Hypothermia in youth sports is rare in the headlines, common enough in the data to take seriously. It happens at outdoor practices below 50°F when a kid is wet from rain or sweat, in cross-country runners on long fall trail courses, in soccer goalies who stop moving for 20 minutes, and in swim-meet competitors between heats in cool pool decks.

The protocol below is the next 10 minutes when you suspect a kid has crossed from cold into hypothermia.

Recognize. Hypothermia is body temperature below 95°F (35°C). The signs:

  • Shivering that does not stop. (Severe hypothermia: shivering stops because the body is too cold to shiver. Worse, not better.)
  • Slurred speech, mumbling.
  • Confusion, clumsiness, dropping objects.
  • Drowsiness. Wanting to lie down.
  • Slow, shallow breathing.
  • Skin pale, blue-gray, very cold to touch.
  • Weak or irregular pulse.

A wet, cold kid who is “just tired” and “wants to sit down” with any of those signs is a hypothermic kid until proven otherwise.

One. Out of cold, out of wet. Indoors if possible. Vehicle if not. Wet uniforms come off. A wet shirt against skin loses 25 times more heat than a dry shirt does. The first move is to dry the kid before warming them.

Two. Wrap and layer. Dry blankets, multiple. Cover the head and neck (head is responsible for significant heat loss). Hands and feet covered. Core warmth matters most because the heart is the priority.

Three. Warm liquids if alert. If the kid is conscious, swallowing without difficulty, and not severely impaired, warm sweet liquids help (warm water with sugar, broth, sports drinks heated). No alcohol. No caffeine. Both make hypothermia worse by changing peripheral circulation.

Four. Skin-to-skin if no other option. When blankets and warm liquids are limited (a backcountry cross-country course, a delayed ambulance), skin-to-skin warming under layered blankets is the field method. Two adults wrapping a kid in a “sandwich” of body heat with blankets over the top. NATA references this for severe field hypothermia.

Five. Call 911. Any confusion, slurring, or drowsiness. Body temperature below 95°F. No improvement within 10 minutes of warming. Severe shivering that does not respond. Any breathing irregularity.

The counter-intuitive rules. Hypothermia rewarming is not “warm the kid as fast as possible.” Rapid rewarming can produce cardiac arrhythmia in severely hypothermic patients. The rules:

Do not rub or massage cold limbs. The cold blood in the limbs returning to the core too quickly can trigger arrhythmia.

Do not place the kid in hot water (a hot bath, a hot shower).

Do not apply direct hot packs to skin. Wrap hot packs in cloth, place at neck and core under blankets.

Do not assume an unconscious cold kid is dead. Hypothermic patients can recover from extreme cold and apparent loss of pulse. The medical maxim is “not dead until warm and dead.” Continue CPR while transporting.

For coaches in cold-weather sports.

Watch the goalie, the bench, the kid who is not running. Movement generates heat; standing still in 35°F rain produces hypothermia within 30 minutes for a kid in a wet uniform.

Have warming options on site. Vehicle access for indoor warming, blankets in the equipment bag, hot water in a thermos for cold-weather practices.

Practice modification at NATA-published thresholds. Below 30°F wind chill, modifications. Below 0°F wind chill, indoor or canceled.

For parents. A kid coming off the field who is shivering uncontrollably, can’t form full sentences, or seems “out of it” is not “just tired.” That kid is in early hypothermia. Get them inside, dry, warm, and to medical attention if symptoms do not improve in 10 minutes.

The honest read. Hypothermia is preventable through cold-weather practice modifications, dry clothing, and warming options on the field. The kid who shows up at 11:30 PM in the ER with severe hypothermia is nearly always a kid whose program did not have the protocol. Programs that take cold weather seriously do not have these stories.