, says Griggs. They also miss out on getting adequate vitamins and minerals from whole food sources.
Caffeine’s diuretic properties may also contribute to a child’s risk of dehydration. “To be on the safe side, it’s wise to avoid excessive caffeine consumption in hot weather when kids need to replace water lost through sweating,” says Griggs. The high sugar content of caffeine-containing drinks also increases a child’s risk of dental cavities and can contribute to a child’s risk of obesity.
Children and adolescents with cardiovascular issues, including hypertension, or those with sleep problems should abstain from all forms of caffeine, Griggs recommends. She adds that for kids with anxiety or nervous disorders, caffeine can make them worse.
What About Chocolate Milk?
“There is a small amount of caffeine in chocolate milk, but the bigger concern is the amount of sugar,” says Tanguay. “A major issue with caffeine and children is the link with sugar. Many sweet and caffeinated drinks that children and adolescents consume contain a lot of sugar, which is clearly linked to serious health problems, like childhood obesity and diabetes.”
Says Sleeper, “I would recommend water or low-fat milk as healthier alternatives.”
Griggs suggests that chocolate milk be viewed as a special occasion drink and that low-fat or skim milk be offered daily. “While chocolate milk provides calcium, its sugar content is high,” she says. “To put it in perspective, about 4 grams of sugar is in a sugar packet or sugar cube. Some brands of chocolate milk have 24 grams of sugar in 8 ounces, or about six sugar packets.”
Sources of Caffeine
Caffeine is found in many natural sources like beans, leaves and fruits. The caffeine in coffee, tea and chocolate occurs naturally, says Tanguay. Caffeine is also an added ingredient in carbonated beverages and energy drinks. “Most people are aware of caffeine from these sources, but you may be surprised to know that there are caffeinated gums and mints,” he says. “This is concerning because they’re often marketed toward children and adolescents.”
Sleeper says caffeine is found in some over-the-counter medications, as well, such as in headache remedies.
“A product that I have been quite impressed with lately is fruit-infused water from brands like Infuser, Savvy Infusion, Idealist and AdNArt,” says Griggs. “Infuser water bottles allow you to put fresh fruits and herbs into a cylinder, which infuses out into the ice water. Families can make fun flavored water combinations for on the go, like cucumber and melon, strawberry and basil, and raspberry and mint.”
Other alternative drinks, Griggs notes, include home-brewed green tea, low-fat or fat-free milk, and soy, almond or rice milk. Sport drinks may be used in moderation, although the AAP says adolescents should only consume them after vigorous and prolonged physical activity.
Katzenstein adds that a low-fat milk-based (or almond milk-based) smoothie made with fresh or frozen fruits, or a sparkling seltzer water infused with orange or lemon are great options.
If you have questions related to caffeine or other substances consumed by your kids, consult your pediatrician, a registered dietician or other health care specialist.
“Energy should come from food, not caffeine,” stresses Katzenstein.
Mary Alice Cookson is associate editor of Boston Parents Paper.