Energy on the Rise – Caffeine Intake in Children and Adolescents

By Jessica Lieb, RD, LDN, Children’s Hospital of Pittsburgh of UPMC

Jessica_Lieb_0200Sleek colorful cans. Celebrity endorsements. And promises to “Give you Wiiings,” “Party like a Rockstar,” “Unleash the Beast,” “Elevate your Performance,” and “Go Fast.” Or how about a nice warm espresso macchiato while studying for finals or an iced caffé mocha on a hot day while socializing with friends at the nearest Starbucks or Crazy Mocha?

It’s no wonder caffeine, one of the most popular drugs in our country, has become so enticing for kids.

A study released earlier this year by the American Academy of Pediatrics (AAP) looked at trends in caffeine intake among children and adolescents in the Unites States, finding that 73 percent of children consume caffeine on a given day. That equals three out of every four children. Soda still makes up the majority of this intake, but coffee and energy drinks are quickly on the rise.

Caffeine is a central nervous system and heart muscle stimulant. Excess consumption of caffeine has been found to result in increased blood pressure, decreased heart rate, insomnia, hyperactivity, inability to focus, anxiety and decreased appetite. Although considered a safe substance by the FDA, adverse side effects and dosage limits remain unknown, especially for the pediatric population.

Another recent study published by the AAP, and now being talked about in the news, found gender differences in cardiovascular response to caffeine, even with moderate doses, in post-pubertal boys and girls, showing boys having a greater response than girls. It also revealed differences in cardiovascular response to caffeine across the menstrual cycles of post-pubertal girls. This study affirms the already known response caffeine has on children in general (increasing blood pressure and decreasing heart rate) even with doses equivalent to just one 12 ounce can of soda or two cups of regular coffee. It also sheds light on new findings that hormonal changes of puberty and sexual maturity may affect the way boys and girls metabolize caffeine. Further research is needed to determine why these differences occur; but how will these results affect recommendations of pediatric health care professionals? Should they at all?

There are currently no guidelines from the Dietary Guidelines for Americansor the Institute of Medicine for caffeine intake as a nutrient. This could be because there is no nutritional need for caffeine with regards to healthy growth and development of a child. For the pediatric population, the risks far outweigh the presumed benefits.

From a medical standpoint, the risks of heart muscle stimulation are apparent. But from a nutritional standpoint, caffeine-containing beverages pose hidden risks that parents and even healthcare professionals may not be aware of.

Caffeine-containing beverages like soda, coffee and energy drinks are loaded with added7816398_web sugar, offering kids empty calories. They are void of essential nutrients like protein, calcium, vitamins D, A and B12, zinc and riboflavin. When caffeinated beverages make their way into a child or adolescent’s diet, intake of beneficial fluids like water, milk and a limited amount of 100 percent juice declines. This increases the risk of both obesity and overall malnutrition. Caffeine also suppresses the appetite, placing children at risk for skipping meals and suboptimal intake of nutrient rich foods.

Children and adolescents with cardiovascular issues like hypertension or those with sleep problems should abstain from all forms of caffeine intake. Further, it is my professional recommendation that all children and adolescents abstain from caffeine-containing beverages like soda, coffee and energy drinks until they are well beyond puberty. For adults, as with all things, caffeine should be consumed in moderation.

Although it may be a challenge, it is certainly never too late to change the diet of a growing and developing child. Caffeine intake should be weaned gradually over a period of a few weeks to prevent unpleasant side effects of withdrawal that can include headache, irritability, lethargy, constipation and depression.

Decrease your child or patient’s intake of caffeinated beverages by one beverage per week, replacing fluid intake with water, milk and a limited amount of 100 percent juice. It is also important to encourage a consistent sleep schedule to allow for optimal rest and energy replenishment.

For more information or to make an outpatient appointment for nutrition counseling, please visit:

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Acne: For Some, It May Not Be a Problem That’s “Just Skin Deep”

By Robin P. Gehris, MD, FAAD, FAAP, Chief, Pediatric Dermatologic Surgery, Children’s Hospital of Pittsburgh of UPMC

Dr. GehrisNow that its summer and we’ve peeled off all the layers of winter clothing, many of us are realizing that our skin could look better than it does! We may notice new or changing moles, or even some acne that had gone unnoticed in the colder months. These are both conditions that can be evaluated and treated by your pediatric dermatologist.

