A disturbing trend towards creatine use by schoolchildren has been uncovered by a major US study of middle and high school athletes. Of 1,103 athletes aged 10-18 taking part in a confidential survey, 62 (5.6%) admitted taking creatine. Use was reported among all age groups, although it was greatest among athletes in the highest grade (grade 12), of whom 44% reported using creatine.

Creatine use was significantly more common among boys (8.8%) than girls (1.8%). And, although it was taken by participants in every sport - including tennis and cheerleading - its use was significantly more common among football players, wrestlers, hockey players, gymnasts and lacrosse players.

The most common reasons cited for taking creatine were enhanced performance (74.2% of users) and improved appearance (61.3%), while the most common reason for not taking creatine was safety (45.7% of non-users). Of the five schools sampled, creatine use was most prevalent in the private high school, suggesting a connection with family income.

Should we be concerned by this trend? Undoubtedly, say the paediatricians who organised the study, for the following reasons:

1. the safety of creatine use in under-18s has not been demonstrated and the short and long-term health risks in adolescents and pre-adolescents are unknown;

2. use of performance-enhancing nutritional supplements could set children and young adults on a path leading to use of dangerous and banned substances, like anabolic steroids.

So why are children as young as 10 using creatine? First, say the authors, creatine, in common with other nutritional supplements, is touted as a safe and natural method of improving performance, which is widely marketed and readily available; secondly, teenagers may be taking ergogenic aids to imitate famous athletes; finally, young athletes are under increased pressure from parents, coaches and peers to succeed in athletics, and the win-at-all-costs mentality has emerged in youth sports.

They conclude: 'Open communication is needed among a team of physicians, nurses, coaches and athletic trainers, all of whom are responsible for the health and safety of young athletes. Until more information is available about safety in children and adolescents, health care providers should actively discourage use of creatine in their young patients.'
Paediatrics 2001 Aug 108(2), pp421-425

Isabel Walker