Parents and coaches need to be aware of signs of heat-related illness in young athletes

Children who participate in sports or are physically active in hot weather can be at risk for heat-related illnesses. Each year in the United States, there are a number of tragic stories about young athletes who lose their lives after playing or practicing in the heat. The good news is that heat illness can be prevented and successfully treated.

Matthew Matava
Matthew Matava

Matthew J. Matava, M.D., assistant professor of orthopaedic surgery at Washington University School of Medicine in St. Louis, spends a lot of time in athletic settings. A former athlete himself, Matava is the head team physician for the St. Louis Rams football team. During training camp and the early part of the season, a big part of his job involves treating players who have problems with the heat.

“There are four major things we look for: dehydration, cramping, heat exhaustion and heat stroke,” Matava says. “Those problems can occur when athletes work hard in extreme heat and humidity, but the risks can be even greater in children.”

That’s because children tend to sweat less than adults, making it harder for their bodies to cool off, so Matava says parents and coaches need to make sure kids take things slowly and gradually get used to playing and practicing in the heat and humidity.

He says coaches need to be aware of temperature and humidity levels and change practice length, intensity and equipment as the temperature rises. They also need to make it easy for children to get a drink during practice, with more frequent drink breaks as the temperature and humidity levels rise. Parents also play a part by making sure that their children come to games and practices with a water bottle or a bottled sports drink.

Some children also can be more vulnerable to heat problems if they have a low fitness level. A cold or the flu also increases risk. Others who must be watched closely are those children who have had problems with heat in the past.

“The best case would be to have a medical professional at practice or at games, especially when it’s very hot and humid,” Matava says. “But obviously that’s not always possible, so parents and coaches need to be aware of the danger signals.”


In spite of the fact that children sweat less than adults, young athletes can become dehydrated in heat and humidity, and even a small amount of dehydration can make a child feel bad and play less effectively.

Fluid breaks should be scheduled for all practices and become more frequent as the heat and
Fluid breaks should be scheduled for all practices and become more frequent as the heat andhumidity levels rise. Add 5 degrees to the temperature between 10:00 a.m. and 4:00 p.m. from mid-May to mid-September on bright, sunny days.

“If a child seems very thirsty or complains of a dry mouth or seems cranky, or even if that child doesn’t seem able to run as fast or play as well as usual, those could be warning signs that he or she is becoming dehydrated,” Matava says.

Other symptoms include dizziness, cramps and headache. Matava says children exhibiting those symptoms need to be moved into a shady or air-conditioned area and given fluids to drink. He says a child can return to practice or the game when the headache, thirst or dizziness goes away, but it is important to continue to watch that child closely.

Matava says parents can help prevent dehydration — and other more serious heat-related problems — with a simple experiment. They can have the child step on a scale before practice or a game, and then weigh the child again afterwards. If the child weighs less after the activity, he or she is not drinking enough fluids while active.

Heat Cramps

Cramps are considered a mild form of heat illness, and they can be treated easily. But Matava says children who cramp up should be watched closely in the heat for more serious symptoms.

“Cramps are very intense muscle spasms that can occur when an athlete has lost large amounts of fluid and salt from sweating,” Matava says. “They are most common in the heat, but children also can get cramps when they are not hot, for example when they’re swimming or playing hockey.”

He says children who get cramps should be given a sports drink to help replace fluid and sodium lost through sweating. Light stretching and muscle massage also help. Those children can return to action when the spasms subside, and they feel ready to participate. Matava says good eating and drinking habits, increased fitness and becoming acclimated to heat can help prevent cramps.

Heat Exhaustion

Heat exhaustion is a more serious illness that can occur when a child remains physically active even after he or she begins to suffer from ill effects due to heat, such as dehydration. As the child’s body struggles to meet the demands of competition in the face of dehyradation, heat exhaustion can result.

“The symptoms are relatively easy to spot,” Matava says. “The child will find it difficult or impossible to keep playing. He or she may lose coordination, become dizzy or faint. Stomach cramps, nausea, vomiting and diarrhea also are symptoms.”

Matava says the treatment for children suffering heat exhaustion includes getting a child into shade or air conditioning, removing extra clothing or equipment and cooling the child with cold water, fans or damp towels. It also helps to have a child with heat exhaustion lie down with legs raised above heart level and to have the child drink chilled water or a sports drink, unless there are problems with nausea or vomiting.

“The child’s condition should improve rapidly, but if it doesn’t, it is important to get emergeny medical treatment as soon as possible,” Matava says. “And if a child has heat exhaustion, that boy or girl should not be allowed to play or practice in the heat for at least a day or two. If it was severe enough that the child received medical treatment, games and practices are out of the question until the doctor approves and provides specific instructions for safely returning to play.”

In addition, Matava says parents and coaches should rule out any other conditions or illnesses that may predispose a child to continued problems with heat exhaustion and treat those problems before the child returns to full participation in the heat, especially in sports such as football that require a great deal of equipment.

Exertional Heat Stroke

Heat stroke is a severe heat illness that occurs when the body creates more heat than it can release. It causes a rapid increase in body temperature that can lead to permanent disability or even death.

The symptoms of heat stroke also are more severe and include a core body temperature above 104 degrees farenheit and central nervous system problems such as loss of consciousness, seizures, confusion and irrational behavior. Other signs may include nausea, vomiting and diarrhea, headache, increased heart rate and decreased blood pressure.

“In these cases, it’s critical to locate any medical personnel who are on-site and to get the child transported to an emergency room,” Matava says. “While waiting for the ambulance to arrive, remove any extra clothing or equipment, and immerse the child in cold water if possible or cool the child with damp towels and fanning until medical personnel arrive.”

A child who has suffered heat stroke should not be allowed to return to competition until a physician approves and provides specific instructions for a safe return to play.

“Fortunately, heat stroke is rare, but it does happen, even in children,” Matava says. “So it’s important that parents, coaches and others be on the lookout for problems, and if their team is practicing in the heat, coaches should make sure their players get plenty of fluids and the chance to cool off regularly.”