Acne especially has become one of the most universal medical problems in school-aged children, teens, and young adults. Despite how prevalent acne may be, many patients still feel hesitant or embarrassed about seeking medical care or discussing their acne with their physician or provider and instead seek to treat it themselves with one of the many products they can buy over-the-counter or online. While this may be a reasonable first approach, some patients unfortunately end up spending hundreds of unnecessary dollars on multi-step skin care regimens that ultimately are ineffective. Others attempt to modify lifestyle factors such as diet, which have not been proven in most large studies to improve acne.

Several recent eye-opening medical studies have shown that children, teens, and young adults with acne perceive themselves (and are often incorrectly perceived by others) to be less clean, less attractive, less successful or even less intelligent. While some parents may regard acne as a “rite of passage,” these studies have made us realize that acne should be taken more seriously. Acne is not always a problem that is “skin deep.” It can have serious social and emotional repercussions that may affect a person’s self-confidence. If left untreated, it can persist into adult years, especially in cases where scarring results. The great news is that there are many medical options that can treat current acne and then continue to prevent future acne outbreaks.

What causes acne?

Acne is caused by the pores, or hair follicle openings, of the skin becoming clogged, at first on a microscopic level and next on a visible level, with natural skin secretions known as sebum. Sebum creates a sticky plug in the previously open pores; sebum naturally increases around the time of puberty, but it can occur in infancy or well into adulthood and cannot be controlled by diet. Washing one or two times per day with a gentle cleanser may help rinse some of these secretions from the skin, but more frequent washing usually does not completely prevent the start or progression of acne.

The ideal time to begin medical treatment for acne is at this stage. Topical medicines that open the clogged pores chemically can be prescribed and typically take four to six weeks to become effective. Once the pore becomes clogged, it can then develop secondary bacterial overgrowth and inflammation, which appears as redness of the bumps or “pus” bumps.  This represents a serious level of acne that requires immediate medical attention so permanent scarring does not result.

Who should I call if someone in my family has acne?

Since each person has a unique skin type, it takes specialized medical training and clinical experience to learn which product combinations are best tolerated and most effective for each individual.  For a child or young adult, the medical professionals most highly trained to diagnose and treat acne arepediatric dermatologists, who have formal training and board certification first in adult dermatology and then specialized fellowship training and board certification in pediatric dermatology. Some pediatric dermatologists even have a background and board certification in general pediatrics so that they can better understand a child’s skin problems in the context of any other medical problems he/she may have.

A pediatric dermatologist should pay specific consideration to your child’s skin type, activities, and schedule as well as the safety of the medications. A good pediatric dermatologist also should provide you with reasonable treatment options that are affordable or will be covered by your child’s insurance so that you don’t spend a fortune treating his/her acne. If you are concerned about your child’s acne and desire treatment, don’t wait to make an appointment. Many treatment options begin working maximally after four to six weeks and then show continued improvement thereafter.  Starting a new treatment program a few days before an important social event like homecoming, the prom, an interview, or the start of a new school year may not allow enough time for that program to be successful. The best results require a minimum of several weeks to become effective and give you and your child the results you envision. Luckily, there are many safe and effective treatment options available to children with acne so that they can present their best self physically and emotionally to the world and develop that strong self-esteem we all desire.

For more information or to schedule an appointment with one of our pediatric dermatologists, please visit



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Sleeping … like a baby

By Sangeeta Chakravorty, MD, FAASM, and Hiren Muzumdar, MD, FAASM, associate professors of Pediatrics, and co-directors of the Pediatric Sleep Evaluation Center, Children’s Hospital of Pittsburgh of UPMC

Chakravorty_Sangeeta_MD_PulmonaIsn’t this the dream of every parent?  When their dearest bundle of joy is welcomed into this world, every parent wants to do their best and is determined to help their child learn how to sleep. While most healthy normal infants sleep well in their first two to three months of life, many distractions including breastfeeding, diaper changes, returning to work, and daily demands of older children can all lead to exhaustion, frustration, and sleepless days and nights for new moms and dads.

Sometimes gastroesophageal reflux, colic, breathing problems, and seizures in the newborn period can disrupt normal sleep/wake rhythms and lead to interrupted sleep for parents and children alike.  Once a disrupted pattern is established, the family can be stressed and anxious.

