Pediatricians Revise Heat Guidelines for Young Athletes

As temperatures continued to reach dangerously high levels across the parts of the United States on Monday, drawing weather alerts in many areas, the American Academy of Pediatrics revised its guidelines regarding high school and youth sports athletes practicing in hot weather.

In a revised policy statement titled "Climatic Heat Stress and Exercising Children and Adolescents," published in the September 2011 issue of Pediatrics, the AAP recommends that youth sports program administrators implement comprehensive strategies to safeguard against heat illness. "Most healthy children and athletes can safely participate in outdoor sports and activities in a wide range of warm to hot weather, but adults sometimes create situations that are potentially dangerous," says Stephen G. Rice, co-author of the policy statement and a former member of the executive committee of the AAP's Council on Sports Medicine and Fitness. "Heat illness is entirely preventable if coaches and other adults take some precautions to protect the young athletes."

The AAP's announcement comes after what heat-illness expert Douglas Casa called "the worst week in the last 35 years in terms of athlete deaths" - including the heat-related deaths of two high school football players in Georgia and a high school football coach in Texas.

Among the academy's recommendations:• Provide risk-reduction training for coaches, trainers and other adults.• Ensure trained staff are available on-site to monitor for and promptly treat heat illness.• Educate children about preparing for the heat to improve safety and reduce the risk for heat illness.• Allow children to gradually adapt to physical activity in the heat.• Offer time for and encourage sufficient fluid intake before, during and after exercise.• Modify activity as needed given the heat and limitations of individual athletes. Understand that practices and games may need to be canceled or rescheduled until the weather cools down.• Provide rest periods of at least two hours between same-day contests in warm and hot weather.• Limit participation of children who have had a recent illness or have other risk factors that would reduce exercise-heat tolerance.• Develop and have in place an emergency action plan.

The most notable change in the AAP's policy is the recognition that children can tolerate and adapt to exercise in heat as well as similarly fit adults - when adequate hydration is maintained. The previous AAP policy, issued in 2000, suggested that children were less able to tolerate and adapt to heat stress compared to adults, but more recent research has found children and adults have similar physiological responses when exercising under the same conditions.

The revised policy focuses on what factors put kids in danger of exertional heat illness and how adults can modify youth athletic activities to minimize heat illness risk. The policy includes a detailed list of risk factors and possible modifications. But the new statement, unlike the previous one, does not give precise rules about whether games or practices should be canceled if temperatures reach a certain level.

"While coaches should make on-the-field decisions to improve safety for a team or event as a whole, individual participants may require more or less concern based on their health status and conditioning," says statement co-author Michael F. Bergeron, director of the National Institute for Athletic Health & Performance at Sanford USD Medical Center in Sioux Falls, S.D.

As an example, the policy statement describes a healthy 12-year-old who is fit and overweight football player, who recently recovered from diarrhea and is running wind sprints at the end of the second three-hour workout on the first warm day of preseason football, would be at higher risk even if the temperature was only 85 degrees.

"Athletic directors, coaches, teachers and other adults overseeing children exercising in the heat should make themselves aware of ways to reduce the risk of heat illness, and they should develop an emergency action plan," says Cynthia Devore, co-author of the statement and chairperson of the AAP Council on School Health. "This is especially important [in] high school football."

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