Two-A-Days Are Here: Watch Out For Heat Illness

By Dev K. Mishra, M.D., President, Sideline Sports Doc

It’s time for that annual rite of passage for high school football- two a day practices.  With much of the country stifled in sweltering humid weather it’s a good idea for everyone to remind themselves of the spectrum of heat illness in young athletes, and to take some simple steps to try and avoid heat illness.

“Heat Illness” is a broad term used for a range of problems such as dehydration, cramping, dizziness, heat exhaustion and a very serious problem called heat stroke.  Young athletes are at a higher risk than adults for developing heat illnesses.  Children absorb heat faster than adults, they don’t sweat as much (sweat helps the body cool), they take longer to get conditioned to exercising in warmer weather and often they don’t feel the need to drink fluids before or during exercise.  Add to that the fact that helmets and pads trap heat and you can have a dangerous mix of conditions.

What’s the story?

It is possible to have heat illness on a cloudy day, and without being dehydrated.  But still, most young athletes will first start to show signs of heat-related illness through dehydration.  The athlete may come off the field complaining of being tired, having leg cramps or feeling light-headed.  On a hot day, be suspicious of the athlete with poor performance.  They might not tell you anything- be alert.

Here are some things to look for that could signal heat illness:

• Decreased performance
• Fatigue
• Skin that ranges from pale or sweaty to cool and clammy.  If the skin is hot it’s a red flag! (See below)
• Possibly irritable
• Nausea
• Headache
• Light-headedness
• May have difficulty paying attention or following directions.

Basic field management for heat illness:

• Get the athlete off the field and let him lie down in a cool, shaded place.
• Elevate the legs above the level of the head.
• Provide a sports drink (not carbonated, no caffeine).
• Loosen any tight fitting clothing and remove socks.
• If the player doesn’t start to feel better within 10-15 minutes, seek medical help.
• Prevent future dehydration.

Get the young athlete immediate medical attention in some cases:

• Young athletes should respond within 10-15 minutes from re-hydrating.  You should see them “perk up” and get back towards their normal attitude and appearance.  If an athlete does not improve, it may signal more severe dehydration and they should be evaluated in the emergency department of the local hospital.
• “Heat Stroke” is a medical emergency.  In heat stroke, the athlete will have very hot skin that can be wet or dry, a change in normal behavior (confused, irritable), vomiting, and even seizures or loss of consciousness; the athlete will look in obvious trouble.  If you have any suspicion of this, call local emergency services or 911 immediately.
• If you have called for emergency help, start cooling the athlete by applying ice packs to the armpits, groin, or neck.  If ice is not available, squirt cold water over the head and trunk.
• If you have any doubt at all- even the slightest bit- that this is something out of your ability to handle, call for emergency transport.

And here are a few simple tips for minimizing the chances of heat illness in young football players.  Build intensity level gradually over the course of two weeks.  Acclimating to the heat and humidity through progressive fitness is much safer than going all-out right from the start.  Avoid pads until the players are acclimated. Encourage practice in light colored uniforms- dark colors will absorb heat.  And practice a good hydration strategy.