Clinical Report–Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

Guidance for the Clinician in Rendering Pediatric Care Clinical Report–Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate?

COMMITTEE ON NUTRITION AND THE COUNCIL ON SPORTS abstract MEDICINE AND FITNESS Sports and energy drinks are being marketed to children and adoles- KEY WORDS sport drinks, energy drinks, obesity, caffeine cents for a wide variety of inappropriate uses. Sports drinks and en- This document is copyrighted and is property of the American ergy drinks are significantly different products, and the terms should Academy of Pediatrics and its Board of Directors. All authors not be used interchangeably. The primary objectives of this clinical have filed conflict of interest statements with the American report are to define the ingredients of sports and energy drinks, cate- Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American gorize the similarities and differences between the products, and dis- Academy of Pediatrics has neither solicited nor accepted any cuss misuses and abuses. Secondary objectives are to encourage commercial involvement in the development of the content of screening during annual physical examinations for sports and energy this publication. drink use, to understand the reasons why youth consumption is wide- The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. spread, and to improve education aimed at decreasing or eliminating Variations, taking into account individual circumstances, may be the inappropriate use of these beverages by children and adolescents. appropriate. Rigorous review and analysis of the literature reveal that caffeine and other stimulant substances contained in energy drinks have no place in the diet of children and adolescents. Furthermore, frequent or excessive intake of caloric sports drinks can substantially increase the risk for overweight or obesity in children and adolescents. Discussion regarding the appropriate use of sports drinks in the youth athlete who participates regularly in endurance or high-intensity sports and vigorous physical activity is beyond the scope of this report. Pediatrics 2011;127:1182–1189 www.pediatrics.org/cgi/doi/10.1542/peds.2011-0965 doi:10.1542/peds.2011-0965 Sports and energy drinks are a large and growing beverage industry All policy statements from the American Academy of Pediatrics now marketed to children and adolescents for a variety of uses. Mar- automatically expire 5 years after publication unless reaffirmed, keting strategies for sports drinks suggest optimization of athletic revised, or retired at or before that time. performance and replacement of fluid and electrolytes lost in sweat PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275). during and after exercise, and marketing strategies for energy drinks Copyright © 2011 by the American Academy of Pediatrics purport a boost in energy, decreased fatigue, enhanced concentration, and mental alertness. Sports drinks are different products than energy drinks; therefore, the terms should not be used interchangeably. Sports drinks are flavored beverages that often contain carbohydrates, minerals, electrolytes (eg, sodium, potassium, calcium, magnesium), and sometimes vitamins or other nutrients. Although the term “energy” can be perceived to imply calories, energy drinks typically contain stimulants, such as caffeine and guarana, with varying amounts of carbohydrate, protein, amino acids, vitamins, sodium, and other minerals. With children and adolescents, careful consideration is necessary when selecting a beverage to hydrate before, during, or after exercise and outside of physical activity to prevent excessive sugar and caloric intake that may encourage dental erosion, overweight, and obesity.1

1182 FROM THE AMERICAN ACADEMY OF PEDIATRICS Downloaded from pediatrics.aappublications.org by guest on July 21, 2015 FROM THE AMERICAN ACADEMY OF PEDIATRICS

