Heat Stroke in High School Football Players: A Lack of Regulation Placing Children at Risk

At the start of every school year, thousands of high school athletes come in excited to hit the field.  Unfortunately, heat related death in high school sports, especially high school football, remains a real risk due to lack of regulations and safeguards in place.  However, these injuries and deaths are entirely preventable by proper practices.  Pediatricians have a duty and an opportunity to protect these athletes from environments and circumstances that put them at increased risk for heat stroke and death.


  • From 1990-2010 there were 38 heat related deaths in high school football.
  • While organizations like AAP, Texas UIL, and others make recommendations, it is up to local school boards and cities to enact specific rules related to preventing heat stroke.
  • While the NCAA has enacted rules that have dramatically decreased the number to heat related deaths, this has not translated to the high school level.
  • The first 2-4 days of football practice, especially if there are 2 practices per day, are when athletes are at the highest risk of heat related injury or death.
  • This problem is most severe in the south, especially with hot and humid weather at the beginning of the school year.


  • Water is the most important prevention for heat related injury and death
  • High school athletes need unlimited access to water during practice as well as mandatory water breaks
  • Coaches should be educated on signs of dehydration and heat injury and remove athletes from activities in this event.
  • Set guidelines should be in place to ensure that all athletic programs protect athlete safety
  • Provide awareness to athletes about pre-season conditioning
  • Have an athletic trainer on the field at all times
  • Provide an acclimation period for athletes during the first few days of practice with less pads and frequent breaks.


  • Individual Patients
    • Provide handouts on heat related injury during athletic physicals (CDC website has information on this topic)
    • Encourage patients to create a specific plan for conditioning prior to the beginning of the season, and encourage them to keep a log of their heat acclimation progress
    • Teach patients to advocate for themselves to their coaches if they feel they are not receiving adequate water or breaks.
  • Local Community
    • Contact the local school board to find out what guidelines are in place to protect athletes from heat related injury
    • Offer to help the local school board or city council draft evidence based heat safety guidelines: the NCAA rules could provide a basic framework
  • State Level
    • Contact your local state representative and senator on the need for set guidelines regarding heat related safety
    • Contact the state-wide school athletic governing board to advocate for strict guidelines as opposed to recommendations.

Tyler Terrill, M.D.











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