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Nestlé Waters North America

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Namestring
Nestlé Waters North America
Company typeenum
Private
Founded yearint
1992
Descriptiontext

Nestlé Waters North America is a Stamford, Connecticut-based business unit of Nestlé that produces and distributes bottled water across North America under a portfolio of heritage and premium brands, including Poland Spring (since 1845), Deer Park (since 1873), Arrowhead (since 1894), Saratoga, Pure Life, Ice Mountain, Ozarka, Zephyrhills, Mountain Valley, Primo Water, Sparkletts, and the recently launched Splash Refresher flavored hydration line. The company operates 39 bottling sites — all certified to the Alliance for Water Stewardship (AWS) water stewardship standard, with two sites achieving Platinum certification — and leverages Primo Water North America's direct distribution infrastructure, which covers over 90% of the U.S. population for home and office delivery, alongside retail, exchange, and self-service refill drinking station channels.

The business model is a hybrid CPG-and-DSD (direct-store-delivery) structure: revenue is generated through branded retail sales (still and sparkling spring and purified water), flavored sparkling and hydration products, recurring home and office water delivery subscriptions, and exchange/refill programs. Pricing is not publicly disclosed, but the model implies volume-driven consumer economics across both mass-market (Pure Life, Deer Park, Ice Mountain) and premium tiers (Saratoga, Mountain Valley). Go-to-market spans branded websites, celebrity endorsements (Ken Griffey Jr., Skylar Diggins), sustainability communications, and a national direct distribution sales force.

Sustainability and water stewardship are central to the company's positioning and operating risk profile: it is pursuing 70 global water regeneration projects aimed at regenerating more water than it consumes by 2025, has deployed a 13 MW solar installation at the Poland Spring facility in Hollis, Maine (with Onyx Renewables and PowerFlex Energize), and structures its operations around four pillars — Water Stewardship, Packaging Stewardship, Climate Stewardship, and Community Commitment. The company is led by CEO Joe Pimpernel and employs 5,001–10,000 people; its consumer base is horizontally segmented across U.S. and Canadian households, offices, foodservice, and retail shoppers, with no significant customer concentration risk.

Short descriptiontext

Nestlé Waters North America is a North American bottled water producer and distributor operating 39 bottling sites under heritage brands such as Poland Spring, Deer Park, Arrowhead, Pure Life, Saratoga, and Mountain Valley. It serves U.S. and Canadian consumers and offices through retail, direct delivery, exchange, and refill channels covering over 90% of the U.S. population.

Operating statusenum
Operating
Ownership categoryenum
Headcount rangeband
5,001–10,000
akta.pro rankint
HeadquartersStamford, United States
HQ citystring
Stamford
HQ countrystring
United States
HQ regionstring
North America
Markets served

Serves global market

Keyword5 values
bottled water, natural spring water, purified water, flavored sparkling water, water delivery
Industry5 codes
1Bottled Water (Still, Sparkling, Enhanced)
CodeCRADAHACPrimaryYes
2Bulk Bottled Water Production (Large Format, Home/Office Delivery)
CodeAFAFACAHPrimaryNo
3Spring Water Bottling
CodeAFAFACAAPrimaryNo
4Flavored/Enhanced Bottled Water Production (Essenced, Vitamin, Electrolyte)
CodeAFAFACAFPrimaryNo
5Still Soft Drinks & Flavored Waters (Non-Carbonated)
CodeAFAFABABPrimaryNo
NAICS code3 codes
  • Bottled Water Manufacturing312112
  • Soft Drink and Ice Manufacturing31211
  • Beverage Manufacturing3121
SIC code2 codes
  • Bottled & Canned Soft Drinks & Carbonated Waters2086
  • Beverages2080
Product category
Bottled Water
Social media profiles2 records
Marketing channels3 records

Each record includes

Title, Type, Stage, Description, Source

Distribution channels1 record

Each record includes

Title, Type, Scope, Target buyer, Description, Source

Cost components5 values
Supply Chain, Operations, Personnel, Marketing or Sales, Infrastructure
GTM typeB2C
B2C
Offering typeHardware or Manufacturing
Hardware or Manufacturing
Core offering1 text field

Nestlé Waters North America produces, markets, and distributes bottled water products across the United States, including natural spring water, purified water, and flavored sparkling beverages under well-known regional and national brands such as Poland Spring, Pure Life, Saratoga, Mountain Valley, Arrowhead, Deer Park, Ice Mountain, Ozarka, Zephyrhills, Primo Water, Sparkletts, and Splash Refresher. The company operates 39 bottling sites and serves consumers through retail, foodservice, and direct-to-home delivery channels.

