Poison centers see call increase for child and adolescent exposures to caffeine energy products, according to study

A new study examining calls to United States poison centers for exposures to caffeine energy products in people younger than 20 years, conducted by researchers at the Center for Injury Research and Policy of the Abigail Wexner Research Institute at Nationwide Children’s Hospital and the Central Ohio Poison Center, shows a significant rise in exposure rates from 2011 through 2023, with variations by product formulation.

The study, published in Journal of Medical Toxicology, found 32,482 caffeine energy product exposures reported to U.S. poison centers from 2011 through 2023. While the overall exposure rate increased modestly at 17% during the study period, exposure rates varied by product formulation, increasing by 35% for liquids, decreasing by 52% for solids, and—most alarmingly—increasing by 633% for powders/granules. This study did not include coffee, tea, or caffeinated soft drinks in its data.

“The increase in the powder/granules category includes products such as pre-workout powders and powdered caffeine that consumers can add to drinks. Because of unclear dosing instructions or preparation errors, overdose can occur,” said Hannah Hays, MD, co-author of the study and medical director of the Central Ohio Poison Center.

“Concentrated powder or granules may also be mistaken by a young child as a food item. Our study noted most exposures in children younger than 6 years (98%) and 6–12 years (56%) were unintentional across all caffeine categories, which is consistent with the natural curiosity and exploratory nature of these age groups.”

Across all caffeine formulations in the study, most exposures were among children younger than 6 years (70%), males (57%), or involved liquid formulations (58%). Most (81%) exposures were not treated in a health care facility; however, 1.6% were medically admitted. Teenagers (13–19 years old) were more likely to be medically admitted or have a serious medical outcome than children younger than 13 years old.

Solid energy product formulations (e.g., tablets, crystals, capsules) were more likely to be associated with a serious medical outcome or medical admission than other types of formulations. Among liquid formulation subcategories, the exposure rate for beverages increased (47%) and that for shots decreased (-86%).

“The difference in the adolescent age group was that most exposures were intentional (61%),” said Dr. Hays, also faculty in the Center for Injury Research and Policy at Nationwide Children’s. “Unfortunately, some of these exposures were self-harm attempts, and nearly all (94%) of reported self-harm attempts in this study were in the teen age group.”

Almost two-thirds (64%) of the 959 self-harm attempts were among females and 86% involved solid product formulations. These cases were more likely to be associated with a serious medical outcome or medical admission than other reasons for exposure combined.

More than two-thirds of exposures to caffeine energy products in this study were among children younger than 6 years old, and the rate of exposure in this age group increased by 20% during the 13-year period, emphasizing the need for safe storage of these products.

“The high and increasing rate of exposure in this vulnerable age group indicates that caffeine energy products are accessible and attractive to young children,” said Dr. Hays. “Caffeine energy products should not have packaging that is appealing to young children and should be kept out of the sight and reach of young children.”

Other recommendations for parents/guardians and caregivers:

• Talk to children and teens about caffeine energy products. Have age-appropriate conversations with children about caffeine energy products, explaining what these products are and why they can be dangerous. Review labels together so everyone understands what’s in the products. The American Academy of Pediatrics recommends that children and teens should not consume energy drinks.
• Store caffeine energy products safely. The best way to keep children safe from caffeine energy products is to keep them out of the home. If these products are kept in the home, store them in a safe place away from your children—stored up and out of sight, away from food, and locked if possible. Ask that caregivers around your child do the same in their homes.
• Don’t use these products in front of children. It is helpful to never use these products in front of your children, especially if packaged to look like treats.
• Save the national Poison Help Line number (1-800-222-1222) in your phone and post it in a visible place in your home. The Poison Help Line provides free, confidential advice from experts, 24 hours per day, seven days per week.

Data for this study were obtained from the National Poison Data System (NPDS), which is maintained by America’s Poison Centers, formerly the American Association of Poison Control Centers (AAPCC). Poison centers receive phone calls through the national Poison Help Line (1-800-222-1222) and document information about the product, route of exposure, individual exposed, exposure scenario, and other data, which are reported to the NPDS.