Monday, June 24, 2013
Summer came officially on June 21. I know some of you have been under the heat canopy for several weeks already and others, like we Wisconsinites, have been anxiously awaiting some summertime weather. No matter your temperate zone, there’s no denying that summer brings concerns about our kids and their hydration. As the thermometer rises and exercise continues, kids can lose vital water, electrolytes and protein while at practices or during games. We parents needed to stay alert to the symptoms and effects of dehydration to prevent significant health issues. Every year hundreds of kids suffer from serious cases with some leading to the need for long-term treatment and even death. We often overlook the creeping signs of dehydration because by the time they are apparent, children are already in distress. It’s important to understand what the dangers are and how to avoid them as we set out this summer for tournaments and rigorous practices.
What exactly happens with dehydration? The body needs water to function. Many organ systems can’t operate without sufficient fluids and the electrolytes that go with them. When the body has a deficiency of water it will turn off various water depleting functions. Kidneys shut down and therefore don’t release toxins which build up. The body quits sweating, which interrupts the natural cooling process. Muscles, including the heart, begin to cramp due to poor electrical firing. According to the LiveStrong.com web site, symptoms of dehydration include dry mouth, decreased urination, lethargy, low blood pressure, rapid pulse, loss of skin elasticity and even shock. However, the most obvious sign of dehydration in young players would be cramps and dizziness. Drinking small amounts of fluid may be sufficient if you have mild dehydration. However two serious problems can arise from more advanced dehydration: heat-exhaustion and heat-stroke.
defines heat-exhaustion as the overheating of the body through dehydration and high external temperatures during strenuous exercise. The body temperature rises but remains below 104 degrees Fahrenheit. Since the body cools itself through sweating, high humidity interferes with the ability for sweat to evaporate and cool the body down. In this more extreme form of dehydration, the effects are magnified such as the fluid-deprived body going into protective mode and restricting. When lost through sweating, electrolytes, which fuel our body’s electrical needs such as the firing of our muscles including the proper beating of our heart, need to be replenished by taking in fluids. In most cases just balancing the mix of water with electrolytes already present in the body would be sufficient if we keep up with fluid loss. However, players who regularly get cramps during games are often suffering from low electrolytes or a poor ratio of fluids to electrolytes. Just as cramps are an important signal that the body is suffering from dehydration, they can be a precursor to heat-exhaustion. Look additionally for flushed skin, especially around the face and hands, disorientation, elevated body temperature and complaints of a sick stomach.
Heat-stroke is far more serious. It can occur rapidly and requires immediate medical intervention. Signs of heat-stroke include unconsciousness, convulsions, dry skin, vomiting and even diarrhea. When any of these symptoms appear adults should not hesitate to call in emergency personnel. Heat-stroke is due to the body completely shutting down the cooling system and can be further complicated by various medications and/or humidity. Since once the extreme symptoms of heat-stroke appear they can rapidly cause severe mental and physical damage including death, it’s important to address the less dangerous symptoms of dehydration as early as possible.
How do we treat heat-exhaustion? The best treatment is prevention. We need to insist that players take hydration breaks regularly every 15 to 20 minutes during both practices and games. For the youngest players taking a break during games is easy because the half doesn’t last very long, but for older players it becomes more problematic. The standard for when games should be interrupted for hydration breaks should be temperatures above 80 degrees Fahrenheit and humidity above 60%. Referees need to look for natural breaks such as after a goal or when a ball goes out of bounds so as not to disrupt the equality of action, but breaks do need to be taken to insure the safety of all the players.
Additionally players should have available cool wet cloths to put on the areas of their body where the blood flows close to the surface such as the wrists, temples and back of the neck. Many teams purchase two or three dozen cheap wash cloths and keep them in a cooler of water and ice near the benches. I would also suggest keeping fluids and cloths on the opposite sidelines so players can get a quick treatment without needing to run the width of the field. Remember that throwing drink bottles on the field is not allowed, so players have to come over to the sidelines to retrieve them. Same holds for the cloths. I’ll cover the various options to provide for hydration in a moment. If a player exhibits signs of heat-exhaustion he or she should be pulled out of the game and allowed to rejuvenate before returning to play. This also gives adults a chance to detect if heat-stroke is possible. The sooner heat-stroke is dealt with the more likely it won’t have adverse effects.
