Children's Hospital Colorado

Preventing and Treating Heat Illness in Young Athletes

Death from heat-related illnesses is 100% preventable. As a coach or parent, it is very important to be aware of how to avoid the conditions leading to heat stroke and heat-related illnesses, treating them properly if they occur and preventing all heat-related deaths. To ensure ultimate and essential safety for young athletes during the summer sport season, follow the guidelines below.

Managing heat illness


Prevention means that your Emergency Action Plan (EAP) is updated with the most recent Guidelines for Preseason Heat Acclimatization, and ensuring that you follow these guidelines:

  • Adapting athletes to heat gradually over 10-14 days
  • Establishing hydration policies
  • Establishing hot, humid weather guidelines
  • Ensuring appropriate body cooling methods are available
  • Developing awareness of intrinsic factors (mostly in your control/items you can adjust) and extrinsic factors (mostly outside your control) that cause Exertional Heat Stroke (EHS).


Recognizing heat-related illnesses involves two main things:

  1. Diagnosis of EHS is a core temperature equal to or greater than 104°F (40°C) immediately post collapse and central nervous system dysfunction (e.g. irrational behavior, irritability, emotional instability, altered consciousness, collapse, coma, dizziness, etc).
  2. When observing athletes look for other signs and symptoms that may indicate they are suffering from EHS:
    • Irrational behavior
    • Headache, confusion or just look “out of it”
    • Nausea or vomiting
    • Muscle cramps
    • Inability to walk
    • Profuse sweating
    • Dehydration
    • Dry mouth
    • Rapid pulse
    • Low blood pressure
    • Quick breathing

It is important to differentiate between EHS and other possible conditions, such as, heat exhaustion, exertional sickling from sickle cell trait, concussion, break down of muscle tissue, imbalance of sodium and water in your blood, cardiac condition, diabetes reaction or asthma.


Once the diagnosis of EHS has been established, it is vital to initiate treatment immediately. Treatment includes:

  • Removal of all equipment and excess clothing, cooling the athlete as quickly as possible within 30 minutes via whole body ice water immersion (place them in a tub with ice and water approximately 35–58°F); Stir water and add ice throughout cooling process.
  • Maintain airway, breathing and circulation
  • After cooling has been initiated, activate emergency medical system by calling 911
  • Monitor vital signs such as core temperature, heart rate, respiratory rate, blood pressure, monitor Central Nervous System status
  • Cease cooling when core temperature reaches 101–102°F (38.3–38.9°C)

Note: Exertional heat stroke has had a 100% survival rate when immediate cooling (via cold water immersion or aggressive whole body cold water dousing) was initiated within 10 minutes of collapse.


In order to safely return an athlete to full participation following an EHS, a specific return-to-play (RTP) strategy should be implemented. The following guidelines are recommended for RTP:

  • Physician clearance prior to return to physical activity–athlete must be asymptomatic and lab tests must be normal.
  • The length of recovery time is primarily dictated by the severity of the incident.
  • Athlete should avoid exercise for at least one week after the incident.
  • Athlete should begin a gradual RTP protocol in which they are under the direct supervision of an appropriate healthcare professional such as an athletic trainer or physician.

To schedule an appointment at 720-777-6600. We are happy to consult with parents or referring providers before a patient is seen at Children’s Colorado.