Download Considering the Effects of Caffeine and Caloric Intake on Young

REVIEW
Energy Drinks: Considering the Effects of
Caffeine and Caloric Intake on Young Children
Berna Tuvay, Amsterdam University College
Abstract
Research suggests that there is an on-going trend of children replacing regular soda with energy
drinks. Although the influence of these drinks on adolescents has been well examined, young children have not been studied in this context. By examining the biological and psychological effects of
caffeine and the physiological effects of excess caloric intake in adolescents, this study will consider
the potential impact energy drinks might have on children between the ages of 2 and 11 and propose
policies to restrain consumption of energy drinks among young children. The caffeine content and
excess calories prove to have adverse health effects and clinical implications for children of this age
group. Young children should be restrained from consuming energy drinks by imposing regulatory
policies and health education on this topic. Parents should play an important role in regulating their
child’s consumption of these beverages.
Introduction
The popularity and consumption patterns of energy
drinks have grown rapidly over the past few years.
From 2005 to 2010, the number of energy drinks
that were consumed by Americans increased from
2.3 billion to almost 6 billion a year [1]. In addition, it seems that the consumption of energy drinks
among adolescents is increasing [2] whereas the
prevalence of soft drink consumption has been seen
to decrease among both children and adolescents
[3]. Research suggests that this trend of children
and adolescents replacing regular soda with energy
drinks raises health concern because of the content
of these drinks [4, 5].
Several studies have been conducted on the topic
of energy drink consumption among youth. These
studies approach the subject from at least three perspectives. Some of them locate consumption patterns of energy drinks in relation to other patterns
of behaviour. For example, Larson et al. [2] have
found that energy drink consumption in adolescents
is associated with cigarette smoking and video game
use. Other research examines the impact of advertising on the consumption of energy drinks and might
try to link this to the motivation of children to use
these drinks. Temple [6] states that advertising for
energy drinks is targeted at youth, which, she argues, reinforces the belief that companies attempt
to get children ‘hooked’ at young age. Furthermore,
Costa et al. [5] found out that mainly parents and
advertising influence consumption of energy drinks
by 12 to 15-year-olds. Likewise, these adolescents
use energy drinks because they need to boost their
energy level when tired or during exercise. Many
of them indicate that social settings affect energy
drink consumption [5]. The third perspective of
studies looks into socio-economic factors that influence energy drink consumption. Han and Powell
[3] imply sports and energy drink consumption was
less prevalent in low-income children and black children when compared to high-income children and
Caucasians. Hispanic children and children whose
parents had a lower level of education were likely to
consume sports and energy drinks [3]. The majority
of research deals with adolescents and young adults.
However, little is known about the effects stimulants in these drinks have on young children. As
young children are growing fast and developing continuously, the substances in energy drinks might
affect them differently than adults. Another reason why this population might be of interest is that
children are in the middle of creating their dietary
habits [6]. If they become accustomed to consuming energy-dense and caffeinated drinks, this could
have an adverse effect on their growth. Through examining the physiological and psychological effects
59 | HUMAN BODY | Volume 1 - Issue 2 | December 2016
REVIEW
of caffeine and the physiological effects of caloric
intake in adolescents, this paper will consider the potential impact energy drinks might have on children
between the ages of 2 and 11.
Caffeine and its Physiological Effects
Energy drinks are potions that are promoted on the
basis of enhancing performance and improving attention span [2]. Oftentimes research considers energy drinks in combination with other sugary drinks
[2, 3, 7]. Kit et al. [8] explain that sports and energy
drinks are merged into a single category because
the estimate of energy drinks alone is often not statistically reliable. Nevertheless, unlike these other
drinks, energy drinks contain high amounts of caffeine [2] and excess calories per serving [7]. These
characteristics are assumed to have adverse health
effects on children [7, 9].
