Tier 4 — mechanistic

Use of Performance-Enhancing Substances

Michele LaBotz, Bernard A. Griesemer, Council on Sports Medicine and Fitness
Pediatrics 2016 138(1):e20161300

Bibliography

PubMed
PMID 27354458
DOI
10.1542/peds.2016-1300
Funding
No external funding. The American Academy of Pediatrics states that it neither solicited nor accepted commercial involvement in development of the publication.
Competing interests
The authors indicated no financial relationship relevant to the article and no potential conflicts of interest to disclose. The AAP states that all authors filed conflict-of-interest statements and that any conflicts were resolved through an AAP-approved process.

Study snapshot

DesignAmerican Academy of Pediatrics clinical report / professional pediatric guidance
ModelPediatric clinical guidance
SampleNot applicable — clinical report rather than a participant study
InterventionPerformance-enhancing substances used by children and adolescents, including a specific creatine monohydrate evidence summary
DurationPublished 2016; reaffirmed in August 2025 with reference and data updates and no other changes to the text/content
EndpointsPediatric performance-enhancing-substance use; Creatine performance evidence; Pediatric safety uncertainty; Supplement regulation and contamination; Training and nutrition priorities; Clinician and parent counseling

What the study showed, in plain terms

This American Academy of Pediatrics clinical report places creatine inside the broader pediatric performance-enhancing-substance conversation. It is not a creatine trial; its value is the pediatric risk-management lens: development, nutrition, training, motivations for supplement use, product regulation and clinician-family counseling.

The report was reaffirmed in August 2025 with reference and data updates. Its updated Monitoring the Future data show creatine use remained substantial in 2024, while the clinical guidance continues to emphasize that normal pubertal development plus appropriate training and nutrition can produce large performance gains without relying on supplements.

Key findings

  • The AAP describes creatine’s benefit as generally small and most evident for short-duration, maximum-intensity resistance-type activity, with no general benefit shown for aerobic or on-field athletic performance in the evidence summarized by the report.
  • The creatine safety table states that short-term use at usual doses appeared safe in healthy adults but had not been specifically evaluated in the pediatric population covered by that evidence base.
  • The report advises special caution for athletes at risk for kidney dysfunction and emphasizes that clinical circumstances matter.
  • The report highlights the weaker premarket oversight of dietary supplements and the possibility of mislabeled or contaminated products, making product quality part of the pediatric safety discussion.
  • Updated 2024 Monitoring the Future data reported past-12-month creatine use of 13.0% in 12th grade, 11.7% in 10th grade and 4.6% in 8th grade.

What this study can and cannot tell us

This is broad professional guidance, not a creatine-specific systematic review or intervention trial. Some creatine evidence summarized in the underlying 2016 report is older than the modern adolescent reviews, so the report should be used for pediatric counseling, risk context and professional guidance rather than as the sole source for current creatine safety estimates.

The 2025 reaffirmation updated references and data points; the AAP states that no other changes were made to the report’s text or content.

Related papers in the corpus

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Evaluating the Safety of Creatine Monohydrate in Adolescents: A Systematic Review of Renal, Hepatic, and Cardiometabolic Outcomes
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Tier 2
Creatine supplementation in the pediatric and adolescent athlete-- A literature review
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Creatine Monohydrate in Adolescent Athletes: A Critical Narrative Review of Performance, Safety, and Considerations for Responsible Use
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International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine
Richard B. Kreider et al. · Journal of the International Society of Sports Nutrition · 2017

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Dr. Khaled Mahmoud, MBBChCritical Care Medicine, Longevity Science & Editorial Direction Dr. Amr Yasser, PhDCardiometabolic, Musculoskeletal, Gut & Bioavailability Dr. Abdulla Mostafa, PhDCellular Senescence, Neurological, Mitochondrial & Brain-Ageing Biology