What can families do? Many consult their primary care doctor or nurse practitioner whoMUZUMDAR_HIREN_MD_PDP_20140205 may give sound advice, trial of medications, and reassurance to the family. But, sometimes this is not enough and the chronic sleeplessness is difficult to overcome.

The Pediatric Sleep Evaluation Center at Children’s Hospital of Pittsburgh of UPMC offers expert guidance to young families in order to educate parents and to help establish healthy sleep patterns in developing infants for a lifetime of good sleep.

Dr. Hiren Muzumdar and Dr. Sangeeta Chakravorty staff the multidisciplinary center and bring their respective pulmonary and neurology expertise to help parents create an individual program to improve their child’s sleep habits. After a comprehensive clinical evaluation, they determine the best approach. It may include a behavioral plan, trial of medication, or an overnight sleep study.

167481491_webDuring an overnight sleep study, a child’s brain waves, eye movements, heart and respiratory rhythms, body movements, and oxygen and carbon dioxide levels are monitored by a skilled technologist. The studies are done at the main hospital campus in Lawrenceville and Children’s North in Wexford, where infants and children can be safely studied. Patients and families have a comfortable, child-friendly, secure, and private environment in the sleep rooms in both locations.

With our experienced staff, the center can help children and families achieve their goal and sleep “like a baby.” After all, when the child sleeps well, the family sleeps well!

For more information on the Pediatric Sleep Evaluation Center, visit

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Adolescent and Young Adult (AYA) Oncology Patients and Doctor Help Give New Movie “The Fault in Our Stars” Authenticity and a Pittsburgh Flavor

By Peter Shaw, MD, Director, Adolescent and Young Adult (AYA) Oncology Program, Division of Pediatric Hematology/Oncology, Children’s Hospital of Pittsburgh of UPMC

shawIn a past blog post, I wrote about how the 70,000 or so 15- to 39-year-olds diagnosed with cancer every year in the United States can fall between the cracks of the current health care system and don’t always have a voice. Our Adolescent and Young Adult (AYA) Oncology Program at Children’s Hospital of Pittsburgh of UPMC has worked hard to level the playing field for this unique population, but now, author John Green in his best-selling young adult novel “The Fault in Our Stars” and its new movie version being released nationwide today has given this population a voice. It is the love story between two young adult cancer patients who meet in a support group. The story has been embraced by all who have read it (including me) as being painfully accurate in the way it portrays teens with cancer and their struggles and triumphs in coping with it and its effects on their loved ones.

The movie itself, even though it takes place mostly in Indianapolis, was filmed mostly in Pittsburgh. Last summer during pre-production, executive producer Isaac Klausner reached out to

Arthur S. Levine, MD, dean of the University of Pittsburgh School of Medicine, to find a physician to consult on the movie. Dr. Levine called Nancy E. Davidson, MD, director of the University of Pittsburgh Cancer Institute, who then introduced Isaac to me. After a few phone conversations, I gave Isaac, director Josh Boone, and several other members of the crew a tour of Children’s Hospital, and they picked my brain on the details of what teen cancer patients go through and what each piece of equipment was for. They also put out a casting call for teen cancer patients to be extras and several of our patients answered the call.

When filming started in the fall around Pittsburgh (the South Hills, Hartwood Acres Park, photoMonroeville, and on sets built at the old Westinghouse complex in Turtle Creek), our teen patients and I had the opportunity to be extras. Star Shailene Woodley even took one of our cancer survivors out to lunch to discuss what it is like to have to walk around hooked up to an oxygen tank all day, as her character Hazel Grace Lancaster does. Actor Sam Trammell (who plays Hazel’s dad) had lunch with one of my patient’s father to ask what it is like to be the father of a teen with cancer. Author John Green was omnipresent on the set and became close with several patients, becoming texting and Instagram buddies with them. I had the pleasure of meeting him during my one day on set in November and chatted with him for about 20 minutes. I was so impressed with his commitment to make sure his book was accurate as well as the film version. I had the opportunity to film a scene playing a doctor (I know, a stretch) with Sam Trammell and Laura Dern (who played Hazel’s mother). It gave me an appreciation of how much time and care goes into each shot. Also, the director, Josh, and the actors could not have been more warm and welcoming to this labcoat-clad interloper on the set.

