A: Your pediatrician is 100% correct. Please do follow her advice.
Caffeine is the most commonly used drug in the world. It is a stimulant. Though majority of the users of caffeine are in the low or moderate intake and safe, some individuals do need more and more to sustain themselves, even though they know that it may be harming them. Hence, World Health Organization does deem caffeine dependence as a clinical disorder.
The primary reason to consume caffeine is its ability to reduce fatigue and sleepiness, increase focus and perhaps task completion. It stimulates dopamine levels in the brain. The main withdrawal effect of caffeine is headache and sleepiness, tiredness, irritability, body ache, though stress and depression have been noted. Withdrawal can be noted about 12-24 hours after the last consumption and peaks about 24-48 hours and can last up to a week.
Humans, and especially children, react to the consumption of the same amount of caffeine differently. Caffeine can cause a multitude of symptoms including: hyperactivity, tremors, anxiety, dizziness, insomnia, poor quality sleep, irritability, nausea, anorexia, gastritis especially if consumed on an empty stomach.
As many caffeinated products also have high sugar content, adverse effects of high sugar consumption are also noted.
Caffeine overdose (and the dose may vary from child to child) includes: increased heart rate, heart rhythm problems, vomiting, diarrhea, dehydration, high blood pressure, lack of sleep, hyperactivity. Caffeine overdose leads to ER visits. This is especially true if there is already an underlying heart disease or seizure disorder.
Children and adolescents often consume caffeine, perhaps daily and in ways we usually do not think about products containing caffeine. There are natural foods that have caffeine but for the most part, it is the consumption of certain foods and beverages to which caffeine has been added. For e.g. many sodas contain caffeine (this is one more reason to avoid sodas), unless of course they clearly mention caffeine-free. Food and beverage labelling in the U.S. do require mentioning of the amount of caffeine in that product and hence that is a good way to check consumption.
Some other sources of caffeine include: tea, coffee, sweet tea, iced tea, energy drinks, ice cream, chocolate, weight loss supplements, caffeine (energy) pills. Yes, even green tea has caffeine, though less than black tea or coffee. Many herbal products have this stimulant and some of their packages may not mention the amount in them. Some medications, specially over the counter for cold and headaches, have caffeine added.
So how can we help reduce or prevent caffeine intake by children? There is no safe level of consumption of caffeine in children. Children less than 12 years of age should not be consuming caffeine. There is some relaxation for children between 12 and 18 years and some authorities suggest a maximum of 100mg of caffeine during a 24 hours period. This is equal to about two 12-ounce soda cans per day or one standard coffee per day, but we do need to keep in mind what else is in the soda can (sugar for e.g.) and what time of the day is it being consumed and if there is consumption of any other products along with it.
Clearly energy drinks are a no-no as they may contain 250mg of caffeine, an almost 3 days quota worth. It can take almost 10 hours to remove all the caffeine after its consumption.
Responsible use of caffeine by the elders in the home and school, or other impressionable environments, and education about contents of various products, making a habit of reading the label will help avoiding caffeine use and abuse.
If your child has been consuming caffeine and the aim is to stop, avoid stopping it cold turkey. Reducing the caffeine content by 25% every week will help eliminating it without withdrawal effects, the most common of which is headache and fatigue.
Pankaj Vohra is a Pediatric Gastroenterologist at UNM. Please send your questions to email@example.com.