AAP Revises Heat Safety Guidelines in Exercising Youth

Laurie Barclay, MD

August 15, 2011

August 15, 2011 — Outdoor sports and physical activity in the heat are safe for most healthy children and adolescents given adequate preparation, modifications, and monitoring, according to a revised policy statement of the American Academy of Pediatrics (AAP) entitled "Climatic Heat Stress and Exercising Children and Adolescents," published online August 8 and will appear in the September 2011 issue of Pediatrics.

The new recommendations, which are intended to offer guidance for pediatricians counseling athletes, parents, and coaches involved in conditioning programs for fall sports, describe risk factors for exertional heat illness in youth and possible modifications of sports activities to reduce this risk. Youth sports programs should use comprehensive regimens to prevent health-related illness, including an emergency action plan.

"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 Stephen G. Rice, MD, FAAP, policy statement coauthor and a former member of the executive committee of the AAP Council on Sports Medicine and Fitness, in a news release. "Heat illness is entirely preventable if coaches and other adults take some precautions to protect the young athletes."

The statement reviews new evidence that contrary to conventional wisdom, thermoregulatory ability, cardiovascular capacity, and tolerance for physical exertion are not relatively impaired in youth vs adults exercising in the heat, provided hydration is adequate. Compared with the previous AAP policy statement issued in 2000, the new statement therefore does not give precise recommendations regarding whether games or practices should be canceled if temperatures reach a certain level.

"While coaches should make on-the-field decisions to improve safety for a team or event as a whole, individual participants may require more or less concern based on their health status and conditioning," said coauthor Michael F. Bergeron, PhD, FACSM, director of the National Institute for Athletic Health & Performance at Sanford USD Medical Center in Sioux Falls, South Dakota.

In addition to poor hydration, risk factors for poor performance and exertional heat illness in youth participating in sports and other physical activities in high temperatures include excessive physical exertion; insufficient recovery between repeated exercise sessions or rounds of sports competition; and wearing clothing, uniforms, and protective equipment that retain excessive heat. Exertional heat illness can generally be prevented by avoiding or modifying these risk factors.

Other risk factors to be considered include overweight and obesity, recent recovery from diarrhea or viral illness, chronic physical conditions, poor physical fitness, insufficient sleep or rest, and lack of acclimatization to warm temperatures and/or high humidity when the season of hot weather begins.

"Athletic directors, coaches, teachers and other adults who are overseeing children exercising in the heat should make themselves aware of ways to reduce the risk of heat illness, and they should develop an emergency action plan," said coauthor Cynthia Devore, MD, FAAP, chairperson of the AAP Council on School Health. "This is especially important as we head into high school preseason football."

Specific Recommendations

Specific recommendations include the following:

  • Before, during, and after activity, drinking fluids should be readily available and their consumption encouraged at regular intervals.

  • Participants should be gradually introduced and permitted to adapt to the climate, uniform/protective gear, and intensity and duration of activities.

  • Physical activity should be modified as necessary, for example, by reducing duration and/or intensity, increasing the frequency and duration of breaks and moving them to the shade if possible, and canceling the activity if weather is severe, or rescheduling it to a cooler time.

  • Between same-day sessions, games, or matches, youth should be given longer rest and recovery time (at least 2 hours).

  • Children or adolescents who are currently or who were recently ill, and those with other risk factors, should be permitted only limited or postponed participation.

  • Participants should be closely monitored for signs and symptoms of developing heat-related illness.

  • Trained personnel and facilities to effectively treat heat illness should be readily available on site.

  • Children or adolescents with moderate or severe heat-related stress should promptly receive emergency medical services and rapid cooling.

  • Coaches, trainers, and other adults should receive risk-reduction training.

  • Children and adolescents should be educated about preparing for the heat.

  • An emergency action plan should be developed and implemented.

"Community pediatricians can be instrumental in improving heat safety for children and adolescents engaged in youth sports and other physical activities by actively participating as school team physicians or on school wellness committees or health councils; on school boards; on local, regional, or national sport or sports medicine advisory committees; or in local parks and recreation programs to educate youth and parents and to guide coaches and administrators in developing and implementing effective exertional heat-illness prevention and management strategies," the statement authors write.

"However, field evidence is not currently sufficient to optimally guide pediatricians, coaches, administrators, and youth sport governing bodies in making the most appropriate and advantageous modifications to play and practice specific to heat safety or deciding when to cancel activities altogether if necessary. Accordingly, parents, teachers, coaches, athletic trainers, and pediatricians as well as youth sports governing bodies and administrators should always emphasize and use suitable prevention strategies, to the best of their ability, to improve safety and appropriately minimize the risk of exertional heat illness for all children and adolescents during exercise, sports participation, and other physical activities in warm to hot weather."

Pediatrics. Published online August 8, 2011.

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