AAP Guidelines Nix Energy Drinks for Children, Teens

Laurie Barclay, MD

May 31, 2011 — Energy drinks pose potential health risks for children and adolescents primarily because of the stimulant content in the drinks, according to a new clinical report from the American Academy of Pediatrics (AAP) offering guidelines for use of energy drinks and sports drinks in this age group.

The new recommendations state that energy drinks should never be consumed by children or adolescents, although they are being marketed to this age group for a wide variety of inappropriate uses.

The AAP report was published online May 29 and will appear in the June issue of Pediatrics.

"There is a lot of confusion about sports drinks and energy drinks, and adolescents are often unaware of the differences in these products," said Marcie Beth Schneider, MD, FAAP, a member of the AAP Committee on Nutrition and coauthor of the report, in a news release. "Some kids are drinking energy drinks — containing large amounts of caffeine — when their goal is simply to rehydrate after exercise. This means they are ingesting large amounts of caffeine and other stimulants, which can be dangerous."

Goals of AAP Report

The main goals of the AAP clinical report were to define the ingredients of sports and energy drinks, describe the similarities and differences between the products, and discuss misuses and abuses of these beverages. Secondary goals were to encourage screening for sports and energy drink use during annual physical examinations, to help explain why consumption by youth is highly prevalent, and to improve education aimed at reducing or eliminating the inappropriate use of these drinks by children and adolescents.

Sports drinks contain carbohydrates, minerals, electrolytes, and flavoring, and are intended to replace water and electrolytes lost through sweating during exercise. Although they may be useful for young athletes participating in prolonged, vigorous physical exercise, they tend to be overused and are usually unnecessary.

"For most children engaging in routine physical activity, plain water is best," said coauthor Holly J. Benjamin, MD, FAAP, a member of the executive committee of the AAP Council on Sports Medicine and Fitness. "Sports drinks contain extra calories that children don't need, and could contribute to obesity and tooth decay. It's better for children to drink water during and after exercise, and to have the recommended intake of juice and low-fat milk with meals. Sports drinks are not recommended as beverages to have with meals."

Unlike sports drinks, energy drinks contain stimulants including caffeine, guarana, and/or taurine. Rigorous review and analysis of the literature suggest that energy drinks are never appropriate for children or adolescents. Because caffeine has been associated with harmful neurologic and cardiovascular effects in children, caffeine-containing beverages, including soda, should be avoided. The AAP report lists the contents of specific sports drinks and energy drinks currently available.

"In many cases, it's hard to tell how much caffeine is in a product by looking at the label," Dr. Schneider said. "Some cans or bottles of energy drinks can have more than 500 mg of caffeine, which is the equivalent of 14 cans of soda."

AAP Recommendations

Specific AAP recommendations regarding use of sports drinks and energy drinks in children and adolescents include the following:

• Pediatricians should educate patients and their parents regarding the potential health risks of energy drinks and sports drinks and explain the significant differences between these types of drinks. The terms should not be used interchangeably.
• Energy drinks should never be consumed by children or adolescents, because the stimulants they contain pose potential health risks.
• Children and adolescents should avoid and restrict routine consumption of carbohydrate-containing sports drinks, which can increase the risk for overweight, obesity, and dental erosion.
• For pediatric athletes, sports drinks should be consumed in combination with water during prolonged, vigorous physical activity, when rapid replenishment of carbohydrates and/or electrolytes is needed.
• For children and adolescents, water, not sports drinks, should be the principal source of hydration.

Further Concerns

"Confusion about energy by young people can lead to unintentional ingestion of energy drinks when their goal is simply to rehydrate and replenish carbohydrate, electrolytes, and water with sports drinks," the report authors write. "Using energy drinks instead of sports drinks for rehydration can result in ingestion of potentially large amounts of caffeine or other stimulant substances and the adverse effects previously described."

A 2007 Institute of Medicine report titled Nutrition Standards for Foods in Schools recommended limiting sugars in food and beverages; providing water at no cost; restricting carbonated, fortified, or flavored waters; restricting sports drinks to use by athletes only during prolonged, vigorous sports activities; prohibiting energy drink use, even for athletes; and prohibiting the sale of caffeinated products in school.

"Of additional concern is the intentional use of energy drinks by adolescents who desire stimulant effects to combat fatigue and increase energy during sports and school activities," the authors of the report conclude. "Advertisements that target young people are contributing to the confusion rather than effectively distinguishing between sports and energy drinks. Furthermore, marketing fails to identify appropriate sources and amounts of energy substrate that should be consumed by children and adolescents."

The AAP has neither solicited nor accepted any commercial involvement in the development of the content of this clinical report. All report authors have filed conflict-of-interest statements with the AAP, and any conflicts have been resolved through a process approved by the Board of Directors.

Pediatrics. 2011;127:1182-1189. Full text