Do You Need to Be Worried Your Kids Are Getting Too Much Caffeine?

Caffeine2-FBIf you’re among the 64 percent of American adults who drinks at least one cup of coffee every morning, you may know exactly how much to drink and what time to stop drinking to avoid any unpleasant caffeine side effects such as jitters and insomnia. What you may not know is that an increasingly wide variety of foods and beverages contain significant amounts of caffeine, making it nearly impossible to accurately gauge yours and your children’s daily intake.

The tragic story of 16-year-old Davis Allen Cripe underscores why counting caffeine milligrams is important. The South Carolina teen, who was found to have no undiagnosed heart condition, died from a rapid, irregular heartbeat called arrhythmia caused by an overdose of caffeine. Cripe’s friends told the coroner that within two hours of his death, he drank a large diet Mountain Dew®, a McDonald’s café latte and an energy drink.

Dale Yoo, MD, a cardiac electrophysiologist at Medical City McKinney, confirmed that caffeinated drinks can absolutely affect your heart rhythm.

“Anything that’s a stimulant or increases the stress on your heart will increase your adrenaline and your heart rate,” Dr. Yoo said. “Things like coffee, tea and herbal supplements will increase your adrenaline and heart rate. Drinks like 5-hour ENERGY®, Red Bull® and Monster Energy® have a lot of taurine and caffeine that can also increase the stimulant effect on your heart and increase the risk of arrhythmia.”

In addition to soft drinks and energy drinks, caffeine is being added to a growing list of products, including marshmallows, oatmeal, jelly beans, waffles, gum, mints, sunflower seeds, syrup and even water. It can be found in chocolate, ice cream (those with chocolate or coffee flavors) weight loss pills and over-the-counter pain relievers  This prompted the FDA last year to announce an investigation into the safety of caffeine in food products, with special attention paid to its effects on children and adolescents.

Because caffeine is not a nutrient, but a naturally occurring chemical found in items such as tea leaves, coffee beans and cacao (used to make chocolate), the FDA does not require the amount in a food or beverage to be listed on nutrition labels unless it is added. Many of these products also contain hidden caffeine or other stimulants. Here’s what to look for:

  • Sugar
  • Guarana
  • Taurine
  • Kola nut
  • Yerba mate
  • Cocoa or cacao

How much caffeine is too much?

According to the FDA, a safe amount of caffeine for healthy adults is up to 400mg a day. That’s anywhere from three to five eight-ounce cups of regular coffee, depending on the bean source and brewing method. For children and adolescents, the American Academy of Pediatrics’ recommendation is to avoid energy drinks entirely — which the CDC says sent 1,499 adolescents to the ER in 2011 — and limit caffeine for ages 12 to 18 to 100mg daily.

We’ll never know for sure exactly how much caffeine Davis Cripe ingested, but we can estimate it thanks to his friends’ report:

Large diet Mountain Dew: “Large” is a relative term, but even if he had a “small large” at 20 ounces, that’s 91mg of caffeine — nearly the AAP-recommended limit of 100mg. A Long John Silver’s large is 40 ounces with a whopping 180mg of caffeine and 7-11 has soda cups much bigger than that.

McDonald’s café latte: These espresso-based drinks come in small, medium and large. Espresso has about 64mg of caffeine per ounce.

Small cafe latte (12 ounces)

Medium café latte (16 ounces)

  • 142mg caffeine, 13g sugar

Large cafe latte (20 ounces)

  • 178mg caffeine, 16g sugar

Red Bull energy drink (12 ounces): The type and size of energy drink Cripe had is unknown, so we’ll use this popular one.

  • 111mg caffeine, 37g sugar

In our example, Cripe would have ingested a minimum of 273mg and a maximum of 468mg of caffeine in a short period. And this may be a very low estimate, as the American Academy of Pediatrics says some energy drinks can contain more than 500mg of caffeine.

Research debunks myth that coffee improves alertness and mood.

