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Caffeine Consumption in Young Children

Published:December 17, 2010DOI:https://doi.org/10.1016/j.jpeds.2010.11.022
      Two hundred twenty-eight surveyed parents reported that their 5 to 7 year old children drank approximately 52 mg of caffeine daily and their 8 to 12 year old children drank 109 mg daily. Caffeine consumption and hours slept were significantly negatively correlated, but caffeine consumption and enuresis were not significantly correlated. Spanish-speaking parents reported fewer bedwetting events than their English-speaking peers.
      Caffeine’s diuretic properties have encouraged behavioral health practitioners to eliminate caffeine from the diet of children with enuresis.
      • Jalkut M.W.
      • Lerman S.E.
      • Churchill B.M.
      Enuresis.
      The Food and Drug Administration has not developed pediatric guidelines for caffeine consumption, but

      The Nemours Foundation 2010. Kids Health: Caffeine Confusion. http://kidshealth.org/kid/stay_healthy/food/caffeine.html# Updated November 2007. Accessed Mar 23, 2010.

      Canadian guidelines recommend that children aged 4 to 6 years old consume no more than 45 mg/d, approximately equivalent to the amount of caffeine found in a 12-ounce can of cola.

      Health Canada. Caffeine and your health. http://www.hc-sc.gc.ca/fn-an/securit/facts-faits/caffeine-eng.php Updated Mar 03, 2003. Accessed December 9, 2009.

      Canadian guidelines for 7- to 9-year-old and 10- to 12-year-old children are higher, with upper limits of 62 mg/d and 85 mg/d, respectively.

      Health Canada. Caffeine and your health. http://www.hc-sc.gc.ca/fn-an/securit/facts-faits/caffeine-eng.php Updated Mar 03, 2003. Accessed December 9, 2009.

      The most recent caffeine consumption data for children living in the United States is almost a decade old,
      • Knight C.A.
      • Knight I.
      • Mitchell D.C.
      • Zepp J.E.
      Beverage caffeine intake in US consumers and subpopulations of interest: estimates from the Share of Intake Panel survey.
      and most of this research has been conducted with older children, adolescents, and adults.
      • Temple J.L.
      Caffeine use in children: what we know, what we have left to learn, and why we should worry.
      To obtain current caffeine consumption data for children and examine the relationships between caffeine, enuresis, and sleep, we surveyed parents of young children. Our sample also permitted a preliminary examination of cross-cultural differences in caffeine consumption by Spanish- and English-speaking children.

      Method

      A convenience sample of 228 English-speaking and Spanish-speaking families was recruited from an urban outpatient pediatric clinic. Parents of 5- to 12-year-old children were surveyed regarding their child’s caffeine consumption during routine clinic visits. Respondents reported their child’s average daily consumption of various beverages and snacks, emphasizing those that contained caffeine. Parents indicated whether a child consumed an item and reported how many servings, and of what size, were consumed per day. Illustrated depictions of serving sizes were provided to help parents report accurate data. The survey also included items that explored enuresis and sleep history. Exclusionary criteria included children with a known sleep disorder or a medical diagnosis that might account for bedwetting; however, no surveys were discarded because of these criteria. Twenty-seven surveys were discarded as incomplete, resulting in 201 surveys for analysis.

       Data Analysis

      Data were evaluated with SPSS (SPSS, Inc, Chicago, Illinois).

      SPSS Inc. PAWS Statistics Base Version 18. Chicago, IL: 2009.

      Pearson correlations were calculated to ascertain the relationship between variables of interest and an independent samples t test was used to evaluate differences between English- and Spanish-speaking children. Finally, a χ2 analysis was conducted to determine whether membership in one group (wets the bed or not) could be predicted when membership in a second group (caffeine consumer or not) was known. Because very few children consumed a meaningful amount of caffeine through food items, only caffeine consumed through beverages is reported.

      Results

      Children who consumed caffeine comprised approximately 75% of this sample. Children aged 5 to 7 years old consumed approximately 52 mg of caffeine per day, and children aged 8 to 12 years old consumed approximately 109 mg, on the basis of parental report (Table I). Being male was positively correlated with enuresis at least one night per week (r = 0.23, P = .001), as was a family history of enuresis (r = 0.16, P = .02). Age was negatively correlated with enuresis (r = −0.23, P = .001). The amount of caffeine the child consumed was negatively correlated with the average number of hours the child slept (r = −0.18, P = .02). Caffeine consumption was not significantly correlated with number of nights the child wet the bed (r = 0.05; P = .49) (Table II).
      Table IDemographic information
      Ages 5-7 years old

