Tuesday, August 16, 2011

Revised Heat Guidelines for Young Athletes

The American Academy of Pediatrics just published their revised heat guidelines called Climatic Heat Stress and Exercising Children and Adolescents.

Some notable comments were:
1. "Researchers have previously suggested that children are less effective in regulating body temperature, incur greater cardiovascular strain, and have lower exercise tolerance during exercise in the heat compared with adults. However, more recent studies, in which both groups were exposed to equal relative intensity exercise workloads and environmental conditions while minimizing dehydration, have compared 9- to 12-year-old boys and girls to similarly fit and heat acclimatized adults. These newer findings indicate thatchildren and adults have similar rectal and skin temperatures, cardiovascular responses, and exercise-tolerance time during exercise in the heat."

2. "Notable chronic clinical conditions and medications that contribute to decreased exercise heat tolerance and increased exertional heat-illness risk include diabetes insipidus,18 type 2 diabetes mellitus,19 obesity,20,21 juvenile hyperthyroidism (Graves disease),22 cystic fibrosis, 23 and anticholinergic drugs or
certain other medications that affect hydration or thermoregulation."

3. "A previous episode of heat stroke, however, generally does not seem to have long-term negative effects on thermoregulation, exercise heat tolerance, or exertional heat illness risk, especially for those who received prompt cooling therapy."

Here are the Action steps recommended:
  • Provide and promote consumption of readily accessible fluids at regular intervals before, during, and after activity
  • Allow gradual introduction and adaptation to the climate, intensity, and duration of activities and uniform/protective gear
  • Physical activity should be modified
  • Decrease duration and/or intensity
  • Increase frequency and duration of breaks (preferably in the shade)
  • Cancel or reschedule to cooler time 
  • Provide longer rest/recovery time between same-day sessions, games, or matches
  • Avoid/limit participation if child or adolescent is currently or was recently ill
  • Closely monitor participants for signs and symptoms of developing heat illness
  • Ensure that personnel and facilities for effectively treating heat illness are readily available on site
  • In response to an affected (moderate or severe heat stress) child or adolescent, promptly activate emergency medical services and rapidly cool the victim
Here are my comments:
WHAT A COP OUT! These are too vague and leave the MEDICAL decision making to non-medical administrators, coaches, and parents. Here are my guidelines based on my 25 years on the side-lines:

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