Any sexual activity with a child (by an adult or another child) is sexual abuse. It causes physical and emotional pain. It has long-term effects on the child. And it is a crime. Recognizing childhood sexual abuse isn’t easy. Children are often afraid and embarrassed to tell someone. Many times, the abuser is someone the child knows and trusts. This could be a family member or someone living in the child’s home. It also can be a stranger.

Path to improved health

You do not need to be overly suspicious of sexual abuse. The risk of childhood sexual abuse is low. A stable family home lowers a child’s risk of sexual abuse. However, parents should always keep a watchful eye on any form of childhood abuse. These physical and behavioral signs should raise concern:

• Your child tells you they have been touched inappropriately or sexually.
• Your child is behaving sexually inappropriately around others (this includes touching others inappropriately).
• Your child uses sexually inappropriate language.
• Your child’s knowledge of sex seems to be more than it should be at their age.
• Your child seems withdrawn and doesn’t want to be hugged by some or all of their family members, family friends, teacher, or a particular person.
• Your child is suffering from depression or anxiety.
• Your child has harmed themself.
• Your child is making comments about their low self-worth.
• Your (young) child has blood in their underwear.
• Your (young) child is complaining of pain in their genital area.
• Your child has injuries in their genital area, such as bruising, bleeding, or swelling. The injuries might cause your child pain when walking or sitting.
• Your child shows signs of infection in their urinary or genital area. This would include frequent burning, itching, or discharge.
• Your child becomes pregnant.
• Your child has new academic changes (falling grades, missing assignments, repeated absences).
• Your young child is regressing, such as wetting the bed or thumb sucking.
• Your child is acting overly concerned for a sibling.
• Your child has changes in hygiene, such as refusing to take a bath (in younger children). Older children may shower more (to cleanse themselves of what they perceive as shame and embarrassment).
• Your child is suddenly receiving gifts or money from a person in authority (a teacher, coach, etc.).

If you know your child has been sexually abused, report it to the police. Take your child to the doctor for an exam. Ask your child’s doctor for the name of a counselor or psychologist. Talk to your local police about tracking sex offenders in your neighborhood or city.

Things to consider

Certain situations put children at a higher risk of sexual abuse. Your child may also be at higher risk if they:

• Live in a home where the parents are divorced and/or living with stepparents
• Live in a home without either parent (in foster care)
• Live in a rural or low-income area
• Have been a victim of another type of abuse, such as physical or emotional
• Spend long periods of time alone with people in authority (teachers, clergymen, coaches, babysitters, etc.)

Girls and children with intellectual disabilities face a higher risk. Remember, childhood sexual abuse can occur between a male and female, as well as in same-sex situations.

Questions to ask your doctor

• What other things could explain injuries to my child’s genitals?
• How young can a girl become pregnant?
• What are the signs of sexually transmitted diseases or infections in boys and girls?
• What is the treatment for sexually transmitted disease?
• Can my child eventually overcome the emotional pain of childhood sexual abuse?
• What physical or behavioral signs should I look for if I suspect my child is the one sexually abusing a child?
• How do I raise a concern with my child about possible sexual abuse?

Resources

National Institutes of Health, MedlinePlus: Sexual Abuse in Children – What to Know

Rape, Abuse & Incest National Network: Child Sexual Abuse

The U.S. Department of Justice National Sex Offender Public Website: How to Identify

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Underage drinking is a concern for all parents. It can happen in any family, regardless of income, status, or ethnicity. Many parents are surprised to learn that underage drinking can start earlier than the teenage years.

It’s important for parents to understand the reasons their child may experiment with alcohol. You should also know, how it can become an addiction and how to treat that addiction. Even more important is your role in talking with your child about the dangers of underage drinking. Research shows that the earlier a child starts drinking, the greater the likelihood they will abuse alcohol later in life.

Binge drinking also is dangerous. This is when you drink an excessive amount of alcohol at one time. Binge drinking is commonly tied to alcohol poisoning.

The American Academy of Family Physicians (AAFP) recommends that children between 12 and 17 years old avoid alcohol. As a reminder, drinking alcohol while under the age of 21 is not legal and is unsafe.