The caffeine content as well as the caffeine concentration within energy drinks can vary widely
across different brands [9]. Research among 6 to
11-year-olds showed that between 2003-2004 and
2005-2006, the percentage of caffeine intake from
energy drinks in relation the total caffeine intake
increased from 0.1% to 5.3% [4]. These findings
could be associated with the growing popularity
of large containers [4] or with a possible shift of
children towards higher-caffeinated drinks. This is
troublesome as caffeine might have negative health
effects on young children.
In fact, caffeine has physiological effects on children, for instance coronary and cerebral vasoconstriction, smooth muscle relaxation, skeletal muscle
stimulation, heart rate alterations and reduction in
insulin sensitivity [10]. It also triggers the release
of catecholamines, such as epinephrine, and sympathetic stimulation including increased blood pressure [1, 11]. It has been shown in adolescents that
caffeine consumption causes elevated blood pressure [12] and increased heart rate [13], which can
result in tachycardia, hypertension and hyperactivity
[4]. Extending these findings to the current research
population, caffeine may similarly be hazardous for
children, especially those with ADHD [10]. Furthermore, consumption of large amounts of caffeine
prompts fluid loss through augmenting urine flow
and sweat excretion [10].
60 | HUMAN BODY | Volume 1 - Issue 2 | December 2016
Psychological Effects of Caffeine
Aside from physiological changes, psychological
effects due to caffeine consumption can occur. Improved reactivity and alertness and decreased fatigue
and reaction time are effects of caffeine consumption [11]. According to the literature, increased
arousal and anxiety are other well-observed effects
[6, 11, 14]. Among adolescents, popular incentives
for caffeine use include boosting physical endurance
and experiencing a sensation [6]. As a result, a connection between caffeine intake and impulsivity and
risk-taking among adolescents has been made [1].
By extension, this link can be applied to children, as
they are targeted with extreme sports commercials
and powerful slogans as well [10]. In addition, study
among 5-year-old children has reported that caffeine
intake caused slightly more disturbing classroom behavior [15].
With caffeine being a psychoactive stimulant, the
idea of caffeine dependence has been put forward
[11]. It is debatable whether caffeine addiction is a
legitimate concept [9]. Reissig et al. [9] note:
The DSM-IV-TR defines substance dependence using a generic set of cognitive, physiological, and behavioral
symptoms, including the inability to
quit, use despite harm, using more than
intended, withdrawal, and tolerance.
Some of these principal symptoms are observed
in caffeine use. Reissig et al. [9] name inability to
quit and withdrawal as conclusions of studies on
adolescents. Wolk et al. [1] add that one out of six
adolescents continues consuming caffeine despite
negative health consequences. In studies with respectively 13-17 and 11-15-year old children that
consume caffeine daily, Bernstein et al. [14] and
Hughes and Hale [16] have found that 22% of the
research group exhibits behavior that is thought to
be consistent with caffeine dependence. However,
both dependents and non-dependents consumed similar amounts of caffeine [14]. This may suggest that
caffeine dependence has to do with tolerance. The
fact of the matter is that there are indications that
caffeine dependence may be considered the consequence of habitual caffeine use.
Caffeine withdrawal, on the other hand, can
cause diminished cognitive function [1]. Specifically, it may cause decreases in concentration and
REVIEW
performance. As a result, children might experience learning difficulties. Therefore, children’s
school performance may be affected [11]. Other
withdrawal symptoms include yawning, fatigue, depression, anxiety, and headaches [17]. Regarding
the emotional manifestations, a 12 or 13-year-old
girl noted:
I got a lot more confident than what
I usually am. I got really hyper and
when it wore off, I got really sad and
tired [5].
It is evident that children can experience withdrawal symptoms after cessation from caffeine.
When comparing withdrawal symptoms of high consuming children to low consuming children, more
high consumers felt angry and were unable to think
clearly. On the second abstinence day, many high
consuming children experienced even more negative effects. In contrast with adults, children might
express withdrawal symptoms more often through
physical anxiety [18].