Differentiator
Functional benefit
Problem solved
Scale indicator4 records

Each record includes

Type, Value, Description, Source

Partnership3 partners
Strategic tierCoreTypeStrategic or Co-development PartnerAnnounced on2026-04-02
Description

Nestlé Waters & Premium Beverages achieved AWS water stewardship certification across all 39 bottling sites, including two sites with Platinum certification. This represents an industry-leading milestone in water stewardship practices.

Strategic tierCoreTypeStrategic or Co-development PartnerAnnounced on2026-02-18
Description

Partnership for 13 megawatt solar project at Poland Spring facility in Hollis, Maine. Onyx Renewables and PowerFlex Energize collaborated on this solar initiative.

Strategic tierCoreTypeStrategic or Co-development PartnerAnnounced on2026-02-18
Description

Partnership for 13 megawatt solar project at Poland Spring facility in Hollis, Maine. Onyx Renewables and PowerFlex Energize collaborated on this solar initiative.

Recent move5 records

Each record includes

Date, Type, Title, Description, Source

Expansion highlight6 records

Each record includes

Type, Description

Peers10 records
TypeDirect peer
Description

Spin-out of Nestlé's U.S. regional water brands (Arrowhead, Deer Park, Ice Mountain, Ozarka, Zephyrhills, Poland Spring) prior to the Primo Brands combination; the closest head-to-head competitor across regional spring water brands, retail channels, and direct delivery.

TypeBroad incumbent
Description

Owns major U.S. bottled water brands (Dasani, Smartwater, Topo Chico) and competes directly with NWNA across retail and foodservice; broader beverage portfolio provides scale advantages in promotion and shelf negotiation.

TypeBroad incumbent
Description

Owns Aquafina, LIFEWTR, and Bubly, competing directly across still and flavored sparkling water; massive distribution and marketing scale make it one of NWNA's primary national-share competitors.

TypeBroad incumbent
Description

Global bottled water leader with Evian and Volvic, competing in the premium and imported water segments where Saratoga and Mountain Valley also play; relevant peer for category positioning and international benchmarking.

TypeDirect peer
Description

Premium imported still water brand competing head-to-head with Saratoga and Mountain Valley in the premium/prestige retail and on-premise channel; directly comparable price tier and consumer positioning.

TypeDirect peer
Description

Premium still and sparkling water brand with strong on-premise (luxury hospitality) presence; competes directly with Saratoga in fine-dining and premium retail channels.

TypeDirect peer
Description

Owns LaCroix, a leading flavored sparkling water brand; directly competes with NWNA's Splash Refresher and sparkling portfolio in the fast-growing flavored sparkling water category.

TypeDirect peer
Description

Privately held U.S. producer of seltzers and bottled water with strong regional concentration in the Northeast; competes with NWNA brands in regional bottling, retail, and direct-store-delivery networks.

TypeBroad incumbent
Description

Large North American beverage portfolio that competes across adjacent hydration and at-home beverage occasions (including bottled water and flavored drinks); relevant for retail shelf and route-to-market dynamics.

TypeOthers
Description

Parent entity following the 2024 combination of Nestlé Waters North America and Primo Water Corporation (NYSE: PRMB); included as an ecosystem/corporate-structure peer rather than a direct competitor.