Pediatric athletes can benefit from us- mid environment or be subjected to DEFINITION AND CATEGORIZATION ing sports drinks that contain carbohy- prolonged, repetitive exercise, often OF SPORTS DRINKS VERSUS drates, protein, or electrolytes2; how- without adequate recovery time in be- ENERGY DRINKS ever, for the average child engaged in tween competitions), or other pro- Sports drinks are beverages that routine physical activity, the use of longed vigorous physical activities, be- may contain carbohydrates, miner- sports drinks in place of water on the cause these uses have been reviewed als, electrolytes, and flavoring and 4 sports field or in the school lunchroom elsewhere. are intended to replenish water and is generally unnecessary. Stimulant- DEVELOPMENT OF THIS REPORT electrolytes lost through sweating containing energy drinks have no during exercise. In contrast, the place in the diets of children or adoles- The American Academy of Pediatrics term “energy drink” refers to a very 3 cents. Excessive regular consumption Committee on Nutrition (CON) and different type of beverage. Today’s of carbohydrate-containing beverages Council on Sports Medicine and Fit- energy drinks also contain sub- increases overall daily caloric intake ness (COSMF) conducted a thorough stances that act as nonnutritive stim- without significant additional nutri- review of the literature from 2000 ulants, such as caffeine, guarana, tau- tional value. Therefore, frequent con- to 2009. Various approaches were rine, ginseng, L-carnitine, creatine, sumption adversely affects the appro- used, including numerous PubMed and/or glucuronolactone, with pur- priate balance of carbohydrate, fat, searches. Reference lists from related ported ergogenic or performance- and protein intakes needed for optimal studies, reviews, editorials, and posi- enhancing effects. Tables 1 and 2 list growth, development, body composi- tion statements from other profes- some popular commercially available tion, and health. This report defines sional organizations were used. sports drinks and energy drinks and and categorizes selected popular Search terms included sports drinks, their respective contents. sports and energy drinks, reviews energy drinks, children, and adoles- their contents, and examines the evi- cents. The recent Institute of Medicine COMPONENTS OF SPORTS AND dence for and against the use of sports report on school health3 and position ENERGY DRINKS AND THEIR and energy drinks in children and ad- statements on this subject from the INDICATIONS olescents. Recommendations are pro- American Dietetic Association and vided for counseling patients, parents, American College of Sports Medicine2 Water government policy-makers, and ad- were reviewed for this report. Com- Water is an essential part of the daily ministrators who run both school pro- ments were solicited from commit- diet. Adequate hydration is necessary grams and youth sports organizations tees, sections, and councils of the for maintaining normal cardiovascu- with regard to appropriate use of American Academy of Pediatrics; 7 en- lar, thermoregulatory, and many other sports drinks. It is not intended to be a tities responded. For recommenda- physiologic functions during exercise guide for the use or effectiveness of tions for which high levels of evidence and routine daily activity. In children, these drinks in children and adoles- are absent, the expert opinions and maturation and body size are the pri- cents involved in competitive endur- suggestions of the CON, the COSMF, mary determinants of the necessary ance, repeated-bout sports (such as and other groups/authorities con- daily water intake. The quantity of wa- tournaments in which the athlete may sulted were taken into consideration ter needed to maintain a euvolemic have prolonged exposure to a hot, hu- in development of this clinical report. state is influenced by a number of fac-

TABLE 1 Contents of a Sampling of Sports Drinks per Serving (240 mL [8 oz]) Product Manufacturer Calories Carbohydrate, g Sodium, mg Potassium, mg Vitamins Other All Sport Body Quencher All Sport, Inc 60 16 55 60 C —

All Sport Naturally Zero All Sport, Inc 0 0 55 60 B3,B5,B6,B12 — Gatorade PepsiCo Inc 50 14 110 30 — —

Gatorade Propel PepsiCo Inc 10 3 35 — B3,B5,B6,B12,C,E — Gatorade Endurance PepsiCo Inc 50 14 200 90 — Calcium, magnesium Gatorade G2 PepsiCo Inc 20 5 110 30 — —

Powerade Zero Coca-Cola Company 0 0 100 25 B3,B6,B12 — Powerade Coca- Cola Company 78 19 54 — — Iron

Powerade Ion4 Coca-Cola Company 50 14 100 25 B3,B6,B12 — Accelerade Paciﬁc Health Laboratories, Inc 80 15 120 15 E Calcium, protein Selection of the speciﬁc sports drinks listed was based on the most commonly available products at the time this report was under development.

PEDIATRICS Volume 127, Number 6, June 2011 1183 Downloaded from pediatrics.aappublications.org by guest on July 21, 2015 tors such as diet, medications, ill- nesses, and chronic health conditions. -carnitine, -carnitine,

L L With exercise, daily water needs can increase quickly and dramatically on Other

-carnitine, ginseng, -carnitine, ginseng, the basis of environmental conditions L L (eg, heat, humidity, sun exposure), ex- -carnitine -carnitine L L glucuronolactone, phosphorus glucuronolactone, phosphorus glucuronolactone glucuronolactone

Inositol, ginseng, Inositol, Inositol, ercise time and intensity, heat- acclimatization state, and individual sweat rates. Therefore, a deliberate in- a a a —— Inositol, glucuronolactone Inositol, glucuronolactone mg crease in water intake is frequently re- Guarana, quired during exercise to avoid significant dehydration and related health a a —— — mg 1000 10001000 25 25 Ginseng, inositol, ginkgo, Ginseng, inositol, ginkgo, consequences such as heat illness.5 Dehydration is caused by a mismatch , C 1300 30 Inositol, glucuronolactone , C, D 1000

