Protecting Young Athletes from Heat Stroke

Young athletes participating in outdoor sports are at risk for heat illness. The medical team at Arkansas Children's prepares for more athletes to visit our Emergency Department needing treatment for heat exhaustion and even heat stroke every fall.

Unfortunately, nice breezy summer days mean young athletes may not have had a chance to acclimate to the intense Arkansas heat – an important part of preventing heat illness.

Parents, coaches and their own teammates need to be on the lookout for signs of heat illness.

Each summer, especially when it is unusually hot, we treat multiple football players in our Pediatric Intensive Care Unit for heat-related illnesses. Early treatment prevents long-term damage and can save lives.

What does heat illness look like?

Heat illness can develop gradually or progress rapidly. Parents, coaches and athletes should watch for symptoms such as:

• Noticeable, increased thirst
• Muscle cramps
• Weakness
• Decreased performance
• Nausea
• Headache
• Fatigue, light-headedness or dizziness and difficulty paying attention.

More serious symptoms, such as confusion, unusual behavior, collapse during exercise, seizures or loss of consciousness, may indicate exertional heat stroke. This is a life-threatening medical emergency that requires immediate treatment.

What can I do to prevent heat illness?

Jonathan Elrod, a member of the Sports Medicine team at Arkansas Children's, says the first step in preventing heat illness is heat acclimatization.

"We want kids to gradually spend longer periods exercising outdoors as they prepare for summer practices," Elrod said. "Giving the body time to adapt to exercising in the heat is one of the most important ways to reduce the risk of heat illness."

A few basic good health principles can also help:

• Getting a good night's rest
• Eating a well-balanced diet of fruits and vegetables
• Drinking plenty of water and sports drinks
• Avoid drinks high in sugar or caffeine
• Never drink energy drinks before or during athletic activity

Athletes should also wear lightweight, moisture-wicking clothing whenever possible and avoid unnecessary layers that trap body heat. Elrod said, "Wearing lightweight clothing and allowing sweat to evaporate helps the body cool itself naturally during exercise."

Hydration Matters

Hydration is one of the most effective ways to help prevent heat illness.

Children and teens should have unrestricted access to water before, during and after activity. Compliance is just as important as the type of beverage. Water is the best choice for most athletes, but flavored sports drinks may be appropriate for longer or more intense workouts if they encourage athletes to drink enough fluids.

Schools should also provide scheduled hydration breaks and designated shaded or cooled areas where athletes can recover during periods of extreme heat.

Environmental Conditions Matter Too

Temperature alone does not determine whether conditions are safe for exercise.

Schools should be using a Wet Bulb Globe Temperature (WBGT) device, which measures temperature, humidity, sun exposure, wind and other factors to better estimate the body's heat stress during activity.

WBGT readings, combined with the Arkansas Activities Association's activity modification guidelines, help coaches and administrators make informed decisions about:

• Adjusting practice times
• Shortening workouts
• Increasing the frequency and length of rest breaks
• Modifying workout intensity
• Limiting protective equipment when environmental conditions become hazardous

These preventive measures significantly reduce the risk of heat-related illness, but they cannot eliminate it completely.

Preparation Saves Lives

Even when schools follow every recommended prevention strategy, exertional heat stroke can still occur.

Because every minute matters, schools should be prepared to recognize and respond immediately when an athlete develops signs of heat stroke.

Arkansas law requires schools to maintain venue-specific Emergency Action Plans for athletic emergencies, including heat illness. Public school employees are also required to receive training on recognizing and responding to heat-related emergencies.

When exertional heat stroke is suspected, rapid cooling is the priority. The most effective treatment is immediate cold-water immersion while emergency medical services are activated. Sports medicine professionals often summarize this approach with a simple phrase: Cool first, transport second.

The Importance of Athletic Trainers

One of the best ways schools can prepare for athletic emergencies is by providing access to a certified athletic trainer.

Athletic trainers are licensed healthcare professionals who specialize in preventing, recognizing and responding to emergencies such as exertional heat stroke, concussion, sudden cardiac arrest and cervical spine injuries. They also help schools develop emergency action plans, educate coaches and athletes and coordinate emergency care when every second counts.

Having an athletic trainer available can provide an added layer of protection for student-athletes by helping schools prepare for emergencies before they happen and ensuring a rapid, coordinated response if one does occur.

Questions Every Parent Should Ask

As young athletes prepare to begin their seasons, parents should consider asking your school's coach, athletic director or athletic trainer these questions:

• Does the school use a Wet Bulb Globe Temperature (WBGT) device to monitor environmental conditions?
• Does the athletic program follow the Arkansas Activities Association's heat acclimatization and activity modification guidelines?
• Do athletes have unrestricted access to water and scheduled cooling breaks?
• Is cold-water immersion available if an athlete develops exertional heat stroke?
• Does every athletic venue have a written Emergency Action Plan, and is it practiced regularly?
• Does the school have the equipment and a plan in place to begin rapid cooling for an athlete with a suspected heat stroke?
• Does the school have access to a certified athletic trainer?

Working together, families and schools can help prevent heat illness, recognize emergencies early and ensure every young athlete has the best possible chance for a safe and healthy season.