Study Shows Young Children Comprise Half the Cases Reported for Energy-Drink Toxicity

Children under 6 who mistakenly consumed caffeine-laced energy drinks accounted for half the cases of energy drink-related toxicity reported to the U.S. National Poison Data System during the first year the surveillance data base began tracking such cases. That’s the startling conclusion of a Miller School study published July 24 online ahead of print in Clinical Toxicology, the official journal of the American Association of Poison Control Centers, that analyzed all energy-drink related calls to the nation’s poison centers during the 2011 federal fiscal year.

But the study, “An analysis of energy-drink toxicity in the National Poison Data System,” also contains some encouraging data that suggests the public is heeding warnings about the risks associated with the popular beverages that typically contain high concentrations of caffeine and other stimulants. Led by the Miller School’s Steven E. Lipshultz, M.D., professor of pediatrics and public health sciences and Director of the Batchelor Children’s Research Institute, a team of pediatricians, epidemiologists and poison control specialists found that widespread media reports chronicling the risks, and the corresponding restrictions on the sale of alcoholic energy drinks, coincided with significant declines in the number of energy drink-related calls to poison centers.

“This study provides the first look into energy-drink use and outcomes among children, adolescents and adults in the U.S., and it is shocking,” said Lipshultz, the George E. Batchelor Professor of Pediatrics. “The results suggest that energy drinks are within easy reach of and appealing to young children, who probably mistake them for other beverages they like to consume. The upside is that the growing drumbeat of warnings about the health risks associated with children consuming energy drinks appears to be having a positive effect. As the American Academy of Pediatrics said, ‘Caffeine and other stimulants contained in energy drinks have no place in the diet of children and adolescents.’”

Just last month, the American Medical Association added its voice to the chorus calling for a ban on the marketing of energy drinks to children under 18, saying the high-caffeine beverages could cause heart problems and other health issues.

Other Miller School authors on the study were first author Sara Seifert, M.D., Class of 2012; Judith L. Schaechter, M.D., associate professor and Interim Chair of Pediatrics; Eugene R. Hershorin, M.D., professor of pediatrics and Associate Chair for Community Provider Relations; Kristopher L. Arheart, Ed.D., associate professor of public health sciences; and Vivian I. Franco, M.P.H., senior research associate in the Division of Pediatric Clinical Research.

Lipshultz, Seifert, Schaechter and Hershorin also co-authored one of the first national studies to raise concerns about energy-drink usage among adolescents and young adults. Published in the journal Pediatrics in February 2011, that study’s review of current literature found that 30 to 50 percent of adolescents and young adults self-reported using energy drinks, and that the drinks posed a risk for serious adverse effects among those with seizures, diabetes, cardiac abnormalities, mood and behavioral disorders, or on certain medications.

Of the 5,448 caffeine overdoses reported in the U.S. in 2007, that study also noted, 46 percent occurred in people younger than 19.

In the ensuing months, many school districts, states and countries began regulating energy-drink content or sales to children and adolescents, and in November 2010, the Food and Drug Administration effectively banned the sale of all energy drinks that also contain alcohol.

For their latest study, the Miller School researchers joined forces with poison control experts in New Mexico and Colorado to analyze the 4,854 energy-drink exposure calls made to one of the nation’s 57 poison control centers between October 1, 2010, and September 30, 2011, the first year the U.S. National Poison Data System began tracking energy-drink related cases. The majority of those calls, 3,192, concerned energy drinks that had been consumed with other substances or had unknown additives, and were excluded from the analysis.

Of the 1,662 remaining calls, 1,480 concerned nonalcoholic energy drinks, and 182 alcoholic drinks. A demographic analysis of the nonalcoholic energy drink exposures showed children younger than 6 made up 717, or 50.7 percent, of the cases reported as unintentional exposures to energy drinks, with minor or moderate adverse effects reported in 28 percent of the cases reporting adverse effects. In most cases, the children consumed energy drinks that contained only caffeine, and none of the other additives known to exacerbate the effects of caffeine.

Still, the researchers were concerned by the ease with which young children accessed energy drinks, the fastest growing segment of the soft drink market.

“Given what is known about other unintentional childhood toxic exposures, these results suggest that energy drinks are easily within reach of children and that packaging is appealing and looks like other beverages children consume,” they wrote. “If so, similar preventive measures should be used: childproof containers, unappealing packaging, and keeping products out of the reach of children. Adult consumers of energy drinks must be alerted to the potential adverse effects of energy drinks in children.”

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