Avoiding Heat Stroke in Athletes

Summers in Texas bring a unique health risk to vulnerable populations such as young children and senior citizens. Heat related deaths occur every year due to heat stroke. An additional population at risk for heat related illness and death are school age children participating in vigorous sports practices during the height of summer heat. Since 1995, on average three players a year have died of heat stroke in Texas? Pediatricians can advise parents to help kids avoid dangerous heat stroke while participating in sports.

Pediatricians should highlight in visits with their patients these facts about heat stroke:

  • Heat stroke can happen to anyone, but football players and distance runners are at particular risk.
  • Many factors play a role in the development of heat stroke: heat, clothing that restricts sweat evaporation, lack of adaptation to heat, and lack of fitness.
  • The most important factor in preventing heat stroke deaths is quickly identifying when someone is heat exhausted and at risk for heat stroke.
  • COOL FIRST and transport second is the most important thing to remember when someone contracts heat stroke.

To prevent heat stroke, pediatricians should share with their patients the warning signs and the symptoms of heat exhaustion, the milder form of heat stroke. When any of these symptoms occur, adults must help the child to cool down and stop exercising/practicing in the heat:

  • Excessively heavy sweating
  • Muscle weakness
  • Pale, clammy skin
  • Fast heart rate above that expected for exertion
  • Nausea or vomiting
  • Fainting

Parents and coaches need to pay particular attention to the practice of “two-a-days” or the twice daily practice sessions common to many sports teams, typically football teams as they prepare for the fall season. The following are the AAP’s recommendations for these types of sports practices:

  • Providing risk-reduction training for coaches, trainers and other adults.
  • Ensuring trained staff are available on-site to monitor for and promptly treat heat illness.
  • Educating children about preparing for the heat to improve safety and reduce the risk for heat illness.
  • Allowing children to gradually adapt to physical activity in the heat.
  • Offering time for and encouraging sufficient fluid intake before, during and after exercise.
  • Modifying activity as needed given the heat and limitations of individual athletes. Practices and games may need to be canceled or rescheduled to cooler times.
  • Providing rest periods of at least 2 hours between same-day contests in warm to hot weather.
  • Limiting participation of children who have had a recent illness or have other risk factors that would reduce exercise-heat tolerance.
  • Developing and having in place an emergency action plan.

I encourage all Texas pediatricians to make a habit of educating patients on the warning signs of heat stroke and providing tips for safe exercising in the heat!


Brittney Rhem, MD







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