On May 29, I had the pleasure of attending the Pittsburgh pre-screening at the Waterfront where John Green made an appearance. Most of our patient stars attended and sat in a VIP section. All of the heart and effort that went into making the movie true to the book and therefore true to the young adult cancer world were not in vain. The tearjerker film was beautifully done and well-acted and I loved seeing my patients on the screen (but not as much as they did!). My team didn’t need a movie screen to tell us our AYA patients are stars, but to see their smiles in the theater and hear the applause when they popped up on screen and during the credits was priceless.

My three or so hours of filming translated into about 5–10 seconds of my being on screen, which unfortunately only featured my hand making a short-lived cameo pushing a medication. Needless to say, I will not be giving up my job at Children’s to pursue a career in acting anytime soon. I wouldn’t have it any other way. Taking care of AYA oncology patients is a greater privilege than being in 100 movies.

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Nolan’s Heart of Steel

Nolan FamilyAt one-year-old, Nolan McLaughlin has already been through more than most. Born six weeks early, Nolan was in and out of hospitals as he fought respiratory issues. On Sept. 30, 2013, at just five months old, his condition went from bad to worse. This time Nolan wasn’t responding to the normal treatments. Doctors did a chest x-ray and realized Nolan’s heart was enlarged.

When the McLaughlins arrived at Children’s, they were taken to the Cardiac Intensive Care Unit (CICU). “The staff was very welcoming in what was a really crazy and scary world,” said Corinne, Nolan’s mom. The family then met with the transplant team. The gravity of the situation hit hard.

Nolan was diagnosed with dilated cardiomyopathy. To survive, he needed a Ventricular Assist Device (VAD), which helps the heart function until a donor heart is available. Peter Wearden, MD, surgical director, Pediatric Heart and Lung Transplantation, prepared the family for this procedure. “Dr. Wearden instilled a lot of confidence in us that everything would go well,” said Corinne. “I know that Dr. Wearden is an amazing surgeon so I had full faith that everything would be OK. And it was.” The day after the VAD procedure, Nolan was put on the transplant list.

At 8 a.m. on Jan. 23, 102 days after being placed on the transplant list, the McLaughlins received news — there was a donor heart for Nolan. “I was very relieved and thought, ‘OK, we’re going to make it.’”

Nolan went into surgery at 9 p.m., and the surgery ended around 5 a.m. “It was the longestNolan night of my life,” said Corinne. “It’s a day that you never forget, and it truly is like another birthday for him.”

On March 12, Nolan was released from Children’s and moved into the nearby Ronald McDonald House with his parents, and on March 28, the family headed home. They were a complete family, along with 3-year-old Riley, for the first time in 6 months.

“Overall, this has been a great experience, and we are so glad that we chose Children’s. It’s a shorter trip to go to Philadelphia, but the minute we walked in, I knew we made the right choice.”  The doctors, nurses, therapists, and transplant team exceeded all expectations. “The whole continuum of care, every single aspect of it, was great.”

Nolan Organ DonationThe situation has also made the McLaughlins and their friends think more about organ donation for themselves as well as for their children. Corinne said they hope to meet the donor’s family one day. “I want them to know how courageous they are and how well we will take care of their son/daughter. I want them to know we will do our best to make sure he/she continues to thrive for many years to come. I just want to give them a big hug and let them have their time with Nolan, should they choose. I really want to know that they are OK.”

On April 12, Nolan turned one. The family was ecstatic for this birthday, that just months earlier, they weren’t sure they would get a chance to celebrate.

Check out the video to learn more about Nolan’s story.

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The Child Advocacy Center at Children’s Hospital: Protecting Our Most Vulnerable Children

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By Rachel Berger, MD, MPH, chief, Child Advocacy Center April is National Child Abuse Prevention Month. As a pediatrician who cares for children who have been victims of abuse and neglect, I look forward to April as a time when … Continue reading

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Applying the Science of Nutrition to Family Meals

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By: Ann Condon-Meyers, RD, LDN, Children’s Hospital of Pittsburgh of UPMC March is National Nutrition Month, which is good news for licensed dietitian nutritionists (LDNs) because it gives us a chance to blog about our favorite subject … food! Now, … Continue reading

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