Heat Illness and Hydration in Young Athletes

Heat Illness and Hydration in Young Athletes
Posted on 09/27/2018
Male athlete hydrating

Some of the common risks for athletes, especially during the fall season, are heat illnesses and dehydration. According to the National Athletic Trainers’ Association: “Heat illness during practice or competition is the leading cause of death among U.S. high school athletes.” During the late summer and early fall months, not only do we see relatively high temperatures but also a fluctuating level of humidity that can dramatically increase the heat intensity. All of this, coupled with our high altitude here in Colorado, leaves high school athletes predisposed to risks of heat illness and dehydration.

Heat illness can vary in severity and symptoms but can become fatal if left untreated. This is why it is important to recognize early onset symptoms and treat accordingly. Some early signs and symptoms of heat exhaustion can include:

-Flushed face with cool skin
-Excessive sweating or lack of sweat (dehydration)
-Abnormal vision: seeing spots, darkness, white spots, etc.
-Muscle cramps
-Dizziness, nausea, confusion, lightheadedness, or verbal fatigue

Basic steps we can take to limit exposure to the early stages of heat illness can include acclimatization for the athletes (with the coaches), maintaining hydration and fluid balance throughout the day and during practice/exercise, understanding environmental changes and reacting accordingly (i.e. humidity and heat), and helping bystanders such as coaches, teachers, and parents recognize and act on early stages of heat illness that present in athletes. The sooner we can recognize and act to help an individual who is suffering from a heat illness, the sooner we can work to rehydrate and cool him/her so that symptoms do not worsen.

Simple steps to take if we notice any of the above heat illness symptoms include:

-Getting out of the heat into a cool area (shade or indoors)
-Removing excess sports gear or clothing
-Drinking electrolyte and mineral enhanced water (i.e. Gatorade)
-Possibly apply a cold, wet ice towel to the head
-Cold water immersion for more severe symptoms (heat stroke)
-Monitor closely for increased severity and activate EMS (911) or monitor until all symptoms subside

Acclimatization should take place over 7-14 days in pre-season, particularly in equipment-laden sports per the NATA 2015 Position Statement on Exertional Heat Illness. With the start of activity in higher heat environments, understanding environmental changes in key in practice planning. Additional rest breaks and modification of the work-to-rest ratio are two important pieces for consideration with intensity of activity and high humidity or temperature. These rest breaks and acclimatization will allow athletes to re-hydrate or begin using water more efficiently to help with heat dissipation during exercise.

Many people already understand the need for water, but when these symptoms start to occur the athlete is already likely in a dehydrated state and may even be depleted in certain vitamins and mineral stores. For example, some muscle cramps can come from lowered potassium and sodium levels. When these symptoms start to occur and heat is a factor, water intake alone may no longer be enough. The vitamins and minerals lost through sweat can be replaced through an electrolyte-replacement beverage. Athletes in season should stick to water and sports drinks and avoid sugary drinks such as soda, as these have no nutritional value to their bodies during exercise. Steps you can take to prevent this aspect of dehydration and its contribution to more severe heat illness include:

Drink enough plain water (take your athlete’s body weight in pounds and divide by half to determine the amount of ounces they should be drinking. Ex: 200 lb athlete needs 100 oz of water daily.)

This number will likely go up when athletes are in-season and/or when they have a hard game or practice in hot weather. However, an individual fluid maintenance plan is best.

There is such a thing as drinking too much water and depleting the body of sodium; this is called hyponatremia. Alternating water with Gatorade or another electrolyte-enhanced sports drink can help to keep a balance. Here are a couple tips:

Take the pee test! Healthy hydration shows up in urine. The color of urine should be a light yellow showing adequate hydration. The color can be affected by nutrition and medications but this is a good rule of thumb. If the urine is clear, your athlete has drunk too much water and needs to switch to Gatorade. If the urine is dark yellow, your athlete needs more water.

Weigh yourself before and after practice to monitor fluid loss. Fluid loss during practice should be replaced before the next day’s practice.

Eat potassium-rich foods such as baked potatoes (930 mg), dark leafy greens like spinach (840 mg), cantaloupe (430 mg), and bananas (420 mg).

In summary, the most important things we can do to help prevent heat illness and dehydration are prevention, education, and recognition of early signs. Many athletes try to “tough it out” during a hard practice or game and may not take advantage of structured rest breaks or take in fluids during those breaks. Education is often the key to making sure they don’t ignore symptoms like those mentioned above.


1. National Athletic Trainers' Association Position Statement: Exertional Heat Illnesses. Douglas J. Casa, Julie K. DeMartini, Michael F. Bergeron, Dave Csillan, E. Randy Eichner, Rebecca M. Lopez, Michael S. Ferrara, Kevin C. Miller, Francis O'Connor, Michael N. Sawka and Susan W. Yeargin. Journal of Athletic Training Sep 2015, Vol. 50, No. 9 (September 2015) pp. 986-1000.

2. National Athletic Trainers' Association Position Statement: Fluid Replacement for the Physically Active. Brendon P. McDermott, Scott A. Anderson, Lawrence E. Armstrong, Douglas J. Casa, Samuel N. Cheuvront, Larry Cooper, W. Larry Kenney, Francis G. O'Connor and William O. Roberts.Journal of Athletic Training Sep 2017, Vol. 52, No. 9 (September 2017) pp. 877-895.

Article By:
Pederson, Lindsey., ATC, CAFS
Bricker, Anthony., ATC
Legend High School

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