Monday, June 09, 2014
Summer has become the season for training, tournaments and games for youth sports. It’s the one season where coaches can have players for large blocks of time and schedule competitive tournaments without having to work around school commitments. It’s a perfect time for everyone involved to get serious about their sport. The downside? It’s summer, and the temperatures combined with the humidity make for some dangerous conditions for young athletes. The statistics aren’t good when it comes to heatstroke injuries and death over the last decade. Heatstroke is the third biggest cause of deaths among high school athletes. We parents need to be sure that our kids play and train safely when the heat index rises.
Heat-related illness in youth players has increased 133 percent from 1997 to 2006. Young athletes account for 47.6 percent of heat-related injuries, the highest group rate. Boys are more likely to sustain these injuries. From 1997 to 2006, 31 football players died of heat-stroke injuries and 64.7 percent were either overweight or obese, a strong contributing factor in the deaths. Although the grueling training that football players go through can lead to dehydration and heat stroke, we parents shouldn’t just assume that heavy exertion is the only thing to fear. Two out of three kids arrive at practices already dehydrated. Even kids playing outside don’t take water breaks often enough and need parents to monitor and insist upon water intake. Overall, the prevention of heat-related illness and death relies on three important factors: 1) Proper hydration; 2) Early identification of heat-related conditions; 3) Proper management and treatment of symptoms.
Before practices or games even begin, players need to hydrate. Gatorade has created products that address the before, during and after of hydration needs, but in reality kids just require sufficient water intake. In the hour before practice, kids should consume proper fluids, which can include sports drinks but need only be as simple as water — drinking at minimum 4 ounces, but 8 ounces would be best. Purchasing a 16-ounce water bottle with ounce lines on the side helps us and our kids know if enough fluids are being consumed. They should be drinking on the way to practice, while the coach is talking, and have their bottle refilled as practice begins. Iced water may taste good, but can cause cramping, so mildly chilled water is a better alternative. We often think about kids losing water during exertion, but most of us can lose as much as two cups of water just being out in the sun and humid weather. Keeping the car air conditioned if possible will help reduce volume lost through normal sweating. Players who lose just 1-to-2 percent of their body weight in during exertion can suffer serious physiological function effects.
Hydration needs to be seriously considered during all practices. Water breaks need to be taken every 20 to 30 minutes. Coaches need to be sure that players replace sufficiently, so watch that kids drink. Thirst is not a good indicator of how dehydrated a child is getting. By the time we experience thirst, we are already well on our way to having serious heat-caused problems. Therefore, even if kids say they aren’t thirsty, they need to drink 4 to 8 oz. during each break. Soccer players naturally have great pride in their endurance of field play. Players go up to 45 minutes without a major break, so they develop a tough guy/gal attitude. However, during times of high heat and humidity, 45 minutes is too long to go without water. Many leagues and tournaments that play during the summer have mandated breaks after 20 to 25 minutes, which most medical personnel say is perfect. Five minutes to rehydrate and cool down can be vital to keeping players healthy on the field.
Hydration doesn’t have to be just pouring fluid down the throats of players. External hydration can be just as important. Here’s the circumstance where ice water can be their friend. Teams should keep a cooler filled with iced wet cloths that players can apply to the back of their necks, their wrists, and their temples to chill themselves down. Having some icy water to pour over their heads and necks can really help lower body temperature, which helps retain fluids. During heat-illness episodes, one of the serious complications is a sudden and severe increase in temperature of 102 to 106 degrees, which can cause seizures, brain damage and death. Ice water will quickly reduce temperatures to a safer level so should always be on hand in case of an emergency.
As important as maintaining hydration before and during exercise is replenishing after exercise. Many adults and young athletes may feel that once they finish the “heavy lifting” they are out of danger of dehydration and heat-related illness, but in fact the stresses of fluid loss and exertion can play out slowly and be just as dangerous 30 minutes to an hour after activity. Therefore, be sure that kids drink at least 8 ounces of fluid following a game and continue to drink for the rest of the day, especially with a high heat index. Most health professionals say we should be drinking half a gallon a day for normal intake. That’s equal to eight 8-ounce glasses of water a day. Another rule is to intake half your body weight in ounces per day. If you weigh 90 pounds, you’ll need a minimum of 45 ounces of water a day. Add another 32 ounces if you do strenuous exercise no matter your weight or size. You can over-hydrate, but that’s really rare so you shouldn’t worry about that. It’s more likely that players will under-hydrate.
