The American Academy of Pediatrics released new guidelines today for managing student-athletes in extreme heat.
Published online in the journal Pediatrics, the guidelines come on the heels of the news that at least three student-athletes died last week during the recent heat wave.
The academy cited new research that shows, despite what was once previously thought, young athletes aren't more susceptible to heat-related illnesses while exercising, at least if they remain adequately hydrated. It notes that the main risk factors for student-athletes working out in heat—undue physical exertion, insufficient recovery time between vigorous activity, and inappropriate use of clothing or equipment—are all modifiable, which means "exertional heat illness is usually preventable."
The new guidelines include 11 main suggestions for schools, including:
• Educating coaches, athletic trainers, and administrators about the risks of heat illness and having them implement risk-reduction strategies. Student-athletes should also be educated about the merits of proper preparation, hydration, and honesty in reporting heat-illness symptoms.
• Mandating that all student-athletes go through a 14-day, graduated return to physical activity, where the intensity and duration of the physical activity increases as the student-athletes progress.
• Providing ample access to water for student-athletes. The academy recommends providing roughly a half cup to a cup of water every 20 minutes for ages 9-12 and up to five to six cups of water per hour for teenagers. (The older the student-athlete, the more water they should be drinking.)
• Changing the intensity/duration of physical activity in extreme heat and increasing the frequency of breaks. In conditions of extreme heat, forcing teams to reschedule practices or hold practices indoors.
• Ensuring that coaches closely monitor student-athletes for symptoms of heat illness and removing them from participation immediately if symptomatic.
• Establishing an emergency action plan with clearly defined protocols developed before athletic activity begins.
• Requiring that schools provide at least two hours of rest between same-day physical activities in warm or hot weather "to allow sufficient recovery and rehydration."
"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," said Dr. Stephen G. Rice, co-author of the policy statement.
"Heat illness is entirely preventable if coaches and other adults take some precautions to protect the young athletes."
Many of these recommendations—specifically, the education component, the "closely monitor and remove from play immediately" aspects, and the establishment of an emergency response plan—mirror many states' recommendations on how to deal with concussed student-athletes. In regard to heat-specific physical activity, the National Athletic Trainers' Association also recently endorsed the gradual, two-week acclimation period.
With roughly 9,300 student-athletes missing practice or game time each year due to heat-related illnesses, according to the U.S. Centers for Disease Control and Prevention, these suggestions from the AAP should give schools more guidance as fall sports practices start back up.
It's also worth noting that a number of state athletic associations have their own rules regarding student-athlete exposure to extreme heat. The Tennessee Secondary School Athletic Association prohibits teams from practicing when the heat index reaches 105 degrees; the Michigan High School Athletic Association says to cancel athletic events when the wet-bulb globe temperature exceeds 90 degrees. (A wet-bulb globe temperature measures environmental factors correlated with physiological responses to heat, and is calculated by using a black globe thermometer, a natural wet-bulb thermometer, and a dry-bulb thermometer.)
The AAP's new guidelines don't give a precise temperature cutoff for the cancellation of athletic activities. Its previous guidelines, released back in 2000, called for all athletic activities to be cancelled once the WBGT exceeded 85 degrees.
Photo: A member of the Salina South High School soccer team works out for conditioning training in Salina, Kansas. Playing sports in hot, steamy weather is safe for healthy children and teen athletes, so long as precautions are taken and the drive to win doesn't trump common sense, the nation's largest pediatricians group said on Monday.
(Tom Dorsey/Salina Journal/AP-File)
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