Path to improved health

It’s important to talk to your child (at every age) about the dangers of alcohol. It’s equally important to understand why they drink. Teens often take their first alcoholic drink because they get pressured by their friends or peers. Peer pressure may take the form of bullying. Peers also will tell your child that alcohol makes them feel good and gives them confidence. They may say that there’s no harm in drinking and that everyone drinks. Tell your child to expect peer pressure and encourage them to talk to you when those times occur.

Another reason your child may drink is because they want to be independent. As your child gains independence, it’s important for you to continue to monitor what’s going on in their lives. Stress (school, social, home) may be another reason your child starts drinking. Teach your child ways to cope with the stress they experience at every stage of their life. Children who have suffered abuse or have behavior or mental health problems are at an increased risk for underage drinking.

Talk to your children

Talking with your child helps reduce underage drinking. Parents can influence their child’s attitudes about alcohol and prepare them for the challenges ahead. Start by being a good role model. Research shows that when parents are actively involved in their child’s life, the child is less likely to drink. Being a poor role model can have negative consequences. Children of a parent who binge drinks, for example, are more likely to binge drink. If you are a parent and you drink, do so in moderation. Don’t drink and drive. Don’t keep an excessive amount of alcohol in your house. Other underage drinking topics you should discuss with your child include:

• The dangers of alcohol. Talk about the dangers of underage drinking and alcohol abuse. These can include blackouts, alcohol poisoning, injuries and accidents, risky behavior, negative effects on the brain, and death.
• Coping with peer pressure. Give your children real-life examples of ways to cope with pressure from friends and classmates. Have them practice their responses with you.
• Managing stress. Tell your child that drinking away their stress is not the answer. Teach them ways to cope, such as physical exercise, listening to music, reading, watching a funny movie, writing about their stress in a diary, volunteering to help people or organizations in need, and talking with you or someone else they trust.
• Legal and academic consequences. Explain the long-term impact of underage drinking and drinking and driving (losing your license, having an arrest record). Underage drinking and drinking and driving can lead to losing a spot on a school team or club. It can also mean losing a college scholarship. Even worse, someone could be injured or even killed by a decision to drink and drive.
• Choosing the right friends. Encourage your child to find friends and classmates who share their same goals and lifestyle choices. If they choose to hang around kids who drink, they are more likely to give in to peer pressure and drink as well.

Take preventive steps

Talking with your child about the dangers of alcohol is important. However, talking is not enough. Take preventive steps, such as networking with other parents who share your same thinking and rules about underage drinking. This can include not serving alcohol at parties, and adult supervision when friends are over.

Keep alcohol out of your own home or under lock and key. Establish strict rules and consequences for underage drinking. Some parents create a written agreement or contract with their children. This can include consequences for underage drinking or drinking and driving. Consequences may be a loss of driving privileges, loss of free time, earlier curfews, or paying fines.

Things to consider

Alcohol abuse doesn’t just affect your child. Negative consequences can cause harm to others as well, such as injuring or even killing another person while driving drunk.

Learn the warning signs of alcohol abuse, which can include:

• Mood changes, including depression, anger, and irritability
• Poor grades
• Behavior problems at work or school
• Suddenly choosing a new group of friends, or not introducing their friends to you
• Low energy
• No interest in the activities or recreation they once enjoyed
• Evidence of alcohol use, such as red eyes, the smell of alcohol on your child’s breath, slurred speech, or inability to concentrate

Treatment is available in several forms. It may require individual or group counseling, or an inpatient or residential treatment program (where your child stays until they have completed treatment). There are also outpatient treatment plans (where your child leaves the house for treatment and returns home each day), hospital programs, medicine to reduce alcohol cravings, ongoing recovery support programs, and peer supports. Ask your doctor which one or combined treatment is right for your child.

Questions to ask your doctor

• If I suspect my child has been drinking, how do I know if my child is abusing alcohol or if it is a one-time thing?
• If my child is under 18, can I authorize treatment? What if he or she is over 18?
• How do I have a conversation with my child about alcohol if my spouse drinks in moderation (but every day) and I don’t?
• Is alcoholism hereditary?

Resources

Centers for Disease Control and Prevention: Underage Drinking

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You can purchase over-the-counter (OTC) medicines for your child without a prescription from your doctor. However, that doesn’t mean these medicines are harmless. If they are taken the wrong way, they can make your child feel worse and can even be harmful. Read through this list of dos and don’ts to make sure you are giving your child OTC cough and cold medicine safely.