Another result from children’s lower tolerance
for caffeine is that they have a higher risk for caffeine intoxication [13]. At the same time, energy
drinks contain high doses of caffeine [1]. These
outcomes seem to hint that caffeine toxicity is likely
to occur with unhabituated children that consume
energy drinks. Seifert et al. [10] describe caffeine
intoxication as ‘a clinical syndrome of nervousness,
irritability, anxiety, insomnia, tremor, tachycardia,
palpitations, and upset stomach.’ Generally, signs of
intoxication include nausea and palpitations at low
doses [17]. Conversely, at larger doses vomiting,
tachycardia, seizures, arrhythmia and hypotension
are diagnostics for poisoning [1]. Reissig et al. [9]
identify three elements that possibly contribute in
making energy drinks more toxic than other caffeine
containing beverages. Firstly, the amount of caffeine in energy drinks is not always presented on the
can. Thus, many people are unaware of the amount
of caffeine they consume. Also, advertising may
give consumers the incorrect impression that more
energy drink means a better performance, which
can lead to individuals consuming large amounts of
energy drinks. On top of that, the lack of regulation
regarding the sale of these drinks to children caffeine could lead to a higher risk of intoxication [9].
These last two attributes are particularly worrisome
for children, as they are target group of advertising
[6] and, due to their sensitivity to caffeine, fairly
easily poisoned.
Furthermore, there are some clinical effects that
are sourced by caffeine. Knowing that caffeine stimulates fluid loss, energy drink consumption during
exercise can enlarge the risk of dehydration. This
phenomenon is especially alarming for children as
they are more vulnerable to dehydration as well as
the biological impacts of caffeine than full-grown
adults [7]. In addition, caffeine consumption in children tends to decrease sleep time and increase sleep
interruptions. [17, 19]. Consequences of disrupted
sleeping habits can include possible skin allergies,
headaches, inability to focus, depression [1], and
daytime sleepiness [5]. Accompanying symptoms
of caffeine withdrawal, poor sleep can result in adverse effects on schoolwork and psychological problems. Moreover, caffeine has been hypothesized
to affect future consumption patterns of children
through neurological influences [10]. Another theory that has been put forward is that caffeine boosts
the sensitivity for sugar [6]. This may insinuate
that energy drink consuming children will be likely
to consume large amounts of caffeine and sugar in
their adulthood.
Physiological Effects of Excess Calories
The large amount of calories, on the other hand, can
also have unfavorable effects on children’s health.
Amendola et al. [20] argue that energy drinks
do not contain more calories than standard soft
drinks, whereas Meadows-Oliver and Ryan-Krause
[7] clearly state that energy drinks generally contain more calories per serving than regular soda or
fruit juices. This can be explained by comparing the
serving sizes. Energy drinks usually have a carbohydrate content between 9 and 10% [7]. Because
energy drinks contain high levels of sugar, they are
presumed to engender poor diet and weight gain
among young children [6]. Moreover, excess consumption of energy drinks can bring about higher
blood glucose levels [4] and therefore amplify the
risk of diabetes. Besides, high amounts of calories
can increase blood pressure, give rise to calcium
deficiency and cause caries [10].
Important to note is that energy drinks also contain high-fructose corn syrup and other unhealthy
additives [7]. Bearing in mind that fructose lowers
leptin concentration and leaves Ghrelin unaffected;
fructose is shown to be less satisfying than glucose
61 | HUMAN BODY | Volume 1 - Issue 2 | December 2016
REVIEW
[21]. On that account, the assumption that fructose
is more hazardous to the health than glucose can be
made. In combination with energy-dense food and
physical inactivity, excess consumption of fructose
could stimulate the prevalence of obesity in young
children [22].
