I was up helping my son for the majority of the night. He’s got a stomach bug (which he got from his brother) therefore I was up dealing with the enormous mess that comes with vomiting in the middle of the night. I know you know my woe. This is the second round of this bug at our house so I was clearly exhausted when 6am rolled around.

First thing I reached for was my cup of coffee. Pretty typical for a working mom just trying to get by. As I write about caffeine, from my perch in this dear coffee town, I’m in no way suggesting we parents should ditch the latte! In fact the health benefits of moderate coffee intake during adulthood continue to unfold amidst ongoing small concerns. The pendulum seems to swing back and forth on the health benefits lurking in coffee. Moderation, like always, is key.

Yet when it comes to children, we may be more lax about caffeine intake than ideal. Caffeine consumption is pretty high in the US with more than 70% of children having caffeine on a daily basis. New research out evaluating trends in caffeine intake from 1999 to 2010 illuminates the shifts in our children’s consumption. The researchers summed it up best here:

Mean caffeine intake has not increased among children and adolescents in recent years. However, coffee and energy drinks represent a greater proportion of caffeine intake as soda intake has declined, and generally have higher concentrations and amounts of caffeine than soda.

Caffeine and children

Long term effects of caffeine on children’s health are largely unknown as most studies evaluating caffeine’s effect have been conducted with adults. That being said, we know caffeine raises heart rate, increases blood pressure, can upset the stomach, increases anxiety and can interfere with sleep. We’ve certainly learned the hard way that caffeine blunts effects of the intoxication experience with alcohol. Teens and young adults have died from alcohol overdoses after pairing liquor with energy drinks, and recent data suggests that although we’re worried that about 1/3 of teens report using energy drinks, those teens who do are at higher risk for drug and alcohol use, too. Caffeine coupled with binge drinking is a toxic slew. So caffeine really isn’t as benign as we’d like it to be, especially for our teens who are learning how to make good decisions. In typical soda and coffee, caffeine concentration is only mild to moderate. So really it’s new preparations marketed as “energy” supplements that appear of more concern.

Energy drinks are the new frontier for caffeine intake. Every parent must know that caffeine content is not regulated in energy drinks. Although caffeine in mandated to max out at  65 mg per 12 oz can, the amount of caffeine in energy drinks has no limit. In most cases, the amount of caffeine is about 4 times that of the caffeine of sodas.

Pediatrics trends on caffeine

• 73% of children consume caffeine daily from food/drinks and this has been stable over the last decade. The Pediatrics study evaluated children’s dietary habits (via NHANES data) between age 2 and 22 years from study period 1999-2000 to 2009-2010. Even though the amount of children who consume caffeine is stable, the source of their caffeine is shifting. Children’s soda drinking is down in the United States. In 1999, 62% of the caffeine intake for children was thanks to soda but now only 38% of overall caffeine comes from the sugary cans. However, older children are reaching for coffee and energy drinks unlike ever before.
• Over 60% of children age 2 to 5 years have caffeine daily. Young children get the majority of their caffeine from soda and tea — the breakdown of caffeine sources for children 2-6 years of age: 29% tea, 27% soda, 17% chocolate or flavored milk, 15% sweetened grains, 7% sweets, & 5% coffee. Teens and young adults get more caffeine from coffee (24% caffeine consumed by teens is coffee) and even energy drinks (10% of teen caffeine).
• Energy drinks didn’t exist in 2000, so teens and young adults have had a significant explosion of energy drink consumption. Previous data found that 1/3 of teens have used energy drinks. The reality of the movement away from soda may be a mixed blessing: many of the coffee drinks that teens consume may contain more than twice the sugar found in soda and double the caffeine.

What to remember about children and caffeine

1. Remember it’s never “good” for children to consume caffeine, although caffeine in mild quantities (cocoa, chocolate, soda as a weekly treat) is also not proven to cause many ill effects. However, if your children compete in athletics, have sleep challenges or anxiety concerns I would work to get caffeine out of their diet. Caffeine dehydrates our body so will not benefit an athlete competing and we certainly know that it can interfere with precious sleep, especially if consumed after 3pm.
2. Energy drinks can have 4 times the caffeine of soda and can also have additional ingredients with stimulant effects. Popular energy drinks have anywhere from 150mg of caffeine per bottle to up to 505mg. For reference, a typical 6 oz cup of coffee has about 100mg caffeine. Although the US has no guidelines for children’s daily caffeine intake Canada does. Recommendations are weight-based but a ballpark suggestion is giving a kindergartner no more than about 45 mg caffeine (small can of soda) daily.
3. Worth remembering: water is still the cheapest, best beverage for children of all ages. All these liquid accessories may not be worth the billions we spend on them.
4. Coffee and caffeinated beverages may start out as a cup a day habit, but as all of us know that’s a slippery slope. Watch your children’s habits closely, especially if teens are drinking coffee late into the evening to stay up to do homework.

Wendy Sue Swanson is a pediatrician who blogs at Seattle Mama Doc.