We all know the negative effects of caffeine. The FDA says that it can make you:

  • Jittery and shaky
  • Unable to fall asleep, stay asleep or get a good night’s sleep
  • Experience
    • rapid, uneven heart rate (arrhythmia)
    • raised blood pressure
    • headaches, nervousness, anxiety and dizziness
    • dehydration
    • heartburn
    • dependency and the need to drink increasingly more

But other than that, coffee is good for you, right? While coffee in moderation has been shown to reduce the risk of several diseases, including certain cancers and stroke, it’s most likely the health benefits of coffee’s antioxidants that are responsible, not the caffeine. Look for other ways to get antioxidants, including eating lots of healthy fruits and vegetables.

As to coffee’s magical brain-enhancing powers, study results from Johns Hopkins Medical School (featured on show that caffeine-related performance improvement (a boost in mood and alertness) is nonexistent without caffeine withdrawal. In other words, the kick that you get from your morning cup of Joe is really just caffeine taking you back to “normal” for a short time.

If someone in your family is feeling the effects of too much caffeine, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

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Five Opportunities and Insights from “13 Reasons Why”

Sad-Girl-FB“13 Reasons Why” is a Netflix series produced by Selena Gomez, a celebrity artist who has struggled with depression and anxiety for several years. Based on Jay Asher’s 2007 novel “Thirteen Reasons Why,” it tells the story of 17-year-old Hannah, who takes her own life and leaves behind a suicide note in the form of 13 cassette tapes. All 13 episodes became available March 31 and the controversial show is so popular that a second season has already been renewed by Netflix.

The show deals with some heavy topics in addition to suicide, including bullying, rape and other mature subjects. It has prompted schools to send warning letters home to parents with recommendations from the National Association of School Psychologists.

Suicide by the numbers.


  • Is the second leading cause of death for ages 10 to 34
  • Is attempted every day by an average of more than 5,240 children in grades 7 through 12
  • Is the cause of death for more teens and young adults than cancer, heart disease, AIDS, birth defects, stroke, pneumonia, influenza and chronic lung disease, combined
  • Was the reason for an average of 420,000 emergency room visits every year during the 16 years of an NCBI study (1993-2008)
    • ER attempts more than doubled from 244,000 in 1993-1996 to 538,000 in 2005-2008

Studies show that 90 percent of those who died by suicide had an underlying mental illness, so we asked Dr. Elizabeth Ucheoma-Cofield, a psychiatrist and the medical director for the adolescent unit at Medical City Green Oaks Hospital, for her thoughts on the show. As both a parent and an adolescent psychiatrist, she feels there are five pivotal points highlighted by “13 Reasons Why.”

Five opportunities and insights provided by the Netflix show “13 Reasons Why.”

Platform for Discussion: Mental illness is still taboo, especially in children and adolescents. “13 Reasons Why” provides the opportunity for parents, teachers, mental health providers and other adults to begin discussions involving depression, suicide and a variety of other topics that are pertinent to teens, including sexual assault and cyberbullying.

Asking for Help/Paying Attention: “13 Reasons Why” highlights the fact that teens in distress need to reach out for help sooner. There were many people in Hannah’s life who could have been very helpful resources for her in her time of distress, but she didn’t utilize them when needed. Conversely, the show is also a cautionary tale for parents regarding the slippery slope of depression and may serve as a catalyst for parents to start researching and paying attention to the warning signs of depression and suicidal thoughts in their children and providing them with professional help sooner.

Perception of Invincibility: Children and adolescents can be impulsive. Many completed suicide attempts in children and adolescents are actually the result of impulsive behavior. Children and teens sometimes do not have the perspective to be able to realize that present crises are temporary. Sometimes children and teens don’t really digest the fact that suicide is permanent and that they will no longer see their friends and family and will no longer have a future.

The main character in the series, Hannah, makes multiple cameo appearances (usually as flashbacks from one of the other characters who are the subjects of her tapes) almost as if she is not really dead. She also controls the actions of the people that she left behind through instructions that she has left on the tapes. This is a very dangerous representation of suicide that alludes to the fact that people who have completed suicide aren’t really gone but exist in some other form that enables them to interact in some way with the people they left behind. This perception of invincibility and lack of finality is actually a soft suggestion to children that suicide is merely an alternate life path and this is not the case.

