Keeping children hydrated while exercising is extremely important Published Feb. 24, 2012 By Maj. Amy Quirke Certified Pediatric Nurse Practitioner TINKER AIR FORCE BASE, Okla. -- Adequate hydration and replacement of salt lost through sweating is extremely important during the warmer months. Equally important is avoiding the use of over-the-counter medications, stimulants and caffeine products that promote excessive heat buildup. People who are physically active in hot and humid weather conditions and who take methylphenidate (concerta, adderall, vyvanse, etc.), should be advised to exercise during the cooler hours of the day (before 9 a.m. and after 4 p.m.), to wear light-colored and light-weight clothing, to take frequent fluid and rest breaks and to modify their training according to weather conditions. Fluid replacement is needed before, during and after activity to ensure that children and adolescents stay adequately hydrated. The American College of Sports Medicine (2005) and the National Federation of State High School Associations (2008) advocate for athletes to drink 16 to 20 ounces of water or sports drinks two to three hours before exercise. The American Academy of Pediatrics (2000) recommends that people weighing more than 90 pounds drink 6 to 12 ounces of water or sports drink one hour before prolonged physical activity and drink and additional 6 to 10 ounces of noncarbonated/non-caffeinated fluids every 15 minutes before the exercise begins. During exercise, children and adolescents should drink an additional 6 to 10 ounces of fluids every 15 to 20 minutes and within two hours after exercising, they should drink enough fluids to replace fluids lost through sweating (20 to 24 ounces of fluid for each pound of weight loss). Children taking ADHD medications should be encouraged to carry water bottles and to drink frequently during the day to prevent dehydration. Athletes who sweat significantly and who are prone to muscle cramping (especially while sleeping) should drink sports drinks during exercise, and add salt to their diet by consuming foods containing salt, such as certain breakfast cereals, tomato or V-8 juice, pretzels, pickles or beef jerky (Eichner, 2008). Athletes should be advised to slowly acclimate to the heat to avoid the development of a heat-related illness. Normal heat acclimation takes 10 to 14 days. Those individuals on ADHD meds should be advised to gradually increase over several days the intensity and duration of their workout. Coaches are advised to schedule practices before or after the hottest part of the day (before 10 a.m. and after 4 p.m.) to allow 10 to 14 days to fully acclimate, to provide adequate water and a covered canopy for shade at each practice and to schedule rest breaks every 15 minutes to facilitate cooling. Heavy pads and equipment should not be worn until the athlete is acclimated to the heat and helmets and excessive clothing should be removed during rest periods.