      (n = 104)
      Ages 8-12 years old

      (n = 97)
      Males5850
      Females4647
      English-speaking8380
      Spanish-speaking2118
      Consumed caffeine7678
      Wet the bed2714
      Mean mg of caffeine consumed52109
      Mean hours slept per night9.468.70
      Table IIIntercorrelations matrix
      AgeSexLanguageHours sleptHeavy sleeperWets bedFamily historyCaffeinated drinks
      Age-0.070.040.130.110.23
      Significant at P ≤ .05.
      0.070.18
      Significant at P ≤ .05.
      Sex-0.020.040.090.23
      Significant at P ≤ .05.
      0.040.13
      Language-0.020.010.15
      Significant at P ≤ .05.
      0.110.11
      Hours slept-0.49
      Significant at P ≤ .05.
      0.21
      Significant at P ≤ .05.
      0.48
      Significant at P ≤ .05.
      0.18
      Significant at P ≤ .05.
      Heavy

      sleeper
      -0.110.53
      Significant at P ≤ .05.
      0.12
      Wets bed-0.160.05
      Family history-0.10
      Caffeinated drinks-
      Significant at P ≤ .05.
      The χ2 analysis of 2 × 2 group memberships (enuresis and caffeine consumption) was not significant (χ2 [3, 197] = 0.66, P = .41). Consuming caffeine did not predict group membership for enuresis. Children from Spanish-speaking families reportedly wet the bed less frequently (t[198] = 2.07, P = .04) and drank less caffeine than their English-speaking peers (t[199] = 1.50 P = .14), although this latter finding was not significant.

      Discussion

      Consistent with previous research, older children consumed more caffeine than younger children; however, the amount of caffeine consumed was greater than the 22 to 23 mg/d previously reported.
      • Temple J.L.
      Caffeine use in children: what we know, what we have left to learn, and why we should worry.
      Children in this study consumed two to three times that amount, with older children drinking the equivalent of almost three 12-ounce cans of soda per day. This is almost twice the amount recommended by Canadian guidelines

      Health Canada. Caffeine and your health. http://www.hc-sc.gc.ca/fn-an/securit/facts-faits/caffeine-eng.php Updated Mar 03, 2003. Accessed December 9, 2009.

      and well above the amount that can create physiological effects in adults.
      • Bolton S.
      • Null G.
      Caffeine: psychological effects, use and abuse.
      Similar to previous findings, children with enuresis were more likely to be younger, male, and have a family history of enuresis.
      • Jalkut M.W.
      • Lerman S.E.
      • Churchill B.M.
      Enuresis.
      • Fritz G.
      • Rockney R.
      • Bernet W.
      • Arnold V.
      • Beitchman J.
      • Benson S.
      • et al.
      Practice parameter for the assessment and treatment of children and adolescents with enuresis.
      Surprisingly, caffeine consumption was not significantly associated with enuresis. Children who consumed caffeine were less likely to wet the bed than children who did not drink caffeinated beverages. Therefore removing caffeine from children’s diets, although a logical treatment recommendation for enuresis, was not supported by the data.
      Regarding the effect of caffeine on sleep, children aged 5 to 7 years old slept an average of 9.46 hours per night. This is above the minimum 9 hours recommended by the Centers for Disease Control and Prevention.

      Center for Disease Control and Prevention. Sleep and sleep disorders: How much sleep do I need? http://www.cdc.gov/sleep/how_much_sleep.htm. Updated June 8, 2010. Accessed June 15, 2010.

      However, approximately one in four of these children slept less than 9 hours per night. Older children, aged 8 to 12 years old, slept an average of 8.47 hours per night, which is below the minimum proposed by the Centers for Disease Control and Prevention for this age group.

      Center for Disease Control and Prevention. Sleep and sleep disorders: How much sleep do I need? http://www.cdc.gov/sleep/how_much_sleep.htm. Updated June 8, 2010. Accessed June 15, 2010.

      Children from Spanish-speaking families were reported to wet the bed significantly fewer nights per week relative to their English-speaking peers, although they did not consume significantly less caffeine.
      Our survey permitted an evaluation of the relationship between caffeine consumption and enuresis as well as provided estimates of caffeine consumption in English and Spanish speaking children. This study did not evaluate causal relationships among these variables. Moreover, there are multiple mechanisms contributory to enuresis, and increased diuresis alone, as a function of caffeine, may not result in enuresis. Furthermore, data were collected in survey form and thus subject to recall and parental bias. In addition, the sample of Spanish-speaking children was of modest size, and cross-cultural comparisons need to be interpreted with care, noting that parental disclosure regarding childhood behavioral health concerns has been reported to differ across cultures.
      • Horenstein V.
      • Downey J.
      A cross-cultural investigation of self-disclosure.
      Finally, we have not investigated the specific physiological and psychological effects of caffeine consumption on young children, but, given the potential effects of caffeine on childhood behavior, a screen of caffeine consumption might be beneficial when evaluating childhood behavioral health concerns.
      The assistance of John Walburn, MD, and Rebecca Dogan, University of Nebraska Medical Center, and Lindy Loneman, University of Nebraska, Lincoln, is gratefully acknowledged.

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        • Jalkut M.W.
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        Enuresis.
        Pediatr Clin North Am. 2001; 48: 1461-1488
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      2. Health Canada. Caffeine and your health. http://www.hc-sc.gc.ca/fn-an/securit/facts-faits/caffeine-eng.php Updated Mar 03, 2003. Accessed December 9, 2009.

        • Knight C.A.
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        • Zepp J.E.
        Beverage caffeine intake in US consumers and subpopulations of interest: estimates from the Share of Intake Panel survey.
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        • Temple J.L.
        Caffeine use in children: what we know, what we have left to learn, and why we should worry.
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        • Null G.
        Caffeine: psychological effects, use and abuse.
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        • Fritz G.
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      4. Center for Disease Control and Prevention. Sleep and sleep disorders: How much sleep do I need? http://www.cdc.gov/sleep/how_much_sleep.htm. Updated June 8, 2010. Accessed June 15, 2010.

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