12 12 12 between body water loss (through , C 1000 23 Inositol, glucuronolactone 12 , C, D, C — — 1000 Inositol, ginseng, , C 1000 23 Inositol, glucuronolactone ,B ,B ,B 12 12 12 12 12 12 12 6 6 6 12 ,B

6 sweating, respiration, urine produc- ,B ,B ,B ,B ,B ,B ,B ,B ,B ,B ,B 6 6 6 6 6 6 6 5 5 5 6 ,B 3 Vitamins Taurine,

,B ,B ,B ,B ,B ,B ,B ,B ,B ,B ,B tion, and fecal loss), and water intake. 3 3 3 5 5 5 5 3 3 3 5 ,B 2 ,B ,B ,B ,B ,B ,B ,B ,B ,B ,B ,B

2 2 2 3 3 3 3 2 2 2 3 Signiﬁcant dehydration can be associated with premature fatigue, im- paired sports performance, cognitive 90 B —B —B —B mg 180 A, B changes, possible electrolyte abnor- Calcium, malities (sodium deﬁcit), and increased risk of heat illness.6,7 Effective a a a a a mg management of hydration, which opti- Caffeine, mizes performance and minimizes risk of heat illness in the setting of pro-

mg longed vigorous sports participation,

Potassium, is complex and beyond the scope of this report. Children and adolescents

mg should be taught to drink water rou- Sodium, tinely as an initial beverage of choice as long as daily dietary caloric and other nutrient (eg, calcium, vitamins) g needs are being met. Water is also generally the appropriate ﬁrst choice for hydration before, during, and after most exercise regimens. Children should have free access to water, particularly during school hours.1,2

Carbohydrates Carbohydrates are the most important source of energy for an active child or Manufacturer Calories Carbohydrate, adolescent. However, daily carbohy- Red Bull GmbHPower Trip Beverages, Inc 100 9.6 26 3 190 193 — — 105 77 — B — B Hansen Natural Corporation 50 6 230 60 Hansen Natural Corporation 10 3Power Trip Beverages, Inc 180 110Rockstar, Inc — 30 130 10drate — intake 0 must 110be 125balanced — — B with 80 ad- — B equate intake of protein, fat, and other nutrients. In general, there is little Contents of a Sampling of Energy Drinks per Serving (240 mL [8 oz]) need for carbohydrate-containing bev-

Product erages other than the recommended Free Original Blue Lo-Ball Carb Extreme Free The amount was not speciﬁed on the nutritional content label. Java Monster Hansen Natural Corporation 100 17 340 240 Power Trip “0” Power Trip Beverages, Inc 5 0 190 — 105 — B Red Bull Sugar Power Trip TABLE 2 Selection of the speciﬁc energya drinks listed was based on the most commonly available products at the time this report was under development. Rockstar Original Rockstar, Inc 140 31 40 — 80 — B Java Monster Monster Energy Hansen Natural Corporation 100 27 180 — Monster Low Red Bull Red Bull GmbHPower Trip the Rockstar Sugar 106Full Throttle 27 Coca-Cola Companydaily 193 110 intake — of 28 fruit 77 juice 85 — and B low-fat —