Dos

• Do learn how to read and understand all parts of the medicine’s drug facts label.
• Do look for a medicine that will treat only the symptoms your child has. For example, if your child only has a runny nose, don’t pick a medicine that also treats headache and fever.
• Do use the correct measuring device (for example, a spoon, syringe, or cup made for measuring medicine) when giving your child the correct dose.
• Do read the medicine’s label carefully. Take note of any special instructions, such as foods or activities your child should avoid while taking the medicine.
• Do make sure everyone who takes care of your child (such as school nurses, day care workers, extended family members, or babysitters) knows what medicines your child is taking and when their dosing schedule.
• Do store medicines in their original packages to keep track of important labels and expiration dates.
• Do store all medicines up and away, out of the sight and reach of young children.
• Do keep medicines in a cool, dry place. This will help prevent them from becoming less effective before their expiration dates.

Don’ts

• Don’t give OTC cough and cold medicines to a child younger than 4 years of age unless your child’s doctor says it’s okay.
• Don’t share your adult OTC medicine with your child. OTC medicines made just for adults can be harmful for children. Once your child is a teenager, they may be old enough and big enough to take adult OTC medicines, but check with your family doctor first.
• Don’t give aspirin or a medicine that contains aspirin (check the “active ingredients” section of the drug facts label) to a child younger than 18 years of age. Aspirin can cause a serious illness called Reye syndrome if it is given to children.
• Don’t combine prescription medicines with OTC medicines unless your child’s doctor says it’s okay.
• Don’t use more than 1 OTC cough and cold medicine at the same time unless your child’s doctor says it’s okay. They may have similar active ingredients that add up to be too much medicine. For example, many OTC medicines contain acetaminophen and antihistamines.
• Don’t use an OTC medicine after its expiration date.
• Don’t store medicines in bathrooms or bathroom cabinets, which are often hot and humid.
• Don’t wait too long to take your child to the doctor. Cold symptoms should get better quickly, and OTC medicines are only meant for short-term use. If your child has been taking an OTC medicine for several days and their symptoms seem to be getting worse, call your doctor.
• Don’t give your child cough or cold medicine just to make him or her sleepy. This is a side effect of some ingredients, such as antihistamines, in cough and cold medicines. If your child has trouble falling asleep, talk to your family doctor about other things you can do to help your child sleep better.

Questions to ask your doctor

• Should I ask my doctor which over-the-counter medicine to use before I give it to my child?
• Is expired medicine harmful or just ineffective?
• What side effects should I look for when giving my child over-the-counter medicine?
• Are generics okay to use?

Resources

U. S. Food and Drug Administration: Should You Give Kids Medicine for Coughs and Colds?
National Institutes of Health, MedlinePlus: Medicines and Children

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Breastfeeding has many health benefits for you and your baby. While breastfeeding, you may need to take medicines. These can get into your milk and have an effect on your baby. They also can get into your body and affect how much milk you produce. Most medicines are safe to take while breastfeeding, but some are not. This includes over-the-counter medicines, prescriptions, and supplements. Talk to your doctor before taking any medicines.

Path to improved health

The American Academy of Family Physicians (AAFP) recommends that all doctors provide breastfeeding support before and after birth. Tell your doctor about all medicines you take or think you may need to take. They can review the benefits, risks, and possible effects of each medicine. The doctor may approve a medicine or provide an alternate based on your need and your baby’s health and age. If you need to take a medicine that is considered unsafe, your doctor can talk about other options, such as formula.

Similar to when you were pregnant, your doctor should provide a drug list. This often has three categories:

• Medicine that should be safe to take as normal.
• Medicine that may be safe to take on occasion (short-term) and/or in a lower dose.
• Medicine that is not safe and should be avoided.

There may be exceptions based on you and your baby’s health. For instance, some medicines should not be taken if your baby was born premature or has a certain health condition. There also may be different instructions for taking a medicine while breastfeeding. For instance, you may need to take it at a certain time of day. Or you may need to take it after a feeding to give your body more time to process it.

Talk to your doctor about vaccines as well. They will tell you which vaccines are safe and recommended to get while you are breastfeeding.

Things to consider

You can use LactMed®, a drug and lactation database, as a resource. This is maintained by the U.S. National Library of Medicine and the National Institutes of Health. Medicines such as some antidepressants, birth controls, and pain relievers are common types that may be unsafe to take. Medicines that contain pseudoephedrine may affect your milk supply. So it is always best to check with your doctor.

