For better or worse, we are moving from a culture of soda drinkers to coffee drinkers, and our kids are following us. Unfortunately, caffeine and kids do not necessarily go well together.
When I was younger, I was much more sensitive to caffeine than I am now. I used to drive my parents crazy if I had a Coca-Cola after lunch because I would have a lot of difficulty falling asleep at night. Specifically, I would feel like I had “too much energy in my legs”. It wasn’t until I was studying for my Sleep Medicine Boards that I realized that this is a common description of restless leg syndrome in children. One night, in college, I had a late evening iced espresso and could not sleep all night. At that point, I gave up all caffeine until my third year of medical school because I was so annoyed. Now I have a cup or two of coffee a day. To be frank, I need it.
There seem to be more and more ways for kids to get caffeine these days. A company has produced an inhaled form of caffeine inhaler called the Aeroshot. Although the manufacturer has said that it is not recommended for children under 18, the FDA recently issued a warning letter to the manufacturer about the marketing program. The FDA, however, does not have recommendations about caffeine intake for children.
I always ask about caffeine intake in Sleep Clinic. Interestingly, in the group of patients seen in clinic, who have already tried to address their own issues, use is relatively low. However, the statistics about use tell a different story.
In children 5-12 years of age, a study of over 200 children showed caffeine use to be significant in children aged 5-12 years of age. Children 5-7 years old consumed 52 mg daily on average, the equivalent of one can of cola. Children 8-12 consumed about twice that. The more caffeine consumed, the less the children slept at night. Interestingly, the authors reported no increase in enuresis (bedwetting); this had been previously reported due to the fact that caffeine increases urine production.
Caffeine can play into the vicious cycle of adolescent sleep, whereby sleepy teens use caffeine to stay awake, but as a result can’t fall asleep, perpetuating the cycle. Three hundred and nineteen children (ages 10-17) were studied as part of the TuCASA study of adolescent sleep. Screen time, caffeine intake and increasing age in kids were associated with decreased sleep, which in turn was associated with increased weight. Earlier I wrote about the association between inadequate sleep and obesity. The majority of children and teens consume caffeine via high calorie drinks such as sodas, energy drinks, and coffee. It stands to reason that reducing intake of these beverages may reduce obesity by both reducing calorie consumption and improving sleep will likely help maintain a healthy weight, as the accompanying editorial pointed out.
Interestingly, caffeine intake does not seem to have changed over the last ten years, but the method of consuming it has. Energy drinks and coffee are much more likely to be consumed, whereas soda intake has decreased. Here is an article from 2014 exploring this trend. This is concerning, because a cup of coffee from Starbucks has significantly more caffeine than, say, a can of Coke (200-400 mg vs. 35 mg). Here’s a great resource telling you how much caffeine is in various foods and beverages. And be aware that some beverages such as hot chocolate, coffee ice cream, and Vitamin Water have more caffeine than you think.
Personally, I recommend that:
- No children under 12 should have caffeine containing beverages routinely.
- It is a good rule of thumb to avoid soda entirely.
- Older children and teenagers should have it in moderation and avoid consuming it 3-4 hours before bedtime.
- For my patients with sleep disorders, I recommend no caffeine after 2 PM.
- The exception to the rule is in the case of drowsy driving. If a teenager is drowsy and has to drive somewhere, a brief nap and a caffeinated beverage are the only methods recommended to improve alertness.
For more on the caffeine content of various beverages and other items (including chocolate bars), head over to KidsHealth. There is also a good article by Vincent Iannelli MD at About.com. Here is a good editorial on caffeine in kids.