With the new school year just around the corner, many student athletes are returning to the fields and courts to prep for the upcoming fall sports season. 

But in the dog days of summer, kids can be well hydrated but still at risk of heat exhaustion and heat stroke at practice. And the risk of heat-related illnesses and deaths is higher than ever because of record-high temperatures around the country. Already, one high school football coach and four players have died across the country.

Fortunately, parents, coaches and administrators who oversee youth sport programs, and savvy kids, can mean the difference between safe and healthy competition and worse-case scenarios that cause death.

Oh, we take water breaks

Coaches and players may say they take plenty of water breaks, but it doesnt pass muster. Hydration is integral to safety, but hydration alone doesnt make young athletes immune to heat-related problems; it works in tandem with humidity, sun intensity and duration of exercise.  

According to Dr. Michael Bergeron, professor in the department of pediatrics at the University of South Dakota and director of the National Institute for Athletic Health and Performance at Sanford Health, youngsters may not be as well-hydrated as they or their supervisors think. Theyre overlooking the fact that at the end of practice players bodies are tired and heated; then players are told to do wind sprints and suicide drills. That can put someone over the edge.

Bergeron is one of three lead authors of the recent American Academy of Pediatrics (AAP) policy statement on Climatic Heat Stress and Exercising Children and Adolescents. Even in a temperate environment, heat illness like heat exhaustion and heat stroke, can be a risk for young athletes, and the risk is highest when they are vigorously active outdoors in hot and humid conditions.

Morning misconceptions

Heat-related challenges can occur any time of day, but conventional thinking leans toward the benefit of early-morning activity. 

In a study of 58 athletes between 1980 and 2009, almost 60% died from heat illness in the morning, according to a study done by Dr. Andrew J. Grundstein, associate professor in the department of geography at University of Georgia.

Individual issues factor in

But youngsters bring their own deficiencies to the playing field. Typically, players undergo a preseason physical which took place as far back as early spring. Bergeron says acceptable physical outcomes give coaches a false sense of security.

Adolescents may be partying during the summer, making them overtired, deconditioned and less prepared; current or recent illnesses increase health challenges, especially gastrointestinal conditions like vomiting, diarrhea and/or fever, as do more chronic conditions like Type 2 diabetes, Graves disease and cystic fibrosis. 

Its also not always clear what medicines kids are taking. Dopamine-reuptake inhibitors , for example, prescribed broadly for youngsters with attention deficit hyperactivity disorder can present problems and taken with other supplements can force the kidneys to process this intake collectively. And energy drinks to enhance performance and alertness can interfere with body temperature regulation and blood pressure management.

Larger and overweight and obese players are at higher risk because they store more heat. Of the 58 deaths Grundsteins team studied, almost 95% of athletes who died were overweight and obese.

Uniforms and protective equipment in general down to shirts, pants, socks, gloves and even armbands impede the heat the body can release. This means harder body work metabolically if a player is overweight.

A need for preparedness

Were trying to put the brakes on a strong culture that under a guise of motivation puts pressure to win on kids, says Bergeron, noting the parallel to the precautions be nationally mandated for concussion in sports.

Beyond that, its essential to have an emergency action plan drafted and in place before hand.

The AAP recommends these safeguards:

1.Comprehensive education and a mandate for execution by adults involved with youth sports and preseason high school football

2. Personnel and facilities onsite and at the ready to effectively treat all forms of heat illness

3. Regular education for young people on the importance of proper preparation, ample hydration and honest reporting of deficits on and off the field

4. Gradual, safe adaption to preseason practice; progressive acclimatization exposure typically over a 10- to 14-day period to the environment, intensity, duration and volume of physical activity and to the insulating and metabolic effects of wearing uniforms and protective equipment

5. Accessibility of sufficient sanitary and appropriate fluid which should be consumed at regular intervals before, during and after all practices. Because electrolyte balance is essential, Bergeron recommends high salt solution sport drinks like Gatorade. Its not the volume of fluid replacement but instead the sodium-chloride replacement within that fluid on a day-to-day basis that rehydrates players. Not all sports drinks do this, he says.

6. Sports participation modified for safety in relation to the degree of environmental heat stress: air temperature, humidity, and solar radiation as indicated by the heat index or the wet-bulb globe temperature as the American College of Sports Medicine recommends in its 2005 youth sports guidelines

7. Avoidance or limited sports participation in the heat if youngsters are currently ill or recovering from an illness

8. Trained supervisory staff to closely monitor players at all times during physical activity; understand the requirement to immediately stop participation and seek appropriate medical attention upon noting negative changes in a players appearance or performance

9. An emergency action plan with clearly defined written protocols; includes immediate onsite measures to move the victim to the shade, remove protective equipment and clothing and cool by cold- or ice-water immersion or by applying ice packs to the neck, extremities and groin and ice-water-soaked towels to the rest of the body Equipment doesnt have to be extravagant. Just something to cool an affected player rapidly such as a tub of ice cold water or a small wading pool, Bergeron says. Dunking a player in water could save a life.

10. Youth sports directors should provide adequate two-or-more-hour rest and recovery periods during double sessions

11. When extreme heat or humidity interfere with thermal balance, outdoor contests and practice sessions should be canceled or rescheduled to cooler times of a particular day

We are working with state legislatures and state athletic governing bodies to regulate heat stress from sports in middle- and high-schools, says Bergeron, and mandating better facilities, better plans and a change in policy so that coaches and others managing youth sports cannot work kids to death.