Policies to Regulate Consumption
Taking into consideration the health risks of energy
drinks, the need for regulation emerges. A large
number of studies mention that energy drink content has not been regulated by the Drug and Food
Administration as they are regarded as dietary supplements [4, 10]. This is remarkable considering
that other products with caffeine do have to comply
with the maximum allowable caffeine limit [12]. It
also gives rise to the question why energy drinks are
not controlled more strictly.
Reissig et al. [9] rightfully criticize the way the
Food and Drug Administration has been handling
this issue in the United States and propose labels
that energy drinks should contain, among which ‘Do
not give to children under 12 years of age’ (p. 3).
This seems in harmony with the results that were
obtained in the current research. However, Reissig
et al. [9] do not provide a motivation for specifically
selecting this age group. Other research might declare that energy drinks are harmful enough to place
warnings for adolescents as well. This critical point
should be taken into consideration when discussing
preventive measures.
Nevertheless, in order to protect children from
the dangerous health impacts of energy drinks, regulation may be beneficial. Firstly, the policies concerning energy drinks should be reviewed and adjusted. In the case of sugar-sweetened beverages,
for example, adjusting guidelines and monitoring
the setting possibly resulted in reduced consumption
of these drinks [3]. Restricting the sale of energy
drinks to young children might be an appropriate
intervention in regard of this paper’s findings.
For another thing, parents might be able to support the prevention of children’s energy drinks use.
They have been seen to discuss energy drinks use
with their children and young adolescents, in contrast with older adolescents, are tended to listen to
this advice [5]. This may imply that younger children are likely to view their parents as role models
and that parents can actively participate in battling
energy drink use in young children. However, Costa
62 | HUMAN BODY | Volume 1 - Issue 2 | December 2016
et al. [5] also discovered that some parents encourage adolescents’ use of energy drinks by buying
and recommending these when their children were
low on energy. This may be attributed to lack of
awareness of the negative impacts of energy drinks
or to inconsideration. Either way, it is important
that both parents and children are conscious about
the harmful effects of energy drinks.
Moreover, education could have potential to increase understanding about energy drinks. Health
professionals could take part in communicating the
effects and risks of energy drink use to parents and
young children. This way they can promote informed consumer choices [12].
Conclusion
This paper set out to examine the health effects of
energy drink consumption among young children.
All in all, consumption of energy drinks is suggested
to be harmful for children because of clinical, physiological and psychological effects of caffeine and
physiological effects of excess sugar consumption.
After analysis of the effects of caffeine and superfluous carbohydrates and their likeliness to cause
adverse health effects, this research concludes that
young children should be restrained from energy
drinks by raising awareness among people about
their clinical health impacts.
As far as future research is concerned, there are
plenty of gaps to be filled. Firstly, as mentioned
before, energy drinks should be considered separately from other drinks. Furthermore, many of the
research on caffeine effects does not consider energy
drinks, but other caffeinated beverages. In order to
determine the effects, interaction between different
ingredients should also be taken into consideration.
This elucidates another insufficiency: there are numerous other stimulants that are commonly used in
energy drinks that have not been examined. On top
of that, the prevalence of consumption on national
level could bring some insight into the consumption patters. Lastly, the impacts and tactics of a
prevention-based approach to regulate energy drink
consumption among young children should be researched.
References
[1] Wolk BJ, Ganetsky M, Babu KM. Toxicity of
energy drinks. Current opinion in pediatrics.
2012;24(2):243–251.
REVIEW
[2] Larson N, DeWolfe J, Story M, NeumarkSztainer D. Adolescent consumption of
sports and energy drinks: linkages to higher
physical activity, unhealthy beverage patterns,
cigarette smoking, and screen media use.
Journal of nutrition education and behavior.
2014;46(3):181–187.
[12] Arria AM, O’Brien MC. The “high” risk of
energy drinks. Jama. 2011;305(6):600–601.
[3] Han E, Powell LM. Consumption patterns
of sugar-sweetened beverages in the United
States. Journal of the Academy of Nutrition
and Dietetics. 2013;113(1):43–53.