When to see the doctor

Watch your baby for any abnormal signs or symptoms. These may include fever, vomiting, diarrhea, rash, or irritability. Keep track if these occur around the time you take certain medicines. Contact your doctor right away with questions or concerns. You also should contact your doctor if your milk supply suddenly changes after starting a medicine.

Questions to ask your doctor

• What medicines are safe to take while breastfeeding?
• Can I take certain supplements?
• What vaccines are safe to get while breastfeeding?
• How do I know if my baby is reacting to a medicine I am taking?
• What are my options if I must take a medicine that is considered unsafe?

Resources

LactMed: Drugs and Lactation Database

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No matter how old you are, getting a shot at the doctor’s office is no fun. As adults, we recognize that the benefit is worth the discomfort. For children, though, the very idea of a needle can be enough to send them running in the opposite direction.

The fear of needles is real. And to your child, it probably seems as though they get a shot every time they see the doctor. Even if they only receive regular vaccinations and flu shots, that adds up to more than 25 shots by the time they are 6 years old.

If your child has anxiety about going to the doctor for fear of shots, you aren’t alone. Most children have this fear. Some outgrow it by the time they are adults. Others never do.

Thankfully, you can help shape your child’s attitude toward doctor visits and begin to calm their fear of needles. With each trip to the doctor, you can show your children that even though shots are not fun, they are quick and help keep you from getting sick. You can also use strategies proven to help ease the pain caused by needles.

Path to improved health

A visit to the doctor begins with the parent. What you say to your child about the appointment can shape your child’s attitude — even long-term — toward doctors, medical care and shots.

Before the appointment:

• Keep things on a need-to-know basis. If you have a young child, it is likely that they will be getting a vaccine at a well-child visit. There is no need to volunteer that information. After all, you probably don’t know for sure that your child will receive an injection. If your child asks you outright, say that it’s possible they could get a shot, but that you’re not sure.
• Be honest. Don’t tell your child that shots don’t hurt. They can. If your child thinks you are lying, they can lose trust in you. They need to feel that you are on their side and will protect them. The truth is that even though shots can hurt, they often don’t hurt that much. And the pain lasts only a few seconds. Focus on that. When your children know that you are telling them the truth, it promotes trust and can help keep them calm.
• Don’t ruin their week. There is no need to tell your child about the doctor’s appointment too far in advance. You are in charge of the schedule, not them. If you tell them too far ahead of time, it can cause the anxiety to build. It can make them dread the appointment all week. Don’t spring it on them at the last minute, either. Doing so can create panic. Instead, tell them a day or so in advance.
• Smile. And relax. Studies have shown that the more you tell a child not to worry, the more he or she thinks there is something to worry about. Instead of stopping anxiety, it increases it. If you are positive and happy, it will help keep your child calm. Let them see that you are not worried. Don’t get frustrated or upset even if your child is panicking. Use a soothing voice to tell them that you know they are scared. Assure them that the shot will take only a few seconds.
• Pretend. This is especially effective for younger children. Role-playing at home is a good way to show your children what happens at the doctor’s office. It can make them feel more comfortable around the equipment. It gives you the chance to talk about shots. Tell your children that shots make us healthy. Tell them that shots can hurt, but only for a few seconds. Demonstrate with a toy doctor’s kit. Have a contest to see who can make the bravest face while getting a shot.

During the appointment:

• Cause a distraction. Studies have shown that pain from a shot is minimized when a child is distracted. Offer to let your child play a game on your phone. Load a movie onto your iPad or Kindle and let them watch it. For younger children, bring bubbles and blow them to distract your child during the shot.
• Offer a bribe. One tried-and-true method used by parents everywhere is the bribe. Promise your child a special treat after the appointment. It could be that you take them somewhere fun, like the park. Or you could go for ice cream. Having something to look forward to will help distract them.
• Cough. According to researchers, coughing as the needle goes in helps to lessen the pain for some people. So, tell your child to cough. Even if it doesn’t ease the pain, the distraction is worth the effort.
• Ice it. Putting ice on the injection area for a minute right before the shot can help lessen the pain.
• Use numbing cream. A topical anesthetic cream can sometimes help ease the pain of needles. Ask your doctor about it before the appointment. It takes some time for the cream to work. Typically, you’ll need to use the cream about 20 minutes to an hour before the shot.
• Relax. Tensing up is one sure way to make shots worse. Encourage your child to relax the area where he or she is getting the injection.
• Model good behavior. If others in your family are also due for a vaccine, make it a family event. Try to get your own shot right before your child.