Market position
Strengths4 records

Each record includes

Headline, Details, Source

Weaknesses4 records

Each record includes

Headline, Details, Source

Competitive moat5 records

Each record includes

Type, Details

Key risks6 records

Each record includes

Headline, Details, Source

Key highlights7 records

Each record includes

Headline, Details, Source

Customer concentration

Classification, Details

Ideal customer profile2 records

Each record includes

Profile, Firmographic size, Sales motion, Sales cycle length, Buying structure, Purchase trigger, Buyer persona, Geography, Industry vertical, Primary use case, Description, Pain points, Evidence proof points, Target buyer

Technology focused
No
API detail
Has APIbool
No

Docs URL, Description

AI maturity
App detail

Has app

Core technology
Revenue estimate
Valuation estimate
Number of profiles
Profiles1 record

Each record includes

Name, Designation, Designation category, Overview, Profile commentary, Source

No data
Compliance1 record

Each record includes

Name, Class, Description

Funding overview

Funding stage, Last funding date, Total funding USD

Funding rounds

Each record includes

Round, Amount USD, Date, Pre money valuation, Total investors, Investors, News

Investors

Each record includes

Name, Type, Date of entry, Rounds participated, Website

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Each record includes

Name, Acquisition type, Announced date, Completed date, Status, Website, News

Investment

Each record includes

Name, Round, Announced date, Lead investor, Website, News

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Nestlé Waters North America

Bottled Waternestle-watersna.com

Nestlé Waters North America is a North American bottled water producer and distributor operating 39 bottling sites under heritage brands such as Poland Spring, Deer Park, Arrowhead, Pure Life, Saratoga, and Mountain Valley. It serves U.S. and Canadian consumers and offices through retail, direct delivery, exchange, and refill channels covering over 90% of the U.S. population.

What Nestlé Waters North America does

Nestlé Waters North America is a Stamford, Connecticut-based business unit of Nestlé that produces and distributes bottled water across North America under a portfolio of heritage and premium brands, including Poland Spring (since 1845), Deer Park (since 1873), Arrowhead (since 1894), Saratoga, Pure Life, Ice Mountain, Ozarka, Zephyrhills, Mountain Valley, Primo Water, Sparkletts, and the recently launched Splash Refresher flavored hydration line. The company operates 39 bottling sites — all certified to the Alliance for Water Stewardship (AWS) water stewardship standard, with two sites achieving Platinum certification — and leverages Primo Water North America's direct distribution infrastructure, which covers over 90% of the U.S. population for home and office delivery, alongside retail, exchange, and self-service refill drinking station channels.

The business model is a hybrid CPG-and-DSD (direct-store-delivery) structure: revenue is generated through branded retail sales (still and sparkling spring and purified water), flavored sparkling and hydration products, recurring home and office water delivery subscriptions, and exchange/refill programs. Pricing is not publicly disclosed, but the model implies volume-driven consumer economics across both mass-market (Pure Life, Deer Park, Ice Mountain) and premium tiers (Saratoga, Mountain Valley). Go-to-market spans branded websites, celebrity endorsements (Ken Griffey Jr., Skylar Diggins), sustainability communications, and a national direct distribution sales force.

Sustainability and water stewardship are central to the company's positioning and operating risk profile: it is pursuing 70 global water regeneration projects aimed at regenerating more water than it consumes by 2025, has deployed a 13 MW solar installation at the Poland Spring facility in Hollis, Maine (with Onyx Renewables and PowerFlex Energize), and structures its operations around four pillars — Water Stewardship, Packaging Stewardship, Climate Stewardship, and Community Commitment. The company is led by CEO Joe Pimpernel and employs 5,001–10,000 people; its consumer base is horizontally segmented across U.S. and Canadian households, offices, foodservice, and retail shoppers, with no significant customer concentration risk.

Nestlé Waters North America firmographics

Firmographics
Name
Nestlé Waters North America
Website
https://nestle-watersna.com
Company type
Private
Founded year
1992
Operating status
Operating
Headcount range
5,001–10,000 employees
Short description
Nestlé Waters North America is a North American bottled water producer and distributor operating 39 bottling sites under heritage brands such as Poland Spring, Deer Park, Arrowhead, Pure Life, Saratoga, and Mountain Valley. It serves U.S. and Canadian consumers and offices through retail, direct delivery, exchange, and refill channels covering over 90% of the U.S. population.
Ownership category
akta.pro rank