The warning signs of heat-related illness come on rapidly and must be dealt with quickly. You need to keep in mind that thirst and dry-mouth come later in the process, so no one should wait until they experience these symptoms. The spectrum of symptoms have two tiers. In the first tier, the symptoms, once recognized and attended to, can result in a cautious return to play. In the second tier, the symptoms require removal from play and often immediate medical attention. In the first tier, muscle cramps are the first serious indication of dehydration. We often see players go down with cramps, which can usually be alleviated on the field with stretching and muscle massage. But the cause of the cramps has to be attended to as well. Players should immediately hydrate, and can usually do so while the cramps are being worked out. Coaches need to watch for flushed faces which are a major indicator of early dehydration. All players will sweat during exercise and particularly during exercise in the heat, but if that sweating continues profusely during a break after being wiped and cooled down, a player should probably sit until the sweating can be controlled. Naturally, any player complaining of thirst or dry mouth should be taken off the field for a break. Players who complain of light-headedness need to sit down and hydrate. When the symptoms progress to the second tier, things take a more serious turn. Fainting, severe dizziness, nausea and vomiting, loss of coordination, abnormally high body temperature and profuse sweating are all symptoms of second tier heat illness. Teams should have an instant thermometer available to take the player’s temperature which can climb to over 104 degrees rapidly if not cooled immediately. The shift from first tier to second tier symptoms can occur in literally a few minutes, so adults need to be watchful of anyone experiencing first tier symptoms. Players should be immediately evaluated and removed from play for the rest of the day. If symptoms persist or worsen, immediate medical care is necessary. It’s always better to err on the side of caution since a kid with second tier conditions can slip quickly into a possible dangerous and fatal medical state.
Most symptoms can be dealt with through simple interventions. Shade with trees, a tent, even an umbrella, should always be available to help a player cool down. Those water bottle fans that spray water while they rotate are actually quite effective in helping to bring temperature down. Ice water cloths and ice water splashes are important to have on hand. Potable water should always be available and used during regular breaks no more than 20 to 30 minutes apart. We stop games for lightning strikes, and we should be just as diligent to the dangers of a high heat index which measures the relationship between heat and humidity. A heat index over 90 indicates activity should be done with extreme caution, an index over 103 means there is danger, and an index over 125 means extreme danger. Experts say that indices over 103 should be considered unhealthy and people should seek cool shelter and refrain from any unnecessary activity. While humid Southern states have higher, consistent heat indices during the summer, “dry heat” states like Nevada can reach a dangerous heat index. For example a temperature of 96 with just 45% humidity qualifies as 104 heat index. Scheduling games in the early morning or early evening hours when the sun is at its lowest point and temperatures are cooler helps alleviate some of the danger. If a club is running a camp, having lunch and indoor chalk board work during the hottest time of day can insure some safety from heat exhaustion and stroke for campers. Coaches should be responsible for keeping track of the heat index, making sure all players are taking appropriate breaks with water and shade, having players remove all unnecessary equipment, and monitoring players’ exercise so that those with less conditioning don’t overdo it. Players should wear light-colored, loose-fitting clothing that can easily allow for evaporation and have water with them at all times. Changing sweaty clothing can be helpful as well.
Studies have shown that flavored waters are consumed more readily and at greater volume than plain water, hence the popularity of sports drinks. But many of these have high sugar content that can actually end up upsetting the stomach, leaching water into the bowels, and causing diarrhea. Therefore parents might want to consider using the flavoring drops from MiO, Dasani and Crystal Light. These contain no sugars, require just a few drops per 16 ounces, and provide a great variety of flavors that kids enjoy. Putting 1/4 teaspoon of salt in 16 ounces of water actually provides the same electrolyte replacement that sports drinks offer at lower cost and without the sugar. The amount of potassium sports drinks provide is negligible. Avocado, bananas, and many citrus fruits can serve as great potassium sources. Whatever we parents can do to insure that our kids drink enough on hot, humid days we should.
Coaches, parents, and players need to take heat seriously rather than just a hardship to be stoically borne. Heat-illness can be dangerous, even deadly, so we need to be watchful for its appearance and diligent in its treatment. It’s better to err to the side of over-caution, than to let symptoms become so serious that they can’t be easily treated. Heat-induced problems come on and progress quickly, often not allowing for time to “wait and see.” Children who take any diuretic medications, have heart arrhythmias, or have any acute medical conditions such as a cold or the flu should either proceed cautiously or not at all when the heat index is above 80. As parents, we can’t be shy about insisting on appropriate water and shade breaks, and we need to be sure our kids have water available at all times. Any child exhibiting serious symptoms of heat-illnesses should be immediately removed from activity, cooled down and hydrated. If the child is disoriented, vomiting, complaining of headaches, or unusually flushed he or she should probably be taken for a medical evaluation or at a minimum placed in an air condition environment and observed. Heat-related deaths are on the rise in the general population and among athletes in particular. When we complain that it’s hot, we need to remember that our active kids, whether at practice or just out in the backyard, can be seriously affected by the heat.