Attention Seeking Through Suicide: “13 Reasons Why” highlights the fact that Hannah achieved the attention and validation that she didn’t get in life through her death. Many children and teens with depression already feel isolated and invisible. Arguably, the show could give impressionable kids the idea that suicide might be an option to get the same results that Hannah did.

Need to Process: Although “13 Reasons Why” does have a discussion panel at the end of the series to talk about the heavy subject matter presented, it would be much more beneficial for children and teens to have a panel discussion built in after every episode to process the topics discussed more pointedly and frequently.

Clearly, there are a variety of reasons that “13 Reasons Why” can be both adverse and beneficial. At the end of the day, it does help kids understand how important it is to be kind and respectful to others. It also might help them feel empowered to reach out to educators, counselors and other adults when they think that someone (child or adult) is struggling.

If you’d like to talk to your kids about the subjects highlighted in “13 Reasons Why” but aren’t sure where to begin, here are some resources:

The JED Foundation, a nonprofit that aims to prevent suicide in teens and young adults, has developed a series of talking points for children and adults.

The Society for the Prevention of Teen Suicide offers helpful information on how to know if suicide is a risk for your family.

The National Suicide Prevention Lifeline (800-273-8255) provides free and confidential resources and support for people of all ages in distress or crisis.

For fast, emergency help in a crisis, look to one of our many Medical City ER locations across North Texas. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

About Elizabeth Ucheoma-Cofield, MD dr-ucheoma-cofield-bio

Elizabeth Ucheoma-Cofield, MD (lovingly known as “Liz” by friends and family), is an avid reader and writer who enjoys spending time with her family, catching up on her fair share of reality TV and engaging in clothes and shoe shopping at frequent intervals. She loves to travel and visiting multiple countries on every continent is on her bucket list. Exercise is her passion and she is very much interested in holistic health (mind, body, and soul) for all of her patients. She truly believes that working with children is her calling and life’s work.

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When Insects Sting: How to Avoid Allergic Reactions

Stings-Wasp-FBIf you think Texas has it all, you’re right — including all five insects whose stings are known to cause allergic reactions: fire ants, honeybees, hornets, wasps and yellow jackets. Yay us.

It’s estimated that roughly 2 million Americans are allergic to the venom of stinging insects. According to the American College of Allergy, Asthma and Immunology (ACAAI), it’s not uncommon to have a “normal” reaction the first few times and then experience increasingly severe reactions with each subsequent sting.

Types of reactions that can occur with insect stings:

  • A normal local reaction, which includes pain, swelling and redness at the sting site.
  • A large local reaction, which results in swelling that extends well beyond the sting site — such as a sting on your hand that causes your whole arm to swell. Swelling usually peaks several days after the sting and can last up to a week or more.
  • A systemic allergic reaction is a severe allergic reaction and requires immediate medical attention, such as calling 911 or going to the closest ER. Symptoms can include:
    • Hives
    • Itchy skin
    • Flushing
    • Swelling beyond the sting site
    • Dizziness or a sharp drop in blood pressure
    • Hoarseness, swelling of the tongue or difficulty swallowing
    • Abdominal pain, vomiting, intense nausea or diarrhea
    • Fainting or cardiac arrest
  • Anaphylaxis is a severe allergic reaction that occurs when the body releases an overdose of allergen-fighting chemicals, sending the body into shock. It’s life-threatening and can worsen quickly. Additional symptoms can include:
    • Breathing problems
    • Constricted throat
    • Rapid heart beat
    • Feeling of doom

People who have a known or suspected allergy to insect stings should carry at least one self-injectable epinephrine pen at all times; the ACAAI recommends two for those who have had a possible systemic reaction.

Gan Su, DO, an emergency medicine physician at Medical City Arlington, discusses signs that an allergic reaction should send you to the ER.

