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1557.Full-Text.Pdf AMERICAN ACADEMY OF PEDIATRICS POLICY STATEMENT Organizational Principles to Guide and Define the Child Health Care System and/or Improve the Health of All Children Committee on Sports Medicine and Fitness Promotion of Healthy Weight-Control Practices in Young Athletes ABSTRACT. Children and adolescents are often in- voluntary dehydration (Table 1). Voluntary dehydra- volved in sports in which weight loss or weight gain is tion practices include fluid restriction, spitting, and perceived as an advantage. This policy statement de- the use of laxatives and diuretics, rubber suits, steam scribes unhealthy weight-control practices that may be baths, and saunas. Weight loss becomes a problem harmful to the health and/or performance of athletes. when nutritional needs are not met or adequate hy- Healthy methods of weight loss and weight gain are dration is not maintained. discussed, and physicians are given resources and recom- mendations that can be used to counsel athletes, parents, Athletes may practice weight-control methods coaches, and school administrators in discouraging inap- during the sports season only or year-round. These propriate weight-control behaviors and encouraging practices can impair athletic performance and in- healthy methods of weight gain or loss, when needed. crease injury risk. They also may result in medical Pediatrics 2005;116:1557–1564; athlete, weight gain, weight complications including delayed physical matura- loss, wrestling, eating disorders. tion; oligomenorrhea and amenorrhea in female ath- letes; development of eating disorders; potential per- ABBREVIATION. NWCA, National Wrestling Coaches’ Association. manent growth impairment; an increased incidence of infectious diseases; changes in the cardiovascular, INTRODUCTION endocrine, gastrointestinal, renal and thermoregula- 1,4,6–9 ith the growth and advancement of youth tory systems; and depression. sports, children and adolescents are be- Dehydration coming more involved in sports in which W Hypohydration and dehydration are used by ath- weight control is perceived to be advantageous for the individual and/or team. Bodybuilding, cheer- letes in weight-sensitive sports in an attempt to lose leading, dancing, distance running, cross-country weight or appear more lean and, thus, obtain a per- skiing, diving, figure skating, gymnastics, martial ceived advantage. Because the body does not store fluid or electrolytes before exercise, it is predisposed arts, rowing, swimming, weight-class football, and 10 wrestling all emphasize thinness, leanness, and/or to dehydration. The extent of the dehydration is determined by sweat loss and the inability or refusal competing at the lowest possible weight. Other 11 sports, such as football, rugby, basketball, and power to replace those losses with oral fluids. On the basis lifting emphasize gaining weight by increasing lean of studies in adults, weight loss by dehydration re- muscle mass. In their attempt to lose weight and sults in suboptimal performance because of impaired body fat or gain weight and muscle mass, some strength, reaction time, endurance, and electrolyte imbalance and acidosis. It also may result in tempo- athletes resort to unhealthy weight-control prac- 4,12–14 tices,1–5 which can potentially be harmful to their rary learning deficits, inability to concentrate, lethargy, mood swings, and changes in cognitive performance and/or their health. Pediatricians need 15–20 to be able to recognize the young athlete who is at state. risk of developing unsafe weight-control practices Hypohydration affects prolonged aerobic exercise more than it affects short, high-intensity anaerobic and provide the athlete, family members, coaches, 10,21 athletic trainers, and athletic directors with accurate exercise. In adults, a decrease in performance is information about healthy weight-control practices. seen when hypohydration is 2% or more (Table 2). Two to 3% hypohydration results in decreased reflex WEIGHT LOSS activity, maximal oxygen uptake, physical work ca- pacity, and muscle endurance and impaired temper- Many athletes attempt to lose weight or body fat, 22 hoping to improve performance, improve appear- ature regulation. With additional hypohydration, ance, or meet weight expectations. Practices that are used to reduce weight include food restriction, vom- TABLE 1. Definition of Hydration iting, overexercising, diet-pill use, inappropriate use Euhydration: a normal state of body-water content of prescribed stimulants or insulin, nicotine use, and Dehydration: the process of incurring water deficit Hypohydration: the extent (or level) of this deficit (usually described as percent of initial body weight) doi:10.1542/peds.2005-2314 Voluntary dehydration: purposeful restriction of fluids