After the appointment:

• Manage the pain. It’s likely that the injection area will be sore after getting a shot. To help manage any pain, you can put ice on it for about 10 minutes. You can also offer your child the recommended dosage of children’s pain reliever, such as Motrin (ibuprofen) or Tylenol (acetaminophen).

Things to consider

Anytime your child gets a shot, you should monitor them for possible reactions and side effects. Your doctor will typically provide you with a list of side effects. The list will describe common side effects and serious side effects.

Common side effects after receiving a vaccine, for example, may include soreness and swelling at the injection site. Your child also may have a mild fever, a headache or be irritable.

More severe symptoms could mean that your child is having an allergic reaction. If your child is having a seizure, is delirious, or is having difficulty breathing, you should call 911 immediately.

Questions to ask your doctor

• Why does my child need so many shots?
• Can my child skip the flu shot this year?
• What should I do if my child is having an allergic reaction to a shot?
• My child is allergic to eggs. Can he still get a flu shot?
• Should I worry about preservatives like mercury in vaccines?
• Can vaccinations cause autism?
• My child has severe fear of needles. Should I see a professional counselor?

 Resources

Centers for Disease Control and Prevention: Vaccines

Centers for Disease Control and Prevention: Needle Fears and Phobia

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It is important to help your child form healthy eating habits from a young age. Teach your child what types of foods are healthy. This will give them confidence to make good choices. Set a strong example at home. This will affect the choices they make now and in the future. Talk to your child about the importance of eating a healthy lunch. It provides them with enough energy to learn and be active.

Path to improved health

School lunches are designed to provide healthy food options for children. To see the nutrition information for lunches offered by your child’s school, check out the United States Department of Agriculture (USDA) Food and Nutrition Service National School Lunch Program (NSLP). Many school districts across the country have changed their school lunch programs to meet the USDA’s nutrition standards.

The NSLP promotes nutrition standards that:

• Offer fruits and vegetables each day.
• Increase whole-grain food options.
• Offer only fat-free or low-fat milk options.
• Serve proper food portions that meet students’ calorie needs.
• Reduce saturated fats, trans fats, and sodium.

Students can choose from several appealing healthy options. Some schools include choices like vegetarian entrees or a salad bar.

You may decide to pack your child’s lunch instead of having them eat what the school provides. This may be a better option, especially if your child is a picky eater or has special dietary needs. Be sure to include a variety of your child’s favorite healthy foods. For example, you could pack fresh fruit, baked chips or pretzels, or fresh vegetables with salsa or a low-calorie dip. You might want to pack your child’s lunch the night before so that you don’t run short on time in the morning. If you’re in a hurry, you may be tempted to toss in prepackaged foods and unhealthy options.

It’s important to keep your child’s lunch at a safe temperature. Check to see if your child’s school offers lunch refrigeration. If not, pack items that do not require refrigeration. Or pack items that can be kept cold with an ice pack. Some items, such as drinks and yogurts, can be frozen ahead of time and safely thaw in the lunch box. Use a thermos for hot foods.

Things to consider

In addition to lunches, some schools offer breakfast or snack programs. This is helpful for children who may not get enough to eat at home. Kids who start the day with a good meal will make healthier choices throughout the day. These meals may be served in the cafeteria or in classrooms. You can inquire with your child’s school.

There are several things you can do if you are concerned about your child’s food choices at school. Review the school menu with them each week. Find out which days they would like to eat lunch at school. Talk to your child about which foods and drinks are healthy options. The school district may provide menus and nutrition information on its website. You can look at this with your child, so they are more informed.

When to see the doctor

Contact your doctor if you think your child is malnourished or has any food intolerance. You should also contact your doctor if you believe your child is overweight. Your doctor can help you create a healthy eating plan for your child. They may refer you to a dietician or a counselor if they suspect a problem.

