NEW YORK (Reuters Health) - As the season of two-a-day football workouts gets underway, young athletes need to be extra careful to drink plenty of water and to rest in between back-to-back sessions, according to a report from the American Academy of Pediatrics.

An AAP committee notes in the new statement that kids don't appear to be at a naturally higher risk of heat- and humidity-related illness than adults during physical activity. But that doesn't mean trainers, coaches, and athletes shouldn't be extra cautious during workouts in extreme conditions.

That involves making sure kids and teens gradually adapt to exercising in the heat during preseason, and that teams take more water breaks, and play with less intensity, on very hot and humid days.

"It's a common-sense thing," said Dr. Thomas Rowland, a pediatric heart doctor at Baystate Health in Springfield, Massachusetts, who wasn't involved in the new report. "There's no magic about this."

Still, he said, he's treated kids whose coaches wouldn't let them drink water during practice. When the simple rules are ignored, Rowland explained, is when things can go wrong.

Over the last decade, an average of three football players -- both kids and older athletes -- have died of heat-related causes each year in the U.S.

In the past two weeks, at least three high school football players -- including two in Georgia, and one in South Carolina -- died after collapsing during workouts.

"Children on their own...will come in from the heat if they begin to get these signs of overheating," Dr. Stephen Rice, one of the authors of the new statement from Jersey Shore University Medical Center in Neptune, told Reuters Health.

The problem, he said, "stems primarily from adults directing children in activity and pushing them intensively for a long time."

Rice and his colleagues highlighted hydration as one of the most important issues to consider on hot days. Generally, they report, preteens should get between half a cup and a cup of fluids every 20 minutes while exercising, while teens may need up to six cups every hour.

Water usually works perfectly well for rehydrating, but during long and intense workouts drinks with a little salt and sugar might also be beneficial, the committee said. Rowland added that whatever beverage -- water versus sports drinks -- that kids prefer and will drink more readily is probably the way to go.

Youngsters who are sick or have recently been sick should avoid working out in the heat, because they may still be dehydrated, especially if they had a stomach bug.

OBESE KIDS MAY FACE GREATER RISK

While easing into harder workouts is important for all athletes, heavy kids might be at particularly high risk of heat illness during early-season workouts, said Kelly Dougherty, who studies exercise and heat at The Children's Hospital of Philadelphia.

"Obese children might need a couple more days in order to attain full heat acclimatization," she told Reuters Health.

The committee also said that coaches and tournament organizers should make sure young athletes have at least two hours of rest between competitions on warm days to rehydrate -- for example, between a tennis player's singles and doubles matches.

"That I think is not quite as well recognized," Rowland said. "The problem of entering a competition or entering a practice already dehydrated -- now we've got trouble."

Teams also need to have an emergency action plan in place if an athlete does start to suffer from heat exhaustion or heat stroke, Rice said. For high school squads, that would include having a trainer on hand, while for youth teams, it might mean a parent volunteer who's trained to do first aid -- such as cooling the body with ice water and wet towels -- while waiting for paramedics to arrive.

If coaches and athletes are taught the dangers of working out in the heat and follow basic heat-safety rules, everything should generally be okay, Rice said.

"Children can handle the heat as well as adults can if they're properly hydrated," he concluded. Heat-related illness "is a preventable condition."

SOURCE: http://bit.ly/qjvvbR Pediatrics, online August 8, 2011.