Nestlé Waters North America industry classification

Industry
Product category
Bottled Water
NAICS
Bottled Water Manufacturing (312112), Soft Drink and Ice Manufacturing (31211), Beverage Manufacturing (3121)
SIC
Bottled & Canned Soft Drinks & Carbonated Waters (2086), Beverages (2080)
akta.pro primary industry
Bottled Water (Still, Sparkling, Enhanced) (CRADAHAC)
akta.pro secondary industries
Bulk Bottled Water Production (Large Format, Home/Office Delivery) (AFAFACAH), Spring Water Bottling (AFAFACAA), Flavored/Enhanced Bottled Water Production (Essenced, Vitamin, Electrolyte) (AFAFACAF), Still Soft Drinks & Flavored Waters (Non-Carbonated) (AFAFABAB)

Keywords

  • Bottled water
  • Natural spring water
  • Purified water
  • Flavored sparkling water
  • Water delivery

Where Nestlé Waters North America is headquartered

Location

Headquarters

HQ city
Stamford
HQ country
United States
HQ region
North America

Markets served

Nestlé Waters North America business model

Business model
GTM type
B2C
Offering type
Hardware or Manufacturing
Cost components
Supply Chain, Operations, Personnel, Marketing or Sales, Infrastructure

Distribution channels1 record

Marketing channels3 records

Nestlé Waters North America product offering

Product offering

Core offering

Nestlé Waters North America produces, markets, and distributes bottled water products across the United States, including natural spring water, purified water, and flavored sparkling beverages under well-known regional and national brands such as Poland Spring, Pure Life, Saratoga, Mountain Valley, Arrowhead, Deer Park, Ice Mountain, Ozarka, Zephyrhills, Primo Water, Sparkletts, and Splash Refresher. The company operates 39 bottling sites and serves consumers through retail, foodservice, and direct-to-home delivery channels.

Differentiator

Problem solved

Functional benefit

Companies that use Nestlé Waters North America

Customer profile

Ideal customer profiles2 records

Nestlé Waters North America technology and API

Technology

Technology focussed No

API detail

Has API
No
API docs
API detail

Core technology

AI maturity

App detail

Nestlé Waters North America partnerships and signals

Strategic signal

Partnerships

Three partnerships are on record, tiered core.

  • AWS (Alliance for Water Stewardship)coreStrategic or Co-development Partner · 2 April 2026Nestlé Waters & Premium Beverages achieved AWS water stewardship certification across all 39 bottling sites, including two sites with Platinum certification. This represents an industry-leading milestone in water stewardship practices.
  • Onyx RenewablescoreStrategic or Co-development Partner · 18 February 2026Partnership for 13 megawatt solar project at Poland Spring facility in Hollis, Maine. Onyx Renewables and PowerFlex Energize collaborated on this solar initiative.
  • PowerFlex EnergizecoreStrategic or Co-development Partner · 18 February 2026Partnership for 13 megawatt solar project at Poland Spring facility in Hollis, Maine. Onyx Renewables and PowerFlex Energize collaborated on this solar initiative.

Scale indicators4 records

Recent moves5 records

Expansion highlights6 records

Nestlé Waters North America competitors and assessment

Company assessment

Direct peers

  • BlueTriton Brands: Spin-out of Nestlé's U.S. regional water brands (Arrowhead, Deer Park, Ice Mountain, Ozarka, Zephyrhills, Poland Spring) prior to the Primo Brands combination; the closest head-to-head competitor across regional spring water brands, retail channels, and direct delivery.
  • FIJI Water: Premium imported still water brand competing head-to-head with Saratoga and Mountain Valley in the premium/prestige retail and on-premise channel; directly comparable price tier and consumer positioning.
  • Voss Water: Premium still and sparkling water brand with strong on-premise (luxury hospitality) presence; competes directly with Saratoga in fine-dining and premium retail channels.
  • National Beverage Corp. Owns LaCroix, a leading flavored sparkling water brand; directly competes with NWNA's Splash Refresher and sparkling portfolio in the fast-growing flavored sparkling water category.
  • Polar Beverages: Privately held U.S. producer of seltzers and bottled water with strong regional concentration in the Northeast; competes with NWNA brands in regional bottling, retail, and direct-store-delivery networks.

