Heat Index Reaches Danger Zone For Young Athletes

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NASHVILLE - As students prepare to return to school this week, Middle Tennessee is under a dangerously high heat index. The unprecedented high temperatures in Middle Tennessee call for precautions for all children, and experts at the Monroe Carell Jr. Children’s Hospital at Vanderbilt have special advice for parents and coaches involved in youth sports.

“We have been seeing an average of one child every day (due to heat-related incidents) for the last few days,” said Thomas Abramo, M.D., director of Pediatric Emergency Medicine.  “These children have generally been at sports practice or at least an all-day outdoor camp and have had heat stress and heat exhaustion. Earlier in the summer we treated two football players with full-blown heat stroke. Those athletes spent time in our critical care unit and face a long recovery,” Abramo said.

Andrew Gregory, M.D., assistant professor of Orthopaedics and Pediatrics, says the start of the season is the most dangerous time for heat stroke, and football is the sport where the risk is the highest.  When the body’s core temperature reaches a critical level, the body can literally begin to cook.

“If the internal temperature stays high organs begin to be damaged, and if untreated, heatstroke leads to multiple organ failure and death,” Gregory said.

Because he serves on the Youth, Sports, Health committee for the American College of Sports Medicine as well as the American Academy of Pediatrics (AAP) Council on Sports Medicine, Gregory speaks at national events, advising coaches to adopt a basic safety plan that includes canceling outdoor practices when the heat index reaches 104.

“What many people don’t realize is the heat index can quickly get that high even when temperatures are in the 80s because of high humidity. A higher humidity means that the body’s sole mechanism of cooling itself--- evaporation of sweat--- no longer works,” Gregory said.

Gregory says that even drinking plenty of fluids cannot fully protect athletes. Coaches need to take into account that it takes most people one-and-a-half, to two weeks to acclimate to the heat if they’ve been spending most of their summer inside in the air conditioning. Caution should be taken to reduce the length and intensity of exercise during a heat wave, as well as lightening up on clothing requirements.

“In college football, they do not wear full uniform and pads until at least day five to allow athletes to acclimate to the heat during exercise. They also refrain from twice-a-day practices for the first two weeks. That would be a good plan for high school and youth sports teams to adopt,” Gregory said.

If a coach or other observer notices a change in the behavior in an athlete, and heat is suspected to be the cause, it is important to be prepared with an ice bath and a way to determine a core body temperature.

“Taking an athlete’s temperature in their ear or mouth or on their forehead is not enough. They may be cool on the outside, but hot in the core of their bodies. Unfortunately, the only way to determine body core temperature is a rectal thermometer. If it indicates a core temperature above 102, that athlete needs to be cooled immediately, even before EMS arrives, with an ice bath. Organ damage begins to occur at a temperature of 104,” Gregory said.

If the outdoor heat index is under 104 and practices are scheduled, proper hydration can help keep children and young athletes safe in the heat. But because of the extended heat wave, it is likely many children are chronically under-hydrated.

According to the American Academy of Pediatrics (AAP), children are often unable to recognize the warning signs of heat illness, so adults need to be vigilant.

Key symptoms of heat stress:

• Complaints of a headache

• Feeling tired or acting confused or combative

• Decreasing bathroom breaks/darker urine

• Nausea

• Unsteadiness or dizziness

Encouraging children to drink frequently during regular outdoor activities is crucial. The AAP recommends cold tap water every 20 minutes in order to stay well hydrated.

Along with hydration, other precautions can be taken to prevent heat-related illness:

• Avoid intense outdoor activity from 10 a.m. to 2 p.m., the hottest part of the day.

• Rest frequently in the shade.

• Wear light-colored and lightweight clothing.

• Cover up. Wear a hat, sunglasses and sunscreen of 15 SPF or greater.

• Drink, even if you don't feel thirsty.

• Stay indoors during extreme heat, using fans and air conditioning to cool the air.

• Never leave children alone in closed vehicles, even for a short period of time.
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