Red Dye 40 and Attention Problems in Children
No, there is no conclusive evidence that Red Dye 40 (or other artificial food dyes) causes attention problems or ADHD in children, according to the American Academy of Pediatrics. 1
What the Guidelines Say
The American Academy of Pediatrics explicitly addressed this concern in their 2019 clinical guidance and found that there are no data to support an association between nonnutritive sweeteners (NNS) use and the development of ADHD or autism in children or worsening of ADHD symptoms. 1 While this statement specifically addresses nonnutritive sweeteners, the guideline also reviewed concerns about food additives including artificial dyes raised by the lay press regarding behavior, cognition, hyperactivity, and attention issues, and found two randomized controlled trials showing no association. 1
The comprehensive ADHD clinical practice guidelines from the American Academy of Pediatrics (2011,2019) do not include artificial food dyes or Red Dye 40 as a recognized cause or contributing factor to ADHD. 1 These guidelines extensively detail the diagnostic criteria, evaluation process, and treatment recommendations for ADHD, yet make no mention of food dyes as a relevant consideration. 1
What the Research Shows
While some older research from the 1970s by Dr. Benjamin Feingold suggested that removing artificial food additives and dyes reduced hyperactivity symptoms, more rigorous empirical studies conducted over the subsequent 20 years were less positive, leading to a decline in research interest in this area. 2
More recent research has examined potential associations:
A 2011 review noted that while some clinical studies supported Feingold's findings, the removal of food dyes is not a panacea for ADHD, which is a multifaceted disorder with both biological and environmental underpinnings. 2
Research has documented that children are widely exposed to artificial food colors, with Red No. 40 being the highest exposure, and that juice drinks, soft drinks, icings, and ice cream cones are major contributors to children's AFC exposure. 3 However, exposure does not equal causation of attention problems.
Some studies have found that children's intake of Red No. 40 from certain over-the-counter medicines can exceed FDA acceptable daily intakes, 4 but this relates to safety thresholds, not proven behavioral effects.
Important Clinical Context
When evaluating a child with attention problems, hyperactivity, or impulsivity, the American Academy of Pediatrics recommends a systematic diagnostic approach that includes:
- Verifying DSM criteria are met, including symptoms beginning before age 12 and presence across multiple settings 5, 6
- Screening for alternative causes including trauma/PTSD, anxiety, depression, sleep disorders, learning disabilities, and substance use in adolescents 5
- Obtaining information from multiple sources (parents, teachers, other clinicians) across at least two settings 1, 5
The critical pitfall to avoid is attributing attention problems to dietary factors like Red Dye 40 when a true underlying condition (ADHD, anxiety, trauma, sleep disorder) goes undiagnosed and untreated. 5
Practical Recommendation
If parents are concerned about food dyes and wish to eliminate them from their child's diet, this dietary modification is unlikely to cause harm. However, this should not delay proper evaluation and evidence-based treatment if the child has functionally impairing symptoms of inattention, hyperactivity, or impulsivity. 1
For children with diagnosed ADHD, the American Academy of Pediatrics recommends FDA-approved medications (particularly stimulants) and/or evidence-based behavioral therapy as first-line treatments, 1 not dietary elimination of food dyes, which lacks supporting evidence from the guideline literature.