When the bee stings.

Texas Parks and Wildlife offers these tips for treating normal (mild) sting reactions:

  • Remove the stinger
  • Wash sting site with soap and water
  • Cover and keep clean
  • Apply cold pack for 15 to 20 minutes to reduce swelling
  • Administer over-the-counter pain relievers and cortisone/anti-itch cream
  • Mild allergic reactions can be treated with antihistamines (Benadryl)

It’s important to act fast if someone who may be allergic has been stung.

“Allergic reactions can come on suddenly and without much warning,” said Scott Corcoran, MD, an emergency medicine physician at Medical City McKinney. “Whether it’s from a bee sting, an ant bite, a peanut or even a strawberry, various things can cause allergic reactions that can be quite serious. Symptoms can include a rash, such as hives, nausea and vomiting, swelling of the eyes, mouth and throat and eventually, the airway closes off. If any of those symptoms are present, patients need to come to the ER right away.”

How to avoid stinging pests and their nests.

Follow the ACAAI’s helpful tips for avoiding insect stings:


  • An open soda can is like bait to a flying stinger — keep sugary drinks covered or better yet, drink water!
  • Same goes for food — keep it covered
  • DO wear
    • Close-toed shoes when walking in grass or brush; this is where stinging insects forage
    • Long pants, long-sleeved shirts, socks and gloves for working outside
  • DO NOT wear
    • Sweet-smelling perfumes, hair products, deodorants, etc.
    • Bright-colored clothing or flowery patterns
  • Be extra cautious near bushes, eaves, trash cans, picnic areas and in attics
  • Call a professional exterminator to inspect for and remove pests and their nests

If someone in your family has an allergic reaction, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

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Bikes, Trikes, Scooters and Skates: How to Stay Out of the ER

Scooters2-FBWheels. No matter how young or old you are, these Bronze Age inventions not only represent freedom; they provide it. From your first tricycle to your first car or truck and everything in between, wheels take you where you want to go faster (and in better style) than you could get there on your own. So it’s not surprising that Americans are crazy for all things wheeled, including skateboards, scooters, roller and inline skates, bicycles, tricycles, three-wheelers and more.

It’s also not surprising that we tend to crash them into things or ride them where bigger wheels can easily crash into us. According to Safe Kids Worldwide, nearly 400,000 children 19 and under were seen in hospital emergency rooms for biking, skateboard and skating injuries in 2014, while the Consumer Products Safety Commission reported that 61,000 children aged 15 and under went to the ER for non-motorized scooter injuries the year before.


To help parents better understand what types of injuries are most commonly sustained from wheeled activities and how to treat and prevent them, we spoke to John Badylak, MD, an orthopedic surgeon at Medical City Alliance.

“I see all types of injuries, including fractures from falls off of wheeled toys, ATVs and exercise equipment,” Dr. Badylak said. “The most common fracture I see in adults and children who have a ground level fall is a distal radius fracture (broken wrist). I also see children with supracondylar humerus fractures, which is a fracture of the humerus bone (broken upper arm bone) just above the elbow.”

Preventing injuries.

In addition to wrist and arm breaks, other common injuries include cuts, bruises, strains and sprains. About half of injuries occur to the arms and wrists, while the other half is split between the head and the legs and feet.

Gan Su, DO, an emergency medicine physician at Medical City Arlington, discusses when to go to the ER with a head injury.

Follow these tips to help prevent injuries:

  • Wear the approved protective gear for your type of activity (helmets, pads, bright clothing, etc.)
  • Wear sturdy, supportive, slip-resistant, close-toed shoes
  • Ride on flat, smooth surfaces away from traffic
  • Don’t ride at night — most motor vehicle accidents involving pedestrians and non-motorized toy/vehicle riders happen between 7 p.m. and 7 a.m.
  • Learn the rules of your chosen activity — take a bike safety class or ask a more experienced child for skateboarding tips
  • Learn how to fall safely by landing on fleshy body parts, tucking arms in and rolling
  • Never text or talk on the phone while driving anything with wheels
  • Always ride in view of caregivers (younger children) or with one or more friends (older kids)

How to tell if a bone is broken.