Questions to ask your doctor

• Do you recommend school lunches or packed lunches?
• What should I do if my child has food allergies?
• How will I know if my child is not getting proper nutrients from school lunch?
• What else can I do to ensure my child makes healthy food choices?

Resources

United States Department of Agriculture: National School Lunch Program

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Many of the food and drink items that children and teens crave have caffeine in them. You can find it in soda, energy drinks, and chocolate candy-even hot cocoa. If these are some of your child’s favorites, they could be consuming more caffeine than you think.

About 73 percent of children consume caffeine on any given day, according to the Centers for Disease Control and Prevention (CDC). That’s roughly 3 out of 4 children who regularly have caffeine. Most of these children get their caffeine from soda. But soda intake is on the decline, says the CDC. It is being replaced by energy drinks and coffee.

Is caffeine bad for my child?

Caffeine is a stimulant. More than that, it is defined as a drug because it has a physiological effect on the body. This means it impacts how the body functions. In this case, it stimulates the central nervous system. In adults, this means it can make you more alert, even give you more energy. In children, caffeine can raise blood pressure and interfere with sleep. It can make children less aware of being tired. It can affect their moods and make anxiety worse. They can even suffer headaches from caffeine withdrawal.

Not a lot is known about how caffeine affects a child’s developing brain. But kids (especially young children) can be sensitive to the effects of caffeine.

The U.S. Food and Drug Administration (FDA) has not offered a recommendation regarding caffeine and kids or teenagers. However, the American Academy of Pediatrics (AAP) recommends against caffeine being a part of a child’s diet.

What about my teenager?

As more and more teens trade soda for energy drinks, they have become a focal point of caffeine consumption.

The AAP states that kids should not consume energy drinks and rarely need sports drinks. “Energy drinks pose potential health risks because of the stimulants they contain, and should never be consumed by children or adolescents,” according to the AAP.

The American Academy of Family Physicians (AAFP) states that the FDA should set guidelines for energy drinks. Labels should be standard and truthful. Products should be tested and controlled. AAFP also is against marketing and selling energy products to kids under 18 years old.

Hidden caffeine

You already know that soda, coffee, energy drinks, and chocolate contain caffeine. What you may not know is that caffeine is sometimes “hidden” in other food and beverages, too. And you won’t even find it on the label. Because caffeine is not a nutrient, food manufacturers aren’t required to list it on the food label.

Here are some examples of food and drinks where caffeine may be hiding:

• Yogurt
• Ice cream
• Decaf coffee
• Protein bars
• Some root beers
• Flavored sodas (that aren’t cola)
• Flavored waters

Path to improved health

It is difficult to completely avoid caffeine. But you can work to minimize the amount of caffeine your child consumes each day.

A good start is to try to eliminate soda from your child’s diet. If your child drinks a lot of soda, you may need to start slowly. Begin by limiting the number of sodas your child drinks until you get to zero. Instead, offer your child water to drink. If your child is active, resist the urge to offer them sports drinks.

It may be more difficult to convince teens to limit their beverages to water. Your teen may complain about needing the energy boost caffeine provides. If so, encourage them to exercise. Working out can cause your teen to sleep better and have more energy.

Things to consider

Many caffeinated beverages are also loaded with sugar. Drinking sodas, flavored coffees, and energy drinks can add hundreds of calories to your child’s diet. Over time, this can cause obesity. Sugar also increases the risk for insulin resistance and type 2 diabetes.

The sugary drinks are also harmful to your child’s teeth. They can cause tooth decay and cavities.

When to see a doctor

If you suspect your child may have overdosed on caffeine, you should contact your doctor immediately. Overdoses are rare but do happen. According to Poison Control, signs of a possible caffeine overdose can be mild or severe. Mild symptoms include shaky hands (jittery) and an upset stomach. Severe symptoms include high blood pressure, seizures, and even coma (loss of consciousness).

Questions for your doctor

• Are there any health benefits related to caffeine?
• At what age can someone safely consume caffeine?
• What other health risks are associated with kids consuming caffeine?
• How can I tell what foods have caffeine in them?
• If my child quits caffeine now, should I worry about withdrawals?

Resources

Centers for Disease Control and Prevention: Trends in Caffeine Intake Among U.S. Children and Adolescents

National Institutes of Health, MedlinePlus: Caffeine

U.S. Food & Drug Administration: Spilling the Beans: How Much Caffeine is Too Much?

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