Creatine Use in Infants and Toddlers
Creatine supplementation should not be used in infants and toddlers, as there is no established safety or efficacy data for this age group, and current guidelines explicitly recommend against creatine use in individuals under 18 years of age.
Evidence Against Supplementation in Young Children
Lack of Safety Data and Guideline Recommendations
The Lancet Neurology guidelines for Duchenne muscular dystrophy explicitly state that no recommendations for the use of creatine were established in pediatric populations, and if a patient is taking creatine and has evidence of renal dysfunction, it is necessary to discontinue this supplement 1.
An RCT of creatine in DMD failed to show clear benefit, further undermining any rationale for use in young children 1.
Despite creatine being widely used by adolescent athletes (with 5.6% of middle and high school athletes reporting use), current recommendations are against use in adolescents less than 18 years old 2.
Age-Specific Concerns for Infants and Toddlers
Infants under 2 years have immature renal function that significantly affects drug clearance and metabolism, making extrapolation of dosing recommendations from older children or adults inappropriate and potentially dangerous 3.
The safety profile established in older populations cannot be assumed to apply to infants and toddlers, whose developing organ systems may respond differently to supplementation 3.
Natural Creatine Intake in Infancy
Physiological Context
Infants aged 0-12 months rely exclusively on dietary creatine from human milk for their first 6 months, and creatine is recognized as a conditionally essential nutrient during this developmental period 4.
Human milk naturally contains creatine in amounts sufficient to support normal infant growth and development without need for supplementation 4.
Clinical Pitfalls to Avoid
Common Misconceptions
Do not assume that because creatine is "natural" or found in breast milk that supplementation is safe or beneficial in infants and toddlers.
Do not extrapolate safety data from adolescent or adult studies to infants and toddlers, as pharmacokinetics, renal function, and metabolic capacity differ substantially 3.
Monitoring Considerations
If a child has been inadvertently exposed to creatine supplementation, monitor renal function closely and discontinue the supplement immediately if any evidence of renal dysfunction appears 1.
The most common reason cited by non-users for avoiding creatine is safety concerns (45.7%), which is particularly relevant given the lack of pediatric safety data 2.
Alternative Approach
Ensure adequate nutrition through age-appropriate feeding (breast milk or formula for infants, balanced diet for toddlers) rather than relying on supplements 4.
For specific medical conditions where creatine metabolism is impaired, consultation with a pediatric metabolic specialist is warranted rather than empiric supplementation 1.