“Unfortunately, fractures and other injuries happen even with precautions,” said Dr. Badylak. “Every situation and every patient is different. It can be very difficult to know whether an ankle is sprained or broken without an exam by a medical professional and an X-ray. But generally speaking, if an injured individual cannot put weight on a leg to walk or cannot move a joint, he or she should go to the ER to be examined. If a child is not using an arm or leg, then that child should definitely be evaluated by a doctor.”

Michelle Underwood, VP of Emergency Services for Medical City Healthcare, explains when to go the ER with a sprain or fracture.

Treating minor injuries at home.

Dr. Badylak recommends treating minor sprains and bruises with ice, elevation and over the counter anti-inflammatories for swelling and pain. If a minor injury doesn’t get better after a couple of days of rest, seeking medical attention at a doctor’s office or urgent care facility would be wise.

If someone in your family suffers an injury while doing a bit of free-wheeling, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

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Why Kids 12 and under are Drinking Hand Sanitizer Gel

Hand-Sanitizer2-FBIf you’ve sent your kids out the door with those cute little bottles of hand sanitizer in their backpacks, lunchboxes and gym bags, you may want to check the ingredient labels to see if ethanol or isopropyl alcohol is listed. If it is, it’ll top the list as the No. 1 ingredient — as much as 60% to 95% according to the CDC. In its new report, the CDC cited information from the National Poison Data System showing that between 2011 and 2014, more than 70,000 children aged 12 and under ingested hand sanitizer and suffered at least one adverse health effect.

Some of those ingestions, especially in children aged 6 to 12, were intentional. So much so that the CDC is suggesting alcohol-based hand sanitizer “might be a product of intentional abuse among older children.”

Damien Mitchell, MD, a pediatrician at Medical City Dallas Children’s Hospital, was interviewed for the NBC/DFW Channel 5 story about the CDC’s report, below.


Why kids are ingesting toxic levels of hand sanitizer:

  • The alcohol effects (older kids)
  • Some of them smell like baked goods, fruits and other yummy treats (younger kids)

“Hand sanitizer is actually rather potent,” Dr. Mitchell said. “It’s about 60 percent alcohol, or 120 proof, so it packs a punch. Children don’t process alcohol the same way adults do, so it has higher toxic effects for them.”

How kids are taking in toxic levels of hand sanitizer:

  • Drinking it
  • Getting it in their eyes
  • Inhaling it
  • Absorbing too much through their skin

Reported adverse health effects from ingesting toxic levels of alcohol-based hand sanitizer:

  • Acidosis (a reaction to chemical toxins with symptoms including breathing problems, confusion, headache, fatigue and rapid heartbeat)
  • Apnea
  • Coma
  • Drowsiness
  • Eye irritation
  • Nausea and vomiting

Christopher Ramos, MD, a gastroenterologist at Medical City Alliance, urges everyone — including physicians — to keep the number for Poison Control (800.222.1222) handy and make them one of your first calls (along with 911 if necessary) in a suspected substance emergency: Their experts will do a phone consult and let you know what to do.

Alternatives to alcohol-based hand sanitizers.

Consider nonalcoholic hand sanitizer alternatives, but be aware that the majority of ingestions are accidental, so you may want to forego hand sanitizer altogether or purchase hand sanitizer wipes. And there’s always good old-fashioned handwashing.

“It’s important to remember that just good handwashing is more effective than hand sanitizer,” Dr. Mitchell said.

Below, Matt Bush, MD, shows correct handwashing technique and how to make it fun by using the “Happy Birthday” song as a timer.

If your child has an adverse or allergic reaction to anything he or she eats or touches, one of our many Medical City ER locations across North Texas has you covered. With average wait times posted online, if you do have an emergency, you can spend less time waiting and more time on the moments that matter most.

Find a fast Medical City ER near you.

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