1184 FROM THE AMERICAN ACADEMY OF PEDIATRICS Downloaded from pediatrics.aappublications.org by guest on July 21, 2015 FROM THE AMERICAN ACADEMY OF PEDIATRICS milk. However, for youth who exercise the primary source of energy in these required treatment was not de- with prolonged vigorous intensity, drinks is caffeine—one of the most fined.21,22 Energy drinks contain large blood glucose becomes an increas- popular stimulants taken today. It is and varied amounts of caffeine, often ingly important energy source as mus- unfortunate that many young people much more per serving than cola. Par- cle glycogen stores decrease and the knowingly ingest large amounts of caf- ents and children should be cautioned use of circulating (blood) carbohy- feine in a variety of forms despite the about the difficulties in being aware of drates rises, which results in a need to fact that regular intake has many how much caffeine is ingested depend- supply an ongoing carbohydrate en- noted negative health effects. ing on the product and the serving size, ergy substrate to avert fatigue and Caffeine has been shown to enhance as differentiated from the product maintain performance. The use of a physical performance in adults by in- size. The actual caffeine content for carbohydrate-containing beverage by creasing aerobic endurance and many energy drinks is not easily iden- a child or adolescent in this situation is strength, improving reaction time, and tified on product packaging or via the the most appropriate use of a com- delaying fatigue.9–11 However, these ef- Internet. The total amount of caffeine mercial sports drink. The carbohy- fects are extremely variable, dose de- contained in some cans or bottles of drate content of sports and energy pendent, and, most importantly, have energy drinks can exceed 500 mg drinks varies widely. Sports drinks not been studied in children and ado- (equivalent to 14 cans of common caf- contain 2 to 19 g of carbohydrates (glu- lescents. Ergogenic effects have been feinated soft drinks) and is clearly cose and fructose forms) per serving reported with doses of 3 to 6 mg/kg. high enough to result in caffeine toxic- (240 mL [8 oz]), and the carbohydrate Some athletes who desire to achieve ity.23 A lethal dose of caffeine is consid- content of energy drinks ranges from 0 performance enhancement may volun- ered to be 200 to 400 mg/kg.24 to 67 g per serving. The caloric content tarily reach daily caffeine intakes of up Additional concerns regarding the use of sports drinks is 10 to 70 calories per to 13 mg/kg of body weight. of caffeine in children include its ef- serving, and the caloric content of en- fects on the developing neurologic and ergy drinks ranges from 10 to 270 cal- Caffeine is absorbed by all body tis- cardiovascular systems14 and the risk ories per serving (Tables 1 and 2). sues. It is structurally similar to aden- Excessive intake of carbohydrate- osine and, thus, can bind in its place to of physical dependence and addiction. containing beverages beyond what is cell membrane receptors, which re- Because of the potentially harmful ad- needed to replenish the body during or sults in a subsequent block of adenos- verse effects and developmental ef- after prolonged vigorous exercise is ine’s actions. The effects of caffeine on fects of caffeine, dietary intake should 14,20 unnecessary and should be discour- various organ systems include in- be discouraged for all children. aged.8 Sports and energy drinks are creases in heart rate, blood pressure, Avoidance of caffeine in young people not indicated for use during meals or speech rate, motor activity, attentive- poses a great societal challenge be- snacks as a replacement for low-fat ness, gastric secretion, diuresis, and cause of the widespread availability of milk or water. Excessive caloric intake temperature. Sleep disturbances or caffeine-containing substances and a can result from routine dietary intake improved moods are considered vari- lack of awareness of potential risks. 12–17 of carbohydrate-containing beverages able and individualized effects. Caf- The primary dietary source of caffeine such as sports drinks, energy drinks, feine can increase anxiety in those for children is soft drinks, which con- or soft drinks. This excessive caloric with anxiety disorders,17 and it is tain approximately 24 mg per serving intake can substantially increase the known also to play a role in triggering (240 mL [8 oz]).25 Ellison et al26 re- risk for overweight and obesity in chil- arrhythmias.18 ported that children 6 to 10 years old dren and adolescents and should be There is heightened awareness of the ingested caffeine on an average of 8 of avoided.1,2 risks of caffeine use, abuse, and even 10 days. Other authors have reported toxicity in children and adoles- variable caffeine intakes of up to 16 Caffeine and Other Stimulants cents.19,20 In 2005, the American Associ- mg/day by 7- to 8-year-olds, 24 mg/day Many children and adolescents per- ation of Poison Control Centers re- by 9- to 10-year-olds, and 37.4 mg/day ceive the need to increase or boost en- ported more than 4600 calls received by 5- to 18-year-olds.27 Symptoms of ergy levels. The body’s need for energy for questions regarding caffeine. Of caffeine withdrawal include head- in the form of carbohydrate and other these calls, 2600 involved patients ache, fatigue, decreased alertness, dietary fuel sources is best provided younger than 19 years, and 2345 pa- drowsiness, difficulty concentrating, through balanced nutrition. Energy tients required treatment, although decreased desire to socialize, flulike drinks often provide carbohydrate, but the number of pediatric patients who symptoms, irritability, depressed

