Safety and Preparation for Warm Weather Sports: Part I by Mark B. Levin, M.D. and Louis J. Tesoro, M.D. The Pediatric Group, P.A., Princeton

This is the fourth article in a series written for Princeton Online on summer hazards. Part II of Safety and Preparation for Warm Weather Sports continues the series.

Sports are fun. They teach teamwork and build character, endurance, coordination and cardiovascular conditioning. But in order to enjoy sports and maximize the potential benefits derived from sports, certain safeguards must be taken, including medical clearance, proper training and coaching, proper co-participant selection, understanding how to manage injuries, environmental adaptation and conditioning and sport-specific injury prevention. In the article that follows, all but sport-specific information will be discussed. This last issue will be addressed in the fifth in this series of articles.

Medical clearance: Right off the bat, if your child has any underlying medical condition, consult his or her doctor regarding the advisability of participation in a particular sport. With proper guidance, most children, even with medical conditions, can and should participate in sports.

Coaching and training: Regardless of the season, proper coaching is basic to learning proper technique. Teaching sports in suitable facilities, providing adequate protective gear and instilling a commitment to teamwork, fair play and sportsmanship engenders a positive self-image and a lifelong enjoyment of sports. Encouragement of preadolescents by parents or coaches to be ruthlessly competitive detracts from the pleasure sports can provide to the child and discourages further participation. It has been said that sports performance is 90% technique and 10% strength. Proper technique not only allows more injury-free participation, but enhances performance. Patient, supportive teaching of technique enhances all the aspects of sports participation.

Co-participant selection: Children undergo physical development at different rates and ages. In the event of a collision in contact sports, those who are pubertal can seriously injure those who are not because of their greater mass and speed. Even in non-contact sports, matching participants by developmental stage rather than age is important. It is unfair to mismatch children in swimming or tennis, even though it may not be dangerous. Ask your physician about your child’s developmental stage and what type of sports and what level of participation would be appropriate.

Understanding how to manage injuries: Injuries are commonplace in sports. Of particular concern are head injuries. There is a common misunderstanding of what a concussion is and how to deal with the athlete who has had a concussion. Any alteration in mental status (confusion, disorientation, immediate or delayed amnesia and/or loss of consciousness, even for a few seconds) constitutes a concussion. In EVERY case of concussion, the participant should be IMMEDIATELY removed from the event. Always check with the team physician or your child's doctor regarding the advisability of returning to sports after a concussion. Since repeated head injuries can increase the severity of the long term outcome, err on the side of caution.

Any organized sports event should be monitored by someone with knowledge of first aid and the approach to the injured child. When a child is injured, whether the injury involves the neck, trunk or extremities, do not move the child. If the child spontaneously moves or gets up, you can be more comfortable that the injury is not serious. But if an injured child is not moving, improper management can worsen the injury. If the child is unable to move after a brief time, it is best to summon the First Aid and Rescue Squad. For a more detailed discussion on sports-specific injuries, watch for the next article in this series, SAFETY AND PREPARATION FOR WARM WEATHER SPORTS: Part II- Sport Specific Injury Prevention.

Environmental adaptation and conditioning: The need to avoid sunburn, heat stroke, heat exhaustion, dehydration is common to all warm weather sports.

Sunscreen remains as important to the athlete as it is to the sunworshipper. Please refer to our previous article on Sunscreens for information on protection from the effects of ultraviolet light. Have your child apply an appropriate sunscreen about one-half hour before going outside. Teach your child to seek a shady spot when resting to avoid overexposure.

Both high and low humidity on hot days have their respective risks. When humidity is high, the air quality is often poor. People with normal lungs may have difficulty breathing and become sluggish, tired and less coordinated. The likelihood of injury increases under these conditions. More important, perspiration becomes more difficult in a high humidity environment, so children are less able to dissipate the heat their bodies create during activity. Increases in blood flow to the skin rob the brain of needed oxygen, causing children to become flushed and dizzy. This is called heat stroke. It is imperative in this situation to move the child to a cool environment and sponge him or her with cool water. Keeping the feet elevated allows adequate blood flow to the head. The best way to avoid this trouble is to keep children in a cool area between 10 a.m. and 2 p.m., the hottest part of the day. Give them plenty of cool fluids to drink and allow them plenty of time to rest. Recognize the early signs of heat stroke and act quickly. Clothing made of the newer “wicking” materials that pull perspiration away from the body can cause a clinical condition similar to that seen in low humidity conditions. Read on.

When humidity is low, children can lose a tremendous amount of fluid through their breath and skin without realizing it. Their perspiration evaporates quickly, making them feel cool despite their precarious fluid balance. When their body fluid is depleted, they can no longer perspire. Body heat builds. They become dizzy and uncoordinated and may pass out. Injuries may result. Like heat stroke, this heat exhaustion is treated by cooling a child with shade, air conditioning, cool sponging and copious fluid intake. Keeping the feet elevated helps in this situation, as well. The same guidelines apply for prevention: avoiding the hottest times, drinking fluids, resting, cooling down during rest periods.

Well conditioned children are less apt to suffer consequences from heat. Children whose bodies are less well conditioned exert more energy to accomplish the same athletic task as a better conditioned child and tire more easily. They are also more prone to musculoskeletal injuries. The best way to be "in shape" for any sport is to be active all year around. Staying in shape is easier than reconditioning at the start of a new sports season.

Conditioning is different for endurance sports, such as distance running and swimming, than it is for sprint sports, such as soccer and baseball. To be in proper physical condition, a child should begin regular exercise sessions at least 4-6 weeks before the onset of the season. But it is up the individual to do this on his or her own. School athletic conference rules often prohibit organized sessions this early.

Children are at their most flexible stage between 5 and 9 years old. Ironically, when children become more serious about competitive sports, between 12 to 14 years old, rapid growth and increasing muscle mass make them much less flexible! Unfortunately, adolescents usually do not take preparation seriously. Stretching repeatedly through the day is instrumental in avoiding injuries and cramps. By discussing this with many athletes over the years, we have heard that many coaches are good about having children stretch before sports, but may neglect stretching afterwards, which is just as important. Coaches of Soccer, gymnastics and dancing are notable exceptions. Virtually no children are aware that it is important to stretch in the mornings and in the evenings, too. Muscles tighten up during exercise and during sleep. Keeping muscles limber decreases the incidence of injuries, but especially strains, sprains and tears. It also increases athletic performance, since a stretched muscle has more contractility than a tight one.

Once these general measures are followed, sport-specific injury prevention can be tackled. Our next article in this series on warm weather hazards deals with this issue.

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Dr. Levin has been a member of the staff at The Pediatric Group since 1977. Currently an attending Pediatrician at the Medical Center at Princeton, he has been Chairman, Department of Pediatrics, Medical Center at Princeton, 1984 to 1986, 1989 to 1992, and past President, Medical and Dental Staff, Medical Center at Princeton, 1987 to 1988. Dr. Levin has served on numerous Departmental and hospital committees. He has published original articles both while at Upstate Medical Center in Syracuse and at The Pediatric Group. He has a wife and three children. Dr. Levin enjoys alpine skiing, jogging, hiking and camping, travel, computers and racquetball.

Dr. Tesoro has been a member of the staff at The Pediatric Group since 1988. Dr. Tesoro is Chairman, Department of Pediatrics, Medical Center at Princeton, 1996 to present and Attending Pediatrician, Medical Center at Princeton, 1988 to present. He has served on several Departmental and hospital committees, lectured at the Universiy of Pennsylvania and has published original articles both while at The Children's Hospital of Philadelphia and at The Pediatric Group.