By Susan Yeargin, PhD, ATC [1] and Randy Eichner, M.D., FACSM
After birth every baby is tested for a wide variety of conditions and diseases. One of the tests looks for a condition called "Sickle Cell Trait." Ordinarily, a relatively benign condition, sickle cell trait can cause youth engaged in sustained, intense exercise to suffer a potentially life-threatening condition called exertional sickling.
Sickle cell trait is found in 1 in 12 African-Americans. It is also found in Caucasians, Mediterranean, Middle Eastern, and Central American children, but is rarer in these ethnicities (1 in 2,000 to 1 in 10,000 Caucasians).
Red blood cells carry oxygen through the bloodstream. Healthy red blood cells are round in shape. Red blood cells in children with sickle cell trait turn into a "sickle" instead of staying round after they release their oxygen, increasing the likelihood that they will get stuck to the walls of blood vessels.
When children with sickle cell trait are exercising, there is the potential for the sickle cells to create a "log jam" in blood vessels and stop the blood flow. This can cause rapid muscle breakdown and potentially overwhelm the kidneys.
Children who exercise intensely, particularly in the heat, can experience a condition called exertional sickling. This can commonly occur in organized sports as a result of:
If your child has sickle cell trait, the signs and symptoms that he is experiencing sickling include:
If your child is experiencing headache, dizziness, or nausea, he is likely experiencing dehydration [2], not sickling.
Heat
Dehydration [2]
Asthma [3]
If you believe your child is experiencing exertional sickling during or after exercise, here's what to do:
Exertional sickling collapse is an intensity syndrome. The common denominator is a "perfect storm" of irrational or unduly intense exercise, sustained for at least a few minutes; an intensity beyond the fitness level and/or physical limits of the athlete with sickle cell trait on that day in that setting.
It is therefore critical, if your child has sickle cell trait, that the following steps be taken to prevent exertional sickling.
When your child is exercising in the heat:
the intensity of workouts should only be increased gradually to allow him to become acclimated to exercising in the heat [6]
the tempo of practice should be slowed down
he should be allowed to set his own pace
he should be allowed longer and more frequent breaks
He should be excused from participating in intense conditioning drills such as timed miles, sprints, "gassers" (no all-out exertion lasting longer than 2 minutes)
Make sure he is well-hydrated
Make sure his asthma is controlled [3]
Dr. Susan Yeargin is MomsTeam's hydration expert and an Assistant Professor in the Athletic Training Department at the University of South Carolina. Dr. Randy Eichner is a retired physician and former team physician for the Oklahoma University football team and one of the leading experts on exertional sickling.
Links:
[1] https://mail.momsteam.com/node/2825
[2] https://mail.momsteam.com/node/867
[3] https://mail.momsteam.com/node/2876
[4] https://mail.momsteam.com/node/387
[5] https://mail.momsteam.com/node/881
[6] https://mail.momsteam.com/node/2697
[7] https://mail.momsteam.com/health-safety/pre-season-heat-acclimatization-guidelines
[8] https://mail.momsteam.com/health-safety/child-hydration-status-several-factors-at-play
[9] https://mail.momsteam.com/health-safety/hydration-safety/fluid-guidelines/drinking-fluids-before-during-and-after-sports-important-for-children
[10] https://mail.momsteam.com/health-safety/dehydration-signs-and-symptoms
[11] https://mail.momsteam.com/nutrition/heat-illness-cramps-exhaustion-stroke-signs-treatment