Energy Drinks are Dangerous for Minors and Sports Drinks are Mostly Unnecessary - New Statement from the American Academy of Pediatrics

In a formal policy statement issued Monday, the American Academy of Pediatrics made it very clear that energy drinks are unsafe and should be avoided entirely by minors and that sports drinks have limited potential use and should be used only in specific circumstances or not at all.

We've all seen them on the shelves - Monster, Red Bull, Amp, Rockstar and a host of other copycats. They are everywhere in Chico it seems, especially in gas stations and convenience stores. These "energy" drinks contain a lot of caffeine. Some have as much as 500mg caffeine which is the equivalent caffeine of 14 caffeinated sodas or several cups of coffee. In addition, many add other stimulants such as guarana or taurine to the drinks.

These drinks are branded in such a way as to make them appealing to children and teenagers. The problem is, they can lead to high blood pressure, high heart rate or insomnia. The non-caffeine additives can make the effects of caffeine even stronger. These drugs will have an even greater effect on children since they are smaller then adults.
A study that came out last February in the journal Pediatrics indicated that one half of the greater than 5000 caffeine overdoses in 2007 were in people under the age of 19 although it doesn't specify how many were from energy drinks.

This simply isn't something that children and teens should be putting in their body! If they are tired, they need more rest, not a stimulant to artificially wake them up. To do that is treating the symptom not the cause of the problem.

Likewise, sports drinks such as gatorade have been around for decades. Certainly for youths doing vigorous sports, they help replenish the salts lost through sweat and give a boost of sugar. the problem is, they are often being drank by children who are sedentary or dong only light exercise. Because they are chock full of glucose - an easily absorbed sugar, they give a big sugar boost to the body. That may increase the risk of obesity or even increase the risk of developing type II diabetes in the obese child. Most children are best off drinking good old water.

Many sports drinks have quite a bit more sugar than a fruit juice. Current guidelines are no more than 4-5 ounces of juice per day in a young child, no more than 6-8 ounces in an older child or teen. You do not need fruit juice in your diet at all. It is much healthier to eat actual fruits as part of a meal. If you do give juice, 100% fruit juice is the way to go.

Likewise milk is way overused in children as well. You do not need milk in your diet at all. It is a reasonable source of calcium, but is also high in sugars. 6-8 ounces a day is plenty for a younger child and 8-12 ounces per day in an older child or teen. I have toddlers as patients who are being given 40 oz a day of milk, this can lead to obesity, iron deficiency and other health problems. I have teenage patients who drink a half gallon jug a day. There is no reason for this, especially as expensive as milk has been lately.

In any case for toddlers, children and teenagers up to age 18, the best thing is absolutely no energy drinks, sports drinks limited to periods of heavy exercise, little or no juice and limited amounts of milk if any. There is also no need for other sources of empty calories such as sodas, Hi-C or other sugary drinks. Water, water, water  - it is the healthiest for you.


IMPORTANT: Worldwide Measles Outbreak is Happening Now!

In the first 19 weeks of this year, there have been 118 cases of measles in 23 states, 40% of whom have required hospitalization. In Europe 33 countries are battling measles. France has had over 10,000 cases in the first four months of this year (source).

The past few years, the US has averaged around 56 cases per year, which means that we have already had more than twice the number of cases seen in an entire year, and it’s not even June yet.

I often remind my patients that an “uncommon” disease in the US is only a plane ride away. This current outbreak is a great example of that. Ninety percent of the cases were caused by visitors to the US who had come from places where there was an epidemic.

Please vaccinate your children against this serious disease. The whole thing about an association between the MMR vaccine and autism has been examined in numerous studios all over the world in the past decade or so, and it is NOT a cause of autism. In fact, the initial report in the Lancet in Britain which started the whole uproar was completely based on fabricated data and the author of the article has been banned from practicing medicine in Britain as a result.

If you don’t vaccinate your child, not only are you putting them at risk, but all other unimmunized or under immunized children in the community as well. The unimmunnized children are often the ones who start the outbreaks. This can be a life threatening or even fatal illness. If your child, or the child of someone else in our community were to die because your child is unimmunized, how would you feel?