Broad incumbents

  • The Coca-Cola Company: Owns major U.S. bottled water brands (Dasani, Smartwater, Topo Chico) and competes directly with NWNA across retail and foodservice; broader beverage portfolio provides scale advantages in promotion and shelf negotiation.
  • PepsiCo: Owns Aquafina, LIFEWTR, and Bubly, competing directly across still and flavored sparkling water; massive distribution and marketing scale make it one of NWNA's primary national-share competitors.
  • Danone: Global bottled water leader with Evian and Volvic, competing in the premium and imported water segments where Saratoga and Mountain Valley also play; relevant peer for category positioning and international benchmarking.
  • Keurig Dr Pepper: Large North American beverage portfolio that competes across adjacent hydration and at-home beverage occasions (including bottled water and flavored drinks); relevant for retail shelf and route-to-market dynamics.

Others

  • Primo Brands Corporation: Parent entity following the 2024 combination of Nestlé Waters North America and Primo Water Corporation (NYSE: PRMB); included as an ecosystem/corporate-structure peer rather than a direct competitor.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks6 records

Key highlights7 records

Customer concentration

Nestlé Waters North America social profiles

Digital presence

Nestlé Waters North America compliance and trust

Trust signal

Compliance1 record

Nestlé Waters North America financial estimates

Financial estimate

Revenue estimate

Valuation estimate

Nestlé Waters North America leadership team

Management profile

Number of profiles

Profiles1 record

Nestlé Waters North America funding detail

Funding detail

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

Nestlé Waters North America M&A and investment

M&A and investment

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Nestlé Waters North America

What does Nestlé Waters North America do?

Nestlé Waters North America produces, markets, and distributes bottled water products across the United States, including natural spring water, purified water, and flavored sparkling beverages under well-known regional and national brands such as Poland Spring, Pure Life, Saratoga, Mountain Valley, Arrowhead, Deer Park, Ice Mountain, Ozarka, Zephyrhills, Primo Water, Sparkletts, and Splash Refresher. The company operates 39 bottling sites and serves consumers through retail, foodservice, and direct-to-home delivery channels.

Is Nestlé Waters North America a public or private company?

Nestlé Waters North America is a private company. It is classified as corporate owned and is currently operating.

When was Nestlé Waters North America founded?

Nestlé Waters North America was founded in 1992. It employs 5,001 to 10,000 people.

Where is Nestlé Waters North America based?

Nestlé Waters North America is headquartered in Stamford, United States, in the North America region.

Who are Nestlé Waters North America's main competitors?

Direct peers on record are BlueTriton Brands, FIJI Water, Voss Water, National Beverage Corp. and Polar Beverages. Broad incumbents are The Coca-Cola Company, PepsiCo, Danone and Keurig Dr Pepper. Primo Brands Corporation is listed as an others.

Does Nestlé Waters North America have an API?

No public API is recorded for Nestlé Waters North America.

What industry is Nestlé Waters North America in?

Nestlé Waters North America's product category is Bottled Water. Its primary akta.pro industry code is CRADAHAC, Bottled Water (Still, Sparkling, Enhanced), with a secondary code of AFAFACAH, Bulk Bottled Water Production (Large Format, Home/Office Delivery). Its NAICS code is 312112 and its SIC code is 2086.

