Energy drinks have become a staple of supermarket shelves in recent years, differentiating themselves from sports drinks by adding caffeine, vitamins and supplements. But a new review in one of the nation's leading pediatric medical journals highlights concerns researchers say parents and doctors should have over the beverages.

Researchers from the University of Miami's Miller School of Medicine reviewed studies from the United States and abroad, highlighting what they say are the negative consequences of energy drink consumption, ranging from poor sleep to death for those with certain conditions. Between a third and a half of children drink energy drinks, the researchers said, and some will be hospitalized as a result. Children with attention difficulties, heart conditions or diabetes might have more severe problems.

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"There really is a need to have pediatricians, children's health providers, schoolteachers, coaches, parents understand what we currently know and don't know about energy drinks in children, teenagers and young adults," said study researcher Dr. Steven Lipshultz, chairman of pediatrics at Miami. "Basically, what we have here is our best attempt to take that information and put it together."

Lipshultz said the review was undertaken after several children ended up in the emergency room in South Florida for heart problems believed to be related to energy drinks. That led the researchers to scrutinize of the drinks' contents.

"We couldn't even ascertain what the ingredients were that were in them originally," Lipshultz said.

He added that while energy drinks may be promoted for boosting athletic performance and energy, "we couldn't find, in the medical literature, any evidence to support that."

Lipshultz said that energy drinks do not enhance athletic performance, and excessive energy drink consumption could actually lead to dehydration. Similarly, he said, children who take the drink to focus, particularly those with ADHD, are likely to end up with the opposite effect from the amount of sugar and caffeine.

And Lipshultz noted that the many supplements included in the drinks may add more caffeine than expected and that many of the supplements' other effects are unknown. The supplements can include yohimbine, also sold as an aphrodisiac, which can cause heart problems and was identified by Consumers Reports last year as one of 12 supplements to be avoided.

Other experts supported the research.

"Their findings are really targeted toward what can pediatricians and their parents do," said Dr. Jonathan Plechter, an adolescent medicine specialist at Children's Hospital of Pittsburgh, who was not involved with the study.

Plechter was especially critical of potential benefits from energy drinks. "The risks far outweigh the benefits of using energy drinks when you're a teenager. There really is no benefit other than the psychological benefit the teen may feel."

Asked what teenagers looking for an energy boost might drink instead, he replied, "Is kind of like asking what should they be smoking in place of cigarettes?"

In the end, he said, the solution was sleep, a regular daily schedule and exercise.

Dr. Maureen Storey, senior vice president of scientific policy for the American Beverage Association, expressed several criticisms of the review in a statement.

"This literature review does nothing more than perpetuate misinformation about energy
drinks, their ingredients and the regulatory process," Storey said, referring to a statement in the study that the drinks have escaped certain regulations because they are classified as beverages rather than dietary supplements, which requires a more thorough listing of ingredients.

FDA spokesman Douglas Karas told MyHealthNewsDaily that, in fact, all energy drinks have been classified as beverages since December 2009.

Storey also criticized the review for overstating emergency room visits for caffeine consumption in energy drinks. Researchers said that 5,448 emergency visits for caffeine overconsumption were reported in 2007.

While Storey said those visits were from pharmaceuticals only, Jessica Wehrman, spokeswoman for the American Association of Poison Control Centers, said the figure "includes approximately 300 products, including caffeine pills, coffee, diet aids and energy drinks."

Storey said energy drinks should not be singled out because, among other reasons, "caffeine consumption from energy drinks for children and teens, on average, is far less than even one can of an energy drink per day.

But while energy drinks are not the only caffeine source for young adults, some say they deserve singling out.

"In my view, it is the caffeine content, marketing and palatability that separates energy drinks from other caffeine containing beverages," said Daniel Evatt, a research fellow in psychiatry at the Johns Hopkins University School of Medicine, who investigates the effects of caffeine on adolescents. "Energy drinks contain a wide range of caffeine contents, they are marketed heavily to adolescents and young adults, and they include a large amount of sweetener, which serves to mask the naturally bitter taste of caffeine. In other words, you have a beverage that contains a psychoactive mood-altering drug, tastes good to children and adolescents, and is marketed heavily to children and adolescents."

Evatt said that the review, while otherwise well done, should have done more to highlight the more common side effects of caffeine use.

"Although people may experience severe responses to caffeine including hallucinations, stroke, and death these kinds of outcomes generally only occur at extremely high levels of caffeine, and are extremely rare," he said. "Caffeine is the most widely used drug in the world, and these kinds of severe adverse effects do not occur frequently."

But Evatt added that parents should be concerned about the more common side effects of caffeine use. "It is very common for caffeine use, especially after midday, to result in sleep problems. Sleep problems can exacerbate other emotional and cognitive difficulties, and can cause significant difficulties in functioning in children and adolescents."

"Withdrawal symptoms, such as headaches and difficulty concentrating, can also interfere with everyday functioning. I would also point out that some adults and children can become dependent, or addicted, to caffeine. These individuals can develop problematic patterns of use and be unable to quit even if they want to."