1. How Much is Too Much: Caffeine Consumption by Young Children William J. Warzak, Ph.D., Shelby Evans, Ph.D., Margaret T. Floress, Ph.D., & Stoolman, S., M.D. Department of Psychology, University of Nebraska Medical Center Munroe-Meyer Institute INTRODUCTION PURPOSE OF THE STUDY The present study was initiated, in part, to evaluate the consumption of caffeinated beverages in young children. 201 parents of children 5 to 12 years of age were surveyed to investigate caffeine consumption. METHOD Participants and Setting MEASURES PROCEDURES aa Background and Rationale  The proliferation of caffeinated energy drinks is recognized as a burgeoning health risk.  Some caffeinated beverages have several times the amount of caffeine that is found in a 6 oz. cup of brewed coffee.  Over-the-counter stimulant drugs contain FDA warnings and directions on the product label, among these is restricting their availability to children 12 years of age and over.  201 parents of children 5 to 12 years of age completed the surveys  Surveys were administered to English and Spanish speaking families  Administered in a large urban pediatric outpatient clinic  Red Bull, 80 mg  Mountain Dew, 55 mg  Coke Classic, 34.5 mg  Diet Coke, 45 mg  Coffee, > 115 mg  Barq’s Root Beer, 23 mg  Many brands of varying caffeine content are widely available  Advertising of these caffeinated beverages targets young children and adolescents  Very young children are observed to drink caffeinated beverages, raising questions of potential caffeine dependence and withdrawal.  Even beverages such as Mountain Dew, Coke Classic, and Dr. Pepper may contain enough caffeine to affect the behavior of young children since as little as 12.5 mg of caffeine can impact the cognition of adults.  As little as 100 mg of caffeine per day has been reported to create nervousness, jitters, and physical dependence in adults. A much lower threshold might result in similar symptoms in children. Survey Beverage Consumption: Descriptive Statistics:  Children between the ages of 8 and 12 consumed the equivalent of almost 3, 12 ounce cans of soda in the average day. This is between 100 and 150 mg of caffeine. This amount of caffeine is well above the amount that can create physiological effects in adults including dependence and withdrawal.  Children between the ages of 5 and 7 consumed 15 ounces of caffeinated beverages per day, or just over 1 can of soda per day. This is about 25 mg per day which is double the 12.5 mg that noticeably impacts the cognitive performance of adults  Based on the findings of this study, it appears that children are consuming enough caffeine on average to impact cognitive function and create physical dependence. Therefore, recent calls for the FDA to require beverage companies to report the amount of caffeine in a product on the label and for the FDA to more closely regulate caffeine use, especially in children and teens appears to be warranted.  When parents brought their children for an appointment with their pediatrician, they were asked to participate in the study by completing a short questionnaire.  If parents agreed to participate they were provided a short description of the study and the survey.  Once the survey was complete the parents returned it to the receptionist. Influencing Factors  Monster, 160 mg  Adrenalyn Shot, 200 mg  Dr. Pepper, 41 mg  Pepsi, 37.5 mg  Iced Tea, 40 mg  Green Tea, 23 mg STATISTICAL EVALUATIONS  The age of the child as well as his or her ethnicity was examined  The quantity of caffeinated beverages consumed per day was calculated 1= Caffeine contents listed for soft drinks are per 12 oz cans, Energy drinks and other beverages are listed per 8 oz serving. 2=Caffeine quantities are reported based on listings from the US Food and Drug Administration RESULTS DISCUSSION  Assessed consumption of caffeinated beverages (e.g., Mountain Dew, Coke, coffee, tea) by:  Serving size (i.e., 8 oz., 12 oz., 24 oz., 32 oz.)  Pictures were provided as a reference for parents  Number of servings consumed per day  Assessed consumption of non-caffeinated beverages such as milk, water, and juice  Assessed caffeine in snacks (e.g., chocolate)  Serving size (i.e., fun size, full size)  Frequency of consumption per day Additional Areas Surveyed:  Nocturnal enuresis  Quality of child’s sleep Demographic and Descriptive Statistics  Mean age was 8.1 years  108 males and 93 females participated  163 English speaking families; 38 Spanish speaking families Caffeine consumption:  The average participant age 8 to 12 consumed 34 ounces of caffeinated beverages per day, or between 100 and 150mg of caffeine per day  Children age 5 to 7 consumed an average 15 ounces of caffeinated beverages per day, or about 25 mg of caffeine per day.  No parents reported that their child(ren) age 5 to 12 drank “energy drinks” such as Monster or Red Bull. Common Caffeinated Beverages 1,2