Intended for healthcare professionals

Editorials

Energy drinks for children and adolescents

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5268 (Published 15 December 2009) Cite this as: BMJ 2009;339:b5268
  1. W H Oddy, associate professor,
  2. T A O’Sullivan, senior nutrition research officer
  1. 1Division of Population Sciences, Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, PO Box 855, West Perth, WA 6872, Australia
  1. wendyo{at}ichr.uwa.edu.au

    Erring on the side of caution may reduce long term health risks

    Energy drinks have catapulted to popularity with young consumers. Clever marketing has been the key, with companies playing on associations with danger, power, and youth culture. The business of “liquid energy” has grown exponentially, with nearly 200 brands of energy drinks available in more than 140 countries. Energy drinks represent a rapidly expanding segment of the beverage industry, and 31% of 12-17 year olds have reported regular consumption of the drinks.1

    Energy drinks are set apart from other soft drinks and sports drinks by their high caffeine content and their promotion as a way to relieve fatigue and improve performance.2 Most energy drinks contain about 80 mg of caffeine per 250 ml can, although some contain as much as 300 mg.3 In comparison, the same amount of tea contains around 30 mg, and percolated coffee contains 90 mg.

    Caffeine is a widely used addictive drug that is generally recognised as safe. It stimulates the central and peripheral nervous system and is the only psychoactive drug legally available to children.4 At moderate intakes, caffeine can enhance endurance performance and concentration in adults.5 6 But when consumed in larger doses, caffeine can cause anxiety, agitation, sleeplessness, gastrointestinal problems, and arrhythmias.7

    Concerns over the side effects of excessive caffeine consumption led to an outright ban of energy drinks in Denmark and France. However, the French government removed the ban after a recent assessment by the European Food Safety Authority found no problems with safety. Sales to children (<15 years) are banned in Sweden, with labels warning against consuming these drinks after exercise or mixing them with alcohol. In Norway, sales are restricted to pharmacies, and Argentina’s senate has proposed a ban on energy drinks in nightclubs. In the United Kingdom, the stimulant drinks committee recommended that labels on energy drinks should state that they are unsuitable for children (<16 years), pregnant or lactating women, and people who are sensitive to caffeine.

    In Australia and New Zealand, manufacturers are bypassing regulation through a legal loophole—if a product is called a “dietary supplement” it is not bound by caffeine limits of 80 mg per 250 ml can. Because energy drinks remain unregulated in the United States, this opens the door for imports containing up to three times the amount of caffeine per can. However this law may soon change after serious community concerns from government ministers, school prinicipals, and health professionals about the effects of energy drinks on children and young people.

    Opinions on whether energy drinks should be banned for children differ, with some experts suggesting that problems occur only with overconsumption. However, anecdotal evidence suggests that children who regularly consume energy drinks become dependent on them,8 and even moderate consumption at this age may be detrimental. Caffeine acts on parts of the brain that mediate reward and addiction, potentially affecting future preferences for foods or drinks paired with caffeine9—in this case, sugary soft drinks, which may have future implications for obesity and type 2 diabetes.

    Childhood and adolescence are periods of rapid growth and the final stages of brain development,9 a time when adequate sleep and good nutrition are especially important. Caffeine in energy drinks can cause sleep disruption, and the sugar content (up to nine teaspoons per can) may replace more nutrient dense forms of energy intake.

    Although some beneficial effects of consuming caffeine have been seen in children,10 most children gain little benefit from habitual caffeine intake.11 Drug Education UK has noted disruptive and hyperactive behaviour associated with the consumption of energy drinks.12 Given that caffeine has no nutritive value, erring on the side of caution by banning the sale of energy drinks may be warranted.

    On a local level, schools are in a good position to limit sales of energy drinks to children and many already have bans in place. However, banning sales to minors from other outlets, such as convenience stores, may be difficult to enforce and may have implications for the sale of other caffeinated drinks, such as coffee flavoured milk drinks and cola. But not all the responsibility can be placed on stores—parents sometimes give their children energy drinks, and they may be unaware of the caffeine risks compared with other soft drinks.

    For practitioners, asking about consumption of energy drinks may be a useful way to identify young people at risk of excess caffeine intake.2 Suspected cases of caffeine toxicity should be referred to a poison control centre, where pooled data can drive national analysis and ultimately legislation on caffeinated products.

    From a cautionary viewpoint, bans in schools are justified and feasible, and parents should also play an important part in limiting their children’s access to high caffeine drinks. Further research into the long term effects of energy drinks and the suitability of restriction options is needed before widespread bans are put in place. In the meantime, health professionals and parents are encouraged to promote water as the preferred drink for everyone, including children and adolescents.

    Notes

    Cite this as: BMJ 2009;339:b5268

    Footnotes

    • Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that (1) WHO and TAO’S have support from the Telethon Institute for Child Health Research for the submitted work; (2) they have had no relationships with companies that might have an interest in the submitted work in the previous 3 years; (3) they have no spouses, partners, or children who have financial relationships that may be relevant to the submitted work; and (4) they have no non-financial interests that may be relevant to the submitted work.

    • Provenance and peer review: Commissioned; not externally peer reviewed.

    References

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