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AAP Warns on Performance Enhancers for Youth

In a strongly worded policy statement issued April 4, the American Academy of Pediatrics (AAP) has warned that "Virtually no data are available on the efficacy and safety in children and adolescents of widely used performance-enhancing substances" such as anabolic steroids. "Virtually no experimental research on either the ergogenic effects or adverse effects of performance-enhancing substances has been conducted in subjects younger than 18 years," the AAP pointed out.

The policy statement defines a "performance-enhancing substance" as "any substance taken in nonpharmacologic doses specifically for the purposes of improving sports performance," by increasing strength, power, speed, or endurance; altering body weight or body composition; or causing changes in behavior, arousal level and/or perception of pain. Performance-enhancing substances include:

  • Drugs, either prescription or non-prescription, taken in doses that exceed the recommended therapeutic doses or taken when the conditions that call for the drug are not present (using decongestants for stimulant effect when exercise-induced bronchospasm is not present, for example);
  • Agents used for weight control, including stimulants, diet pills, diuretics, and laxatives, when the user is in a sport that has weight classifications or rewards leanness;
  • Agents used for weight gain, including over-the-counter products advertised as promoting increased muscle mass;
  • Strategies used to enhance the oxygen-carrying capacity of blood, including red blood cell transfusions;
  • Any substances used for reasons other than to treat a documented disease or deficiency; any substance used to mask adverse effects or detectability of another performance-enhancing substance; or a nutritional supplement taken at levels greater than needed to replace deficits created by disease, training, or participation in sports.

It is not hard to understand why young people are attracted to performance-enhancing substances, given the goal of winning that permeates all athletics in our society and the celebrity, status, and favoritism that’s given to successful athletes, the policy statement notes. Added to that is the fact that adolescents often engage in risk-taking behavior and are intensely preoccupied with body image.

It is also extremely difficult to detect if young persons are using performance-enhancing substances. While all major amateur sports groups, including the National Collegiate Athletic Association and state high school athletic associations, make it a violation of rules to use such substances, the only remedy—drug testing—is primarily punitive and has not been shown to be a deterrent for youngsters. The AAP statement also makes the point that when adults who are responsible for youth sports programs adopt a "don’t ask" attitude about players’ use of performance-enhancing substances, "that has the same effect as active encouragement."

Given the pervasive societal and personal issues involved, the pediatrics group concedes that much remains to be done if children and adolescents are to be convinced not to use performance-enhancing substances. The policy statement makes the following recommendations:

  • Schools, parents, and coaches should be educated about the adverse health effects of performance-enhancing substances and should take a strong stand against them;
  • Interventions that are not punitive should be encouraged, including open discussion of the issues involved in performance enhancement and programs that teach sound nutrition and training practices along with the skills to resist social pressures to use the substances.
  • Pediatric health care professionals should provide or make available sound medical information on exercise physiology, conditioning, nutrition, weight management, and injury prevention .

The AAP policy statement, "Use of Performance-Enhancing Substances," appeared in the April 2005 issue of the journal Pediatrics. Information on performance-enhancing substances prepared by AAP’s Section on Sports Medicine and Fitness can be downloaded from See also Athletes and Performance-Enhancing Drugs at and Parents Resource Center: Substance Use, Other at