Heat-Related Illnesses in Youth

With school about to start, preseason athletic activities are off and running. Whether it is football, cross country, lacrosse, or marching band practice, children participating in these outdoor activities are at risk for heat-related illnesses (HRI). These illnesses are preventable.

According to the Centers for Disease Control and Prevention:

• 7.5 million students participate in high school athletic activities yearly.
• Heat illness during practice or competition is a leading cause of death and disability in U.S. high school and college athletes.
• Some 5,946 people are treated in U.S. emergency rooms for HRI after sports or recreational activities each year (CDC, 2001-2009).
• Of those 5,946 people, 72.5 percent are male, 35.6 percent are ages 15 to 19, and 7.1 percent are hospitalized.
• Since 1995, 23 high school football players have died from heat stroke.

The responded to the threat of the extreme heat this month by canceling all outdoor activites between noon and 6 p.m. each day.

What is heat illness?

It occurs when body systems used to regulate heat become overwhelmed and cannot compensate for an increase in temperature. Heat and body temperature climb uncontrollably. Risk factors for HRI include the following:

• Obesity.
• Physical exertion.
• Heavy protective clothing.
• Certain medications (anti-hypertensive and diuretic).
• Previous heat-related illness.
• Pregnancy or being at least 65 years old. I included these people because they are often in the stands watching their family members play.

There are three types of HRI:

• Heat cramps. Excessive sweating with strenuous activity can deplete the body of salt and moisture. Low levels of sodium in muscles cause painful cramps. Slowly stretching out the muscle, drinking and eating sodium rich foods at this time can eradicate the problem. If multiple muscles are involved in cramping, medical attention should be sought.
• Heat exhaustion. This is due to excess water and salt loss by excessive sweating. Signs and symptoms include heavy sweating, fatigue, dizziness, moist/clammy skin, pale or flushed complexion, muscle cramps, slightly elevated temperature, and fast/shallow breathing. When this occurs, seek cool shade or air conditioning; drink plenty of water or nonalcoholic beverages, sponge or shower with cool water. Symptoms should improve within a few minutes. If symptoms do not dissipate, seek medical attention immediately.  
• Heat stroke. This is the most serious HRI. Without proper intervention, death can ensue. The body’s core temperature (internal temperature) can rise to 106 degrees or above within 10 to 15 minutes. Signs and symptoms include hot skin, profuse sweating, hallucinations, chills, throbbing headache, fever, slurred speech, and confusion. If these symptoms are present, call 911, get into shade, and apply cold water to the body via sponge cloths and fan the affected person. Applying cold compresses especially to the neck and armpits causes rapid cooling. Sponging with cold water and simultaneous fanning cools the body better than full submersion in water. On a playing field, cool submersion is usually not an option.

The National Athletic Trainers Association suggests the following to prevent HRI because prevention is better than treatment:

• Gradually increase activity in terms of intensity and duration in the heat. This prepares the body for more intense, longer exercise in warm conditions. Acclimatization for 14 days by practice frequency, intensity and athletic equipment being gradually introduced.
• Rest breaks between exercise frames should be practiced.
• Drink water and sport drinks before, during and after practice. Usually 7 to 10 ounces is recommended for every 10 to 20 minutes of exercise.
• Exercise during cooler times of the day.
• Do not participate in sporting activities if you are ill with diarrhea, fever or fatigue.

The CDC is developing an Internet-based course for coaches and other people associated with high school athletics to prevent, recognize and respond to heat-related illnesses.

The National Athletic Trainers Association, American Medical Association and the American Association of Family Physicians agree that board-certified athletic trainers and state-licensed trainers should be working in the high school and college setting. These specialized programs properly educate athletic personnel in preventing and handling acute injuries such as HRI.

See you at the game.