What's Going Around 5/24/11

I haven’t written “What’s Going Around” in a while. Now that it is summer somewhat different things are going around Chico than earlier in the year.

There is still quite a bit of Strep. throat around as well as a non-Strep viral sore throat.

I have seen a number of children with vomiting and diarrhea of the 24 hours vomiting / 2-3 days of diarrhea variety.

I have seen a few cases of roseola as well.

Please take a look at the recent post on sun safety as you and your children have some fun in the sun!

Internet Addiction Now Affects One in Twenty-Five Teens

A recent study done at Yale University administered questionnaires to students in 10 Connecticut High Schools which asked over 150 questions about health, risky behavior and impulsiveness including several about internet use.

Some interesting statistics came out of this study. Seventeen percent of boys and 13 percent of girls admitted to spending more than 20 hours per week online.

Three questions were asked to determine “problem Internet use”. Students were asked if they ever had an “irresistible urge” to be online, if they had experienced a “growing tension or anxiety that can be relieved only by using the Internet” or if they had tried to cut down or stop using the Internet. These are symptoms common to any addiction. Four percent of the respondents met the criteria for problem Internet use.

One concerning finding was that those teens who met the criteria for problem use were more likely to be depressed ad would get into serious fights more often. Boys who met the criteria were more likely to drink or use drugs.

This does not, by any means, prove that Internet use is the cause of these problems. It may be as likely that depressed or substance abusing teens are just more likely to use the Internet.

From personal experience, I can confirm that I’ve seen several teens the past few years who wound up really withdrawn and depressed who were spending many hours a day on the Internet. Late nights and lack of sleep can certainly worsen depression and make one more irritable. Teens who use drugs can become depressed, teens who are depressed may use drugs to try and treat themselves.

No matter which came first, excessive Internet use is definitely not a good thing. There are also the very real issues of cyber-bullying, drug dealing, access to pornography and Internet gambling as well.

As a parent, it is your right to limit your teen’s use of the Internet. It is your duty to teach them basic Internet safety and to make sure they know they can talk to you about anything that crops up online. I recommend no Facebook or MySpace pages. If your teen is given the privilege of having one, it needs to be on the stipulation that you need to be a “friend” and check their page regularly. Not only is that a good way to help them be safe, but also a way to be a bigger part in their lives.

Time for Fun (and Safety) in the Sun!

We have been blessed with some truly beautiful days here of late here in the North State. Definitely time to get out and enjoy all of the wonderful activities that our area has to offer.

A little sun is a great thing. It warms us, helps our skin manufacture vitamin D and gives us fun in the park in the garden or on the lake. However, too much sun can be harmful, both in the short and long terms. If you’ve ever had a sunburn, you now it is no fun. If you’ve ever accidentally let a baby or toddler get sunburned, you are aware of the couple of sleepless nights that followed. Most people are aware that too much sun can increase your risk for developing skin cancer.

So safe sun exposure is important for everyone, but particularly for our children. Young children can burn more readily than older ones. Even more importantly, there is a direct correlation between the amount of sun exposure and sunburns one has, by age, to the risk of skin cancer. That is, the younger you are when you get excessive sun exposure or sunburns, the more it increases your skin cancer risk as you age.

According to the American Academy of Pediatrics (AAP), the rate of skin cancer, including malignant melanoma (the most serious kind) is rising, even in young people. There is evidence that as few as six severe sunburns in a lifetime can increase the risk of skin cancer 50%. In fact, that the current thinking is that there is no such thing as a healthy tan. A tan is actually the skin’s reaction to sun induced radiation damage. Tanning over time can lead to wrinkles, freckles, skin texture changes or worst of all skin cancer.

In general, people get about 80% of their sun exposure in the first 18 years of life. A dermatology survey in 2003 of 10,000 american kids age 12 to 18 showed that less than 35% regularly used sunscreen on sunny days and 83% had had at least one sunburn within the year. This is, of course, a real set up for skin problems as these children age.

