Understanding doping and anti-doping: a guide for the general paediatrician.

The use of image and performance enhancing drugs (IPEDs) and the consumption of nutritional supplements are rising in young people, yet most paediatricians have limited experience in this emerging area of practice. This article aims to increase awareness of the scale of the issue; to suggest when IPED use might be suspected; and how to investigate and manage it practically and holistically. It stresses the risks of online nutritional supplements, which are frequently contaminated with potentially harmful substances and increasingly easy to purchase online on social media. It summarises what is known about the risks and adverse effects, particularly cardiac, endocrine and psychological complications, some of which can be irreversible. The article then highlights the risk that some young people involved in sport may be underdosing themselves with necessary medication out of concerns that they could fail drug testing. It also discusses how to prescribe for young competing athletes; how to check which medications are banned for that athlete; and how to prescribe medication which is clinically indicated but on the prohibited list.