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Live signals
ThegrocerNestlé Waters & Premium Beverages appoints new UK managing directorNestlé has appointed Thomas Conquet as managing director of its Waters & Premium Beverages business in the UK, moving him from senior director, brand marketing at the same unit in the USA. Conquet, who joined Nestlé in 2008, will oversee San Pellegrino, Aqua Panna, Buxton, Princes Gate and Nestlé Pure Life. He succeeds Stefano Bolognese, who left in April 2026 after 26 years.Market Report AnalyticsExploring Flavored Sparkling Water Market Evolution 2025-2033The global market for flavored sparkling water is experiencing significant growth driven by consumer demand for healthier beverages and innovative flavor offerings, with key players like Coca-Cola, PepsiCo, and Nestlé Waters North America investing heavily in this segment. The market size is estimated at around $15 billion in 2025, with a CAGR of approximately 7%, and is expected to continue expanding through 2033 amid ongoing product innovation and sustainability efforts.Ken ResearchNorth America Bottled Water Market, Size, Revenue and Market Forecast to 2030A market research report forecasts the North America bottled water market will grow through 2030, driven by rising health consciousness, urbanization, and demand for convenient functional beverages. The analysis highlights significant challenges related to plastic waste and regulatory compliance while noting opportunities in sustainable packaging innovations and e-commerce expansion. Key industry players such as Nestlé Waters North America, PepsiCo, and The Coca-Cola Company are identified as dominant forces leveraging extensive distribution networks.OnerockOne Rock Capital Partners and Metropoulos & Co. to Acquire Nestlé Waters North AmericaOne Rock Capital Partners and Metropoulos & Co. have entered into a definitive agreement to acquire Nestlé Waters North America from Nestlé S.A. The transaction, expected to close in the spring of 2021, will result in Dean Metropoulos becoming the Chairman and interim CEO of the standalone company. Nestlé Waters North America operates leading bottled water brands such as Poland Spring and Ozarka across the United States and Canada.StoryofstuffPress Release: Nestle Waters / Blue Triton Ordered to Cease Unauthorized Removal of Water from San Bernardino National ForestCalifornia’s State Water Resources Control Board issued a draft Cease & Desist Order to Blue Triton Brands, formerly Nestle Waters North America, requiring it to stop removing water from the San Bernardino National Forest due to insufficient proof of valid water rights. The board estimates the company may only have rights to 7.26 acre feet annually, significantly less than the 180 acre feet reported in 2020. Environmental groups are urging the company to accept the order and restore the local ecosystem.PR NewswireOne Rock Capital Partners and Metropoulos & Co. Complete Acquisition of Nestlé Waters North AmericaOne Rock Capital Partners and Metropoulos & Co. announced on March 31, 2021 the completion of their acquisition of Nestlé Waters North America from Nestlé S.A., with Dean Metropoulos appointed as Chairman and interim CEO. The acquired company operates 27 production facilities across North America, managing brands including Poland Spring, Splash, and Pure Life, along with the direct-to-consumer service ReadyRefresh. The deal represents a significant private equity investment in the North American bottled water sector, with the new owners signaling intent to grow the business using their operational expertise.PR NewswireOne Rock Capital Partners and Metropoulos & Co. to Acquire Nestlé Waters North AmericaOne Rock Capital Partners and Metropoulos & Co. have entered into a definitive agreement to acquire Nestlé Waters North America from Nestlé S.A., with the transaction expected to close in Spring 2021. The acquired company is a major North American bottled water provider with iconic brands including Poland Spring, Deer Park, Arrowhead, and Pure Life, operating 27 production facilities and employing approximately 7,000 people in the U.S. and over 230 in Canada. Dean Metropoulos, founder of Metropoulos & Co., will become Chairman and interim CEO as the business transitions to independent ownership.PR NewswireNestlé Waters North America Earns Top Marks in Human Rights Campaign's 2021 Corporate Equality IndexNestlé Waters North America (NWNA) announced it received a score of 100 percent on the Human Rights Campaign Foundation's 2021 Corporate Equality Index (CEI), a benchmarking survey measuring corporate LGBTQ workplace equality policies and practices. NWNA is one of 767 major U.S. businesses to earn top marks and has now achieved this distinction for two consecutive years.PR Newswire2020 Recipients of Ice Mountain Environmental Stewardship Fund AnnouncedNestlé Waters North America and Fremont Area Community Foundation announced the 2020 recipients of grants from the Ice Mountain Environmental Stewardship Fund, which supports environmental conservation projects in the Muskegon River watershed across Michigan. Five local organizations received funding for projects including septic permit digitization, erosion repair, environmental education, hazardous waste collection, and streambank stabilization. The fund has awarded nearly $700,000 in grants since its inception in 2002, with a $2 million commitment made in 2019 to support conservation projects over the next 20-plus years.PR NewswireNestlé Waters North America and the American Academy of Pediatrics (AAP) Team Up to Promote Health Benefits of Kids Drinking More WaterNestlé Waters North America and the American Academy of Pediatrics announced a national partnership in October 2020 to educate parents and caregivers about the health benefits of children drinking more water. The program leverages AAP's network of pediatricians and the HealthyChildren.org website to distribute resources, with a goal of addressing statistics showing 20% of U.S. children do not drink water daily and consume twice as many calories from sugar-sweetened beverages. The collaboration will run through 2020 and into 2021 as part of Nestlé Waters' commitment to promoting healthy hydration habits and reducing childhood obesity, which affects approximately 13.7 million U.S. children and adolescents.