PEDIATRICS Volume 127, Number 6, June 2011 1185 Downloaded from pediatrics.aappublications.org by guest on July 21, 2015 mood, muscle pain or stiffness, and 2). Protein has been shown to en- stimulant-containing energy drinks nausea or vomiting.28 hance muscle recovery when ingested with or without amino acid supplemen- promptly after exercise; accordingly, a tation is always discouraged. Guarana small subset of sports drinks that con- Guarana is a plant extract that contain protein or amino acids are of- Vitamins and Minerals tains caffeine.29 It is marketed to in- ten marketed as “muscle-recovery Many sports and energy drinks con- crease energy, enhance physical per- drinks.” The ingestion of protein (the tain several B vitamins, vitamin C, cal- formance, and promote weight loss. major source of amino acids) should cium, and magnesium. There is no ad- One gram of guarana is equal to ap- occur throughout the day as part of a vantage to consuming these vitamins proximately 40 mg of caffeine.30 Thus, normal diet to allow the body free ac- and minerals in drinks, because they the presence of guarana in an energy cess to necessary amino acids. Most can be easily obtained from a well- drink is a cause for concern, because children and adolescents who eat a balanced diet. For further details, see it increases the total caffeine level in well-balanced diet easily get their rec- the Pediatric Nutrition Handbook.1 the beverage.31 ommended daily allowance of protein (1.2–2.0 g of protein per kg), even HARMFUL DENTAL EFFECTS OF Electrolytes those who are engaged in regular SPORTS AND ENERGY DRINKS Electrolytes (primarily sodium and po- 33 sports activities. If a food source of Dental Erosion tassium) are often found in sports and protein is unavailable, an amino acid– Dental erosions from sports and en- energy drinks (Tables 1 and 2). Sodium containing sports drink can be used ergy drinks are of concern in children content varies from approximately 25 immediately after prolonged vigorous and adolescents. Bartlett et al38 found to 200 mg, and potassium content gen- exercise for muscle recovery. Low-fat enamel erosion in 57% of 11- to 14- erally ranges from 30 to 90 mg per milk is a good option for use as a year-olds in a cluster sample of adoles- serving (240 mL [8 oz]). For most chil- postexercise protein-recovery drink. cents. Most sports and energy drinks dren and adolescents, daily electrolyte The optimal ratio of carbohydrate/pro- have a pH in the acidic range (pH 3–4). requirements are met sufficiently by tein intake is likely individual and is af- A pH this low is associated with enamel a healthy balanced diet; therefore, fected by personal tolerance, dietary demineralization.39 Citric acid is fre- sports drinks offer little to no advan- practices, metabolism, and exercise 32 quently included in sports and energy tage over plain water. During or after type and duration. participation in short training or com- drinks and has been found to be highly petition sessions, athletes generally Additional, heavily marketed effects of erosive, because its demineralizing ef- do not need supplemental electrolyte specific amino acids in sports and en- fect on the enamel continues even af- replacement. However, caution should ergy drinks have not been supported ter the pH has been neutralized.40 be taken with athletes who are inap- by appropriate clinical trials. En- propriately restricting their dietary so- hanced immune function (glutamine), Extent of Use and Misuse dium or who drink excessive amounts vasodilatation (arginine), enhanced li- Sports and energy drink consumption of water, because they may be more polysis (L-carnitine, which is not tech- by children and adolescents is wide- susceptible to serious electrolyte ab- nically an amino acid), and caffeine- spread and continues to grow. O’Dea41 normalities. Electrolyte-replacement potentiating effects (taurine) are studied 78 adolescents and found that requirements in the setting of pro- among the most commonly de- 56.4% used sports drinks and 42.3% longed vigorous exercise or in exces- scribed.34–36 Taurine does have an ino- consumed energy drinks during the 2 sively hot or humid conditions vary tropic effect on cardiac muscle similar weeks before the survey. Adolescents widely because of large variations in to that of caffeine.24 Like caffeine, tau- consumed these products for vari- sweat rates. Severe electrolyte abnor- rine has physiologic effects on the in- ous reasons including good taste, malities that occur in each of these tracellular calcium concentration in quenched thirst, and extra energy settings are serious and potentially smooth muscles that may cause coro- needed to improve sports perfor- life-threatening situations and are dis- nary vasospasm.37 In general, the use mance. Most notably, the adolescents cussed in detail elsewhere.5,32 of amino acids in energy drinks in did not differentiate between sports place of traditional dietary sources is and energy drinks and cited the same Amino Acids/Protein not supported by the scientific litera- benefits for both beverages. None of Specific amino acids are added to ture and, therefore, is discouraged the adolescents surveyed mentioned some sports and energy drinks (Table for children and adolescents. Use of potential problems referable to the