How do we treat heat-stroke? If a player exhibits any of the signs of heat-stroke, he or she needs immediate medical care. Drinking down eight ounces of water isn’t going to resolve the issue. These players need IVs, watchful care and treatment by EMTs and physicians. Again, the methods used to prevent heat-exhaustion can also prevent heat-stroke, but if the temperatures are very high over 90 degrees with high humidity over 60% then players need to be rotated often during practices and games. Every 15 minutes a fourth of the players need to take a break and replace the next group coming out 15 minutes later. Shade is essential, so teams should consider investing in a 10’ X 10’ awning that would be available during practices and travel with the team to games and tournaments. There are water bottle fans which spray water through the blades of a cooling fan that can be quite helpful in lowering body temperature and providing the cooling skin effect that sweat should be accomplishing. In no case in the face of the serious symptoms of heat-stroke should the adults hesitate in getting medical attention. Better to err on the side of treatment since once heat-stroke sets in players can go from very healthy to serious health risk in merely a few minutes. We have read the stories of kids who suddenly dropped to the ground, convulsed and died. While rare, it happens often enough to warrant our attention. We can help insure that players never get to this point with these important steps of fluids, cooling and enforced rest in shade.
What fluids should we use? For most young players water is sufficient. They don’t play hard enough and long enough for extended electrolyte loss, but they can still get dehydrated leading to cramps and general wooziness. Water can also be flavored, although we need to read the labels and be sure the water has less than 10 grams of sugar. Sugar can actually cause water to be leeched into the stomach to break up the sugar molecules, increasing the symptoms of dehydration. Small amounts of sugar can be beneficial in terms of boosting energy, but pure water is overall the best option for most young players. Water is readily available, easy to transport and inexpensive if you use your own water bottles and jugs. If you feel better knowing that the water is filtered, there are great reusable bottles which included a water filter so you can safely replenish your water using the taps at the field or hotel. Brita, Rubbermaid and CamelBak all offer filtered water bottles on sites like Amazon for less than 20 dollars each, and in many cases less than 10 dollars. Keeping several of these in your soccer box in the trunk of your car insures you’ll have fresh water available and be kind to the environment.
Since many kids want to be like their favorite sport star, they want to use the product they promote. These sports drinks can provide the essential electrolytes of potassium and sodium as well as energy producing carbohydrates. But parents need to be cautious of the latter since carbohydrates can actually impair hydration, add calories to the daily diet and provide a quick burst of energy followed by a crash. There are also sports drink drops made by Gatorade, Powerade and MiO Fit that can be added to water. These are convenient and less expensive than buying bottles of sports drinks. You can fill a child’s water bottle, reuse the water bottle and keep costs down. However, it is more difficult to control the actual dilution and amount of electrolytes. Parents also need to keep an eye on the amount of sodium their children are ingesting every day. Even though kids will sweat some out, parents still need to watch their child’s sodium intake. Gatorade Recover Shake has 540 mg of potassium which is a healthy, replenishing amount, but the amount of potassium in their other products and in other sports drinks is negligible, probably because the taste of potassium is pretty gross. Overall the sports drink vs. water controversy comes down to taste rather than which is more beneficial. If it tastes better, players will drink more. During exercise it is recommended that athletes consume four to six ounces of fluids every 15 minutes. If drinking a flavored sports drink helps a child achieve that goal, then go for it.
Another excellent hydration source but not as well-known is coconut water. Coconut water comes from young green coconuts where the water occurs naturally to nurture the endosperm during development and differs from coconut milk, which comes from brown mature coconuts and is squeezed from a mash of the nut meat. Coconut water has seen a surge in popularity as media and sports stars have embraced it as an excellent way to restore fluids and electrolytes. It is naturally high in potassium and anti-oxidants plus it has protein and a broad spectrum of vitamins while being low in sugar and fat. It provides 10 percent of the daily recommended dose of potassium, which is helpful for athletes who lose this electrolyte during activity. Vita Coco now offers juice boxes of flavored coconut water for kids. The problem with flavored coconut water is that sugar is added with the flavoring. So parents need to watch the labels. For one juice box of kid’s Vita Coco there are 8 grams of sugar which falls in the limits so long as kids don’t consume box after box. Coconut water has a salty taste due to the potassium, so most kids will not want to drink the pure form, but the flavored water should appeal to them, just as flavored sports drinks do.
All too often we take the position that something can’t happen to us. We may think it shows weakness to stop the game for fluid breaks or to rotate players out of practice, but nothing could be further from the truth. We show our strength in protecting our kids from potential harm. There isn’t a game or a practice worth endangering a child’s health when preventive measures can ensure a safe experience. We buckle our kids up in the car, hand them their helmets when they go out to bike or skateboard, teach them stranger danger, show them how to safely cross the street, take them under cover during lightning strikes and exercise other protective efforts without feeling that we have exhibited a weakness. We simply want to do our best to assure as much safety as possible. We need to do the same with hydration. It’s not that disruptive or complicated to guarantee the maximum risk-free playing environment for all our players young and old. These suggestions go for adults as well who train and referee our kids, even we parents who sit in the sun and humidity. None of us is immune from the dangers of dehydration, so all of us need to exercise the same vigilance.