or use of PEDIATRICS (ISSN 0031 4005). Copyright © 2005 by the American Acad- measures to dehydrate oneself, often to produce weight loss emy of Pediatrics. Downloaded from www.aappublications.org/news PEDIATRICSby guest on September Vol. 11630, 2021 No. 6 December 2005 1557 TABLE 2. Effects of Various Levels of Hypohydration tes insipidus, and diabetes mellitus), suboptimal Adults sweating (spina bifida, sweating-insufficiency 2–3% hypohydration syndromes), excessive sweating (selective cya- Decreases reflex activity notic congenital heart disease), abnormal sweat- Maximal oxygen uptake decreases by 10%22 ing (cystic fibrosis), inadequate drinking (people Physical work capacity decreases by 22%22 Muscle strength decreases with mental retardation and young children), ab- Muscle endurance decreases normal hypothalamic thermoregulatory functions Impairment in temperature regulation (anorexia nervosa, advanced undernutrition, pre- 4–6% hypohydration vious heat-related illness), and obesity.30,35,36 Maximal oxygen uptake decreases by 27%22 Physical work capacity decreases by 48%22 Children have certain characteristics that, when Muscle strength decreases more compared with adults, predispose them to dehydra- Endurance time is reduced Severe impairment in temperature regulation tion and heat illness, including the following: Headaches, difficulty with concentration, impatience, sleepiness 1. Children produce more heat relative to body Ͼ8% hypohydration mass for the same exercise.21,30,33 Heat cramps 2. Children have lower cardiac output for any Heat exhaustion given metabolic level.30,33 Heat stroke Children 3. Children have higher thresholds before begin- 34,35,37 1% hypohydration ning to sweat. Reduces aerobic performance25 4. Sweating capacity is considerably lower in chil- Increases core temperature26 dren,30 reducing their ability to dissipate body No studies in children for higher levels of hypohydration heat by evaporation.30,34,35,37 exist 5. Children become slightly more dehydrated with lower climatic and metabolic heat stress. these parameters decrease even more,22 and addi- 6. Children have a greater ratio of body surface tional symptoms including reduced muscle strength, area to body mass, which causes them to absorb headache, difficulty concentrating, impatience, and heat more quickly when the ambient tempera- sleepiness occur.23 Dehydration retards the acclima- ture exceeds skin temperature. Thus, a high level tion process and affects thermoregulation during ex- of solar radiation can be more detrimental to ercise. The thermoregulatory effect of dehydration children.28,30 intensifies when athletes exercise. For every 1% hy- 7. Children’s ability to maintain thermohomeosta- pohydration in adults, there is an associated increase sis during prolonged running in very hot or very of 0.1 to 0.4°C in body temperature.23,24 When hypo- cold environments is less efficient.30,34,38 hydration exceeds 8%, heat cramps occur, followed 8. Children are less efficient in dissipating heat in by heat exhaustion and heat stroke (body tempera- very hot environments.11 ture of more than 40.5°C or 105°F). These are serious, 9. Children take longer to acclimate to hot, humid life-threatening events. environments (2 weeks versus 1 week),11,30 In children, 1% hypohydration is enough to induce which increases their risk of heat-related disor- a reduction in aerobic performance.25 For ethical rea- ders.38,39 sons, studies have not been performed in young 10. Core body temperature increases more in chil- children with greater levels of hypohydration. A dren for the same level of hypohydration.11,26 study with 10- to 12-year-old boys who exercised 11. Recent studies indicate that children’s thirst is intermittently in the heat suggested that the increase inadequate and that they become dehydrated in their core temperature, at any level of hypohydra- easier (O. Bar-Or, MD, McMaster University and tion, was greater than in adults.26 Chedoke Hospital, Hamilton, Ontario, Canada, Children have the following characteristics that verbal communication, October 1, 2003). are similar to adults: Children have a few characteristics that are bene- 1. Involuntary dehydration can occur with pro- ficial in protecting them from dehydration in com- longed exercise even if the child is given fluids ad parison with adults, including the following: libitum.11,26,27 This occurs principally when the 1. Children have shorter performance times in hot fluids are unflavored.28,29 environments, and when exercising at the same 2. Dehydration causes greater body heat storage (ex- intensity as adults. With shorter performance cessive increase in core body temperature),21,30 times, children are less likely to dehydrate them- decreases blood volume, and results in reduced
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