From: Linda Miller [maulespt@coastalnet.com]
Sent: Saturday, June 28, 2003 8:30 AM
To: fdadockets@oc.fda.gov
Subject: Caffeine listing in nutritional labels

Dear Mesdames and Sirs:

I respectfully urge you to consider the requirement that all caffeine content be identified in food packaging nutritional labels.  As both a parent and a child psychiatrist, I have discovered that foods commonly consumed by children sometimes contain particularly large doses of naturally occuring caffeine for which identification is not required under current law.  The resulting side effects of irritability, nervousness, anxiety, insomnia and occasional nausea and vomiting can be easily confused with medical disorders such as Mood Disorders, Generalized Anxiety Disorder and Hyperactivity in children who consume these products daily.  From "power drinks" to seemingly innocuous orange flavored sodas to a popular java chip coffee icecream, the effects can be significant on children, and cost the health care system valuable resources when these symptoms result in children being evaluated and even medicated for conditions that are misidentifed because of masked caffeine consumption.

Again, I urge you to take this matter under consideration.  It is a reasonable and relatively inexpensive way to protect children and more efficiently use our limited mental health resources.

Thank you for your consideration.

Sincerely,
Linda Cartner Miller, MD
Fellow
Child and Adolescent Psychiatry
Brody School of Medicine at East Carolina University 
Greenville, North Carolina