[14] Bernstein GA, Carroll ME, Thuras PD, Cosgrove KP, Roth ME. Caffeine dependence
in teenagers. Drug and alcohol dependence.
2002;66(1):1–6.
[4] Branum AM, Rossen LM, Schoendorf KC.
Trends in caffeine intake among US children
and adolescents. Pediatrics. 2014;133(3):386–
393.
[15] Ruxton C. The suitability of caffeinated
drinks for children: a systematic review of randomised controlled trials, observational studies and expert panel guidelines. Journal of
human nutrition and dietetics. 2014;27(4):342–
357.
[5] Costa BM, Hayley A, Miller P. Young adolescents’ perceptions, patterns, and contexts of
energy drink use. A focus group study. Appetite. 2014;80:183–189.
[6] Temple JL. Caffeine use in children: what we
know, what we have left to learn, and why we
should worry. Neuroscience & Biobehavioral
Reviews. 2009;33(6):793–806.
[7] Meadows-Oliver M, Ryan-Krause P. Powering
up with sports and energy drinks. Journal of
Pediatric Health Care. 2007;21(6):413–416.
[8] Kit BK, Fakhouri TH, Park S, Nielsen SJ, Ogden CL. Trends in sugar-sweetened beverage
consumption among youth and adults in the
United States: 1999–2010. The American journal of clinical nutrition. 2013;p. ajcn–057943.
[9] Reissig CJ, Strain EC, Griffiths RR. Caffeinated energy drinks—a growing problem.
Drug and alcohol dependence. 2009;99(1):1–
10.
[10] Seifert SM, Schaechter JL, Hershorin ER, Lipshultz SE. Health effects of energy drinks on
children, adolescents, and young adults. Pediatrics. 2011;127(3):511–528.
[11] Bernstein GA, Carroll ME, Dean NW,
CROSBY RD, PERWIEN AR, BENOWITZ
NL. Caffeine withdrawal in normal schoolage children.
Journal of the American
Academy of Child & Adolescent Psychiatry.
1998;37(8):858–865.
[13] Goldman RD. Caffeinated energy drinks
in children. Canadian Family Physician.
2013;59(9):947–948.
[16] Hughes JR, Hale KL. Behavioral effects of caffeine and other methylxanthines on children.
Experimental and clinical psychopharmacology. 1998;6(1):87.
[17] Babu KM, Church RJ, Lewander W. Energy drinks: the new eye-opener for adolescents. Clinical Pediatric Emergency Medicine.
2008;9(1):35–42.
[18] Goldstein A, Wallace ME. Caffeine dependence in schoolchildren? Experimental and
clinical psychopharmacology. 1997;5(4):388.
[19] Owens JA, Mindell J, Baylor A. Effect of
energy drink and caffeinated beverage consumption on sleep, mood, and performance
in children and adolescents. Nutrition reviews.
2014;72(suppl 1):65–71.
[20] Amendola C, Iannilli I, Restuccia D, Santini
I, Vinci G. Multivariate statistical analysis
comparing sport and energy drinks. Innovative Food Science & Emerging Technologies.
2004;5(2):263–267.
[21] Wanner LA. How does the consumption of
fructose and high fructose corn syrup impact
the health of children and adolescents? Journal
of pediatric nursing. 2010;25(5):459–460.
63 | HUMAN BODY | Volume 1 - Issue 2 | December 2016
REVIEW
[22] Teff KL, Elliott SS, Tschöp M, Kieffer TJ,
Rader D, Heiman M, et al. Dietary fructose
reduces circulating insulin and leptin, attenuates postprandial suppression of ghrelin, and
64 | HUMAN BODY | Volume 1 - Issue 2 | December 2016
increases triglycerides in women. The Journal of Clinical Endocrinology & Metabolism.
2004;89(6):2963–2972.