1186 FROM THE AMERICAN ACADEMY OF PEDIATRICS Downloaded from pediatrics.aappublications.org by guest on July 21, 2015 FROM THE AMERICAN ACADEMY OF PEDIATRICS consumption of these beverages, promote their use, which opens the the market share for full-calorie so- and they did not distinguish use on door to provide education about these das decreased from 39.9% to the basis of the degree of athletic drinks for both patients and their par- 29.8%.44 participation.41 ents. Frequent consumption of energy A few school districts have already Physically active children and adoles- drinks may identify students at risk of fought policy battles over sports cents and their parents are often un- substance use and/or other health- drinks, and Connecticut became the 43 aware of the additional nutrient and compromising behavior. Education first, and so far only, state to have fluid needs relative to exercise. Sports on proper dietary and sleep habits passed legislation barring sports drinks have an important, specific role may help combat fatigue in adoles- drinks and enhanced waters in in the diet of young athletes who are cents and may decrease the common schools.45 Bills have been introduced in engaged in prolonged vigorous sports “stimulant-seeking behaviors.” the US Congress to set new nutritional activity—primarily to rehydrate and Stimulant toxicity should be reported standards for the foods and drinks replenish carbohydrate, electrolytes, to local poison control centers. The that schools sell to students outside and water lost during exercise.2 How- ability to use tracking methods for cafeterias.45 ever, confusion about energy by young sources of stimulant substances, such In April 2007, the Institute of Medicine people can lead to unintentional inges- as energy drinks, will improve our un- published a report titled Nutrition tion of energy drinks when their goal derstanding of dietary habits and facil- Standards for Foods in Schools,3 in is simply to rehydrate and replenish itate the development of appropriate which it recommended a healthier eat- carbohydrate, electrolytes, and wa- public health measures to prevent ing environment for children and ado- 19 ter with sports drinks. Using energy misuse and abuse. lescents in this country. Relevant to drinks instead of sports drinks for re- Given the current epidemic of child- sports and energy drinks, its recom- hydration can result in ingestion of po- hood overweight and obesity, we mendations for schools included: tentially large amounts of caffeine or recommend the elimination of calorie- ● limit sugars in food and drink; other stimulant substances and the containing beverages from a well- ● adverse effects previously described. balanced diet, with the exception of have water available at no cost; Of additional concern is the intentional low-fat or fat-free milk, because it con- ● restrict carbonated, fortified, or fla- use of energy drinks by adolescents tains calcium and vitamin D, which are vored waters; who desire stimulant effects to com- particularly important for young ● restrict sports drinks to use by ath- bat fatigue and increase energy during people. letes only during prolonged, vigor- sports and school activities. Advertise- ous sports activities; ments that target young people are SPORTS AND ENERGY DRINKS ARE ● prohibit energy drink use, even for contributing to the confusion rather NOT INDICATED AS NORMAL FLUID athletes; and than effectively distinguishing be- CONSUMPTION IN SCHOOLS ● prohibit the sale of caffeinated tween sports and energy drinks. Fur- Sales of sports and energy drinks in products in school. thermore, marketing fails to identify schools are increasing. Having agreed appropriate sources and amounts of voluntarily to phase out full-calorie so- energy substrate that should be con- CLINICAL IMPLICATIONS: das from schools by the 2009–2010 GUIDANCE FOR THE PEDIATRICIAN sumed by children and adolescents.42 school year, beverage manufacturers are heavily promoting sports drinks as Regarding consumption of sports and ASSESSMENT OF USE/MISUSE IN a healthier alternative. In 2006, sports energy drinks by children and adoles- THE OFFICE drinks were the third-fastest grow- cents, the pediatrician is encouraged As part of each yearly checkup, it is ing beverage category in the United to: important for pediatric health care States, after energy drinks and bottled ● Improve the education of children providers to review a patient’s nutri- water, according to the trade journal and adolescents and their parents tional status (food and fluid intake) Beverage Digest.44 The trade group in the area of sports and energy and quantify physical activity. Routine representing beverage manufacturers drinks. This education must high- questions that specifically address the reported that sports drinks increased light the difference between use of sports and energy drinks are their market share in schools from sports drinks and energy drinks recommended. Parents may be un- 14.6% in 2004 to 20% in the 2006–2007 and their associated potential aware of their use, or they may, in fact, school year. During the same period, health risks.