New AAP guidelines were published in March of this year in the journal Pediatrics. These guidelines gave a call for parents and caregivers step up skin cancer prevention in our nations children. Specific recommendations include:

Have children wear proper clothing and hats when outdoors.
Time outdoor activities to minimize peak midday sun between 10AM and 4PM.
Apply at least SPF 30 sunscreen regularly and reapply every 2-3 of hours while outside.
Have children wear appropriate sunglasses.
Children under 6 months of age should always be kept out of direct sunlight and be protected from the sun with clothing and hats.

One recent national survey showed that 24% of caucasian teenagers between age 13 and 19 had used a tanning bed at least once. Tanning beds are just as dangerous to the skin as the sun itself. The AAP has actually proposed legislation that would prohibit access to tanning salons or artificial tanning devices under age 18.

It is a good idea for parents to take a look at their children’s moles or freckles every couple of months.If you notice any of the “ABCDE’s” - asymmetry, border irregularity, color variation, increasing diameter or evolving (change in) a mole or freckle, have your pediatrician or a dermatologist take a look!

So, Why Can't I Find Something For My Child's Pain and Fever on the Shelves Anymore?

I am still hearing parents’ frustration when it comes to finding pain and fever relievers on the shelves for their child. Parent’s simply cannot find what they are looking for on the shelves. Unfortunately, it may get even more confusing to parents in the near future because US companies will cease making infant drop forms of these medications this year.

The problems all started in May, 2010. McNeil Consumer Healthcare, makers of Tylenol brand acetaminophen, did a massive recall of over 40 pain, fever and allergy medicines for children, including certain forms of:

• Tylenol Infants' Drops
• Children's Tylenol Suspension
• Children's Tylenol Plus Suspension
• Motrin Infants' Drops
• Children's Motrin Suspension
• Children's Motrin Cold Suspension
• Children's Zyrtec
• Children's Benadryl Allergy liquids in bottles.

The concerns that led to the recall were several including possibly higher than intended concentrations of active ingredients. McNeil also stated that some of the medications 'may contain inactive ingredients that may not meet internal testing requirements' or 'may contain tiny particles' and that some of the raw materials used to make the products were contaminated with bacteria. No bacteria were found in the finished products though. There was only one manufacturing plant involved, but all lots were recalled.

Many of McNeil’s products are still unavailable. You can get Children's Tylenol Grape Oral Suspension and Children's and Junior Strength Tylenol Meltaways, but other forms of liquid and chewable Tylenol and Motrin still aren't available. Children's Zyrtec syrup and Children's Benadryl Allergy Bubblegum Flavored Liquid Dye Free are also still unavailable.

Generic versions of acetaminophen (Tylenol), ibuprofen (Motrin), diphenhydramine (Benadryl), and cetirizine (Zytrec) are available from other companies to help treat kids with pain, fever, or allergies. There are also other flavors of Children's Benadryl Allergy liquid and Advil (another brand name ibuprofen product) available if you need them.
This brings us to the recent issue. In response to an expected FDA review later this month, several of the largest manufacturers have stated that they will cease to make infant drop versions of acetaminophen (Tylenol) containing pain and fever reducers and acetaminophen containing cold medicine drops as well.
The reason for this is that there have been reported cases of parents with children of varying ages accidentally dosing the concentrated infant drops as though they were the children’s liquid. The concentrations are quite different. The concentrated drops have been at a concentration of 80 mg per 0.8 ml’s (100 mg/ml). The children’s liquid has been at 160mg/tsp(5ml), which works out to be only 32 mg/ml. So, a parent could easily give 3 or 4 times the intended dose if they mixed up the two.
So, in the near future, a small baby who would have received 0.4 ml. of the infant drops will instead be given 1.25 ml (1/4 tsp) of the children’s formulation. A larger baby who would have received 0.8 ml. will get 2.5 ml.
Note that it is very important to dose these medications carefully. All of them will be packaged with a measuring device - dropper, syringe or spoon to make sure the correct dosage is given. Do not estimate doses with a household spoon as the amount can vary tremendously. One study showed that standard household eating utensil teaspoons can vary from 3 to over 7 ml.
In large doses, acetaminophen can be toxic to the liver. In big overdoses it can lead to liver failure and even death. Rest assured that if dosed appropriately, it is quite safe, even for use over several days - but getting the dose right is the key factor to its safety.