PEDIATRICS Volume 127, Number 6, June 2011 1187 Downloaded from pediatrics.aappublications.org by guest on July 21, 2015 ● Understand that energy drinks source of hydration for children COUNCIL ON SPORTS MEDICINE AND pose potential health risks pri- and adolescents. FITNESS EXECUTIVE COMMITTEE, marily because of stimulant con- 2010–2011 LEAD AUTHORS tent; therefore, they are not appro- Teri M. McCambridge, MD, Chairperson Marcie Beth Schneider, MD Joel Brenner, MD, MPH, Chair-elect priate for children and adolescents Holly J. Benjamin, MD Holly J. Benjamin, MD and should never be consumed. COMMITTEE ON NUTRITION, Charles T. Cappetta, MD ● Counsel that routine ingestion of 2010–2011 Rebecca A. Demorest, MD Mark E. Halstead, MD Jatinder J. S. Bhatia, MD, Chairperson carbohydrate-containing sports Chris G. Koutures, MD Steven A. Abrams, MD Cynthia R. LaBella, MD drinks by children and adolescents Sarah D. De Ferranti, MD should be avoided or restricted. In- Marcie Beth Schneider, MD Michele LaBotz, MD take can lead to excessive caloric Janet Silverstein, MD Keith J. Loud, MD Stephanie S. Martin, MD consumption and an increased risk Nicolas Stettler, MD, MSCE Dan W. Thomas, MD Amanda K. Weiss-Kelly, MD of overweight and obesity as well as ADDITIONAL CONTRIBUTORS dental erosion. ADDITIONAL CONTRIBUTORS Stephen R. Daniels, Former Committee Michael Begeron, PhD – American College of ● Educate patients and families that Member Sports Medicine sports drinks have a speciﬁc limited Frank R. Greer, MD, Immediate Past Andrew Gregory, MD, Former Executive Chairperson function for child and adolescent Committee Member LIAISONS Stephen G. Rice, MD, PhD, MPH, Former athletes. These drinks should be in- Laurence Grummer-Strawn, PhD – Centers for Executive Committee Member gested when there is a need for Disease Control and Prevention more rapid replenishment of car- Rear Admiral Van S. Hubbard, MD, PhD – LIAISONS bohydrates and/or electrolytes in National Institutes of Health Lisa K. Kluchurosky, MEd, ATC – National Valérie Marchand, MD – Canadian Paediatric combination with water during peri- Athletic Trainers Association Society John F. Philpott, MD – Canadian Paediatric ods of prolonged, vigorous sports Benson M. Silverman, MD – Food and Drug Society participation or other intense phys- Administration Kevin D. Walter, MD – National Federation of Valery Soto, MS, RD, LD – US Department of State High School Associations ical activity. Agriculture ● Promote water, not sports or en- STAFF STAFF ergy drinks, as the principal Debra L. Burrowes, MHA Anjie Emanuel, MPH REFERENCES

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Sports Drinks and Energy Drinks for Children and Adolescents: Are They Appropriate? Committee on Nutrition and the Council on Sports Medicine and Fitness Pediatrics 2011;127;1182; originally published online May 29, 2011; DOI: 10.1542/peds.2011-0965 Updated Information & including high resolution figures, can be found at: Services http://pediatrics.aappublications.org/content/127/6/1182.full.h tml References This article cites 37 articles, 4 of which can be accessed free at: http://pediatrics.aappublications.org/content/127/6/1182.full.h tml#ref-list-1 Citations This article has been cited by 22 HighWire-hosted articles: http://pediatrics.aappublications.org/content/127/6/1182.full.h tml#related-urls Subspecialty Collections This article, along with others on similar topics, appears in the following collection(s): Committee on Nutrition http://pediatrics.aappublications.org/cgi/collection/committee _on_nutrition Council on Sports Medicine and Fitness http://pediatrics.aappublications.org/cgi/collection/council_on _sports_medicine_and_fitness Endocrinology http://pediatrics.aappublications.org/cgi/collection/endocrinol ogy_sub Obesity http://pediatrics.aappublications.org/cgi/collection/obesity_ne w_sub Permissions & Licensing Information about reproducing this article in parts (figures, tables) or in its entirety can be found online at: http://pediatrics.aappublications.org/site/misc/Permissions.xht ml Reprints Information about ordering reprints can be found online: http://pediatrics.aappublications.org/site/misc/reprints.xhtml

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