with Shaun Grammer, MSPA, PA-C
While all children and adolescents have hydration needs - especially in hot and humid conditions - those with cystic fibrosis or diabetes need to pay extra care and attention to hydration.
Cystic fibrosis (CF) is a genetic disorder that can affect all races but is most common in Caucasians, affecting approximately 1 out of 3200 children. It is often diagnosed at birth during newborn screening testing. However, if not detected during the screening, most cases are diagnosed by the age of 2 years.
The genetic mutation affects chloride and water transport. As a result, a person with CF will have thick mucus affecting several glands in the body. This can cause a chronic cough, recurrent lung infections, sinus infections, and nasal polyps. There will also be nutritional deficiencies due to blockage of pancreatic enzymes, which may present as fatty stools and poor growth and development.
One part of the treatment for cystic fibrosis is clearance of lower airway secretions. Current evidence suggests that people with CF may benefit from both aerobic and strength training exercises. In addition to the improved lung function, aerobic training may improve recovery following lung infections and improve clearance of lower airway secretions.
However, it is important to consider each person individually when developing an exercise protocol. Furthermore, cystic fibrosis requires an increased caloric and nutritional diet, which also must be considered in any exercise protocol.
Diabetes mellitus type 1 is the form most often seen in children. It is often caused by the destruction of the insulin-producing cells of the pancreas resulting in an insulin deficiency. Without insulin, glucose (sugar) cannot move from the blood into the tissues that need it for energy.
The most common ages of diagnosis are between 4 to 6 years or 10 to 14 years. Children or teens with diabetes often present with an increased thirst, increased urination, and weight loss. Occasionally, they may present with a serious complication called ketoacidosis. Once diagnosed, insulin injections can maintain glucose levels successfully in the blood.
Exercise can have a major effect on the glucose levels of diabetics. It can lead to:
As a result, the diabetic athlete may easily become hypoglycemic (low sugar) during exercise, and for up to 12 hours after finishing sports. With proper monitoring and medications, the diabetic athlete should not be restricted from participating in sports.
When young athletes with CF perspire during exercise, the sweat their bodies produce has a higher salt concentration. As a result, athletes with CF:
While there is a notable lack of research on the hydration needs of active youth with diabetes (as far as we are aware), here are some general hydration tips:
Drink (per 8 fl oz. | Calories | Carbohydrate (g) |
Sugar (g) | Sodium (mg) |
Gatorade | 50 | 14 | 14 | 110 |
Gatorade G2 | 25 | 7 | 7 | 110 |
GFit Series Recovery | 120 | 14 | 10 | 280 |
Propel | 10 | 3 | 2 | 35 |
Powerade | 60 | 15 | 15 | 52 |
Powerade Zero | 3 | 0.1 | 0.1 | 55 |
Pedialyte | 100 | 6 | 4.8 | 248 |
Dr. Yeargin is Assistant Professor and Graduate Program Director in the Athletic Training Department at Indiana State University and MomsTeam's hydration expert. Shaun Grammer is an Assistant Professor in the Department of Applied Medicine and Rehabilitation - Physician Assistant at Indiana State University working in family practice and pediatrics and as a Physician Assistant.
Sources:
1. Doorn NV. Exercise programs for children with cystic fibrosis: A systematic review
of randomized controlled trials. Disability and Rehabilitation. 2010; 32(1): 41-49.
2. www.cff.org [1]
3. Pivarnik JM, Coe DP. Overview of aerobic exercise testing in children and adolescents. UpToDate. 2009. http://www.uptodate.com/contents/overview-of-aerobic-exercise-testing-in... [2]. Accessed June 18, 2011.
4. Baker RD, Coburn-Miller C, Baker SS. Cystic fibrosis: Nutritional issues. UpToDate. 2010. http://www.uptodate.com/contents/cystic-fibrosis-nutritional-issues?sour... [3]. Accessed June 18, 2011.
5. Levitsky LL, Madhusmita M. Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents. UpToDate. 2011. http://www.uptodate.com/contents/epidemiology-presentation-and-diagnosis... [4]. Accessed June 18, 2011.
6. Levitsky LL, Madhusmita M. Complications and screening in children and adolescents with type 1 diabetes mellitus. UpToDate. 2011. http://www.uptodate.com/contents/complications-and-screening-in-children... [5]. Accessed June 18, 2011.
7. Bar-Or O, Blimkie CJ, et al. Voluntary dehydration and heat tolerance in cyctic fibrosis. Lancet 1992; 339:696-699.
8. Kriemler S, Wilk B, et al. Preventing dehydration in children with cycstic fibrosis who exercise in the heat. Med Sci Sport Ex 31 (6): 774-779. 1999.
9. Zinman B, Ruderman N, et al. Diabetes Mellitus and Exercise. Med Sci Sport Ex 1997; 29(12): 1-6.
Links:
[1] http://www.cff.org
[2] http://www.uptodate.com/contents/overview-of-aerobic-exercise-testing-in-children-and-adolescents?anchor=H22#H22
[3] http://www.uptodate.com/contents/cystic-fibrosis-nutritional-issues?source=search_result&selectedTitle=6~150
[4] http://www.uptodate.com/contents/epidemiology-presentation-and-diagnosis-of-type-1-diabetes-mellitus-in-children-and-adolescents?source=search_result&selectedTitle=1~150
[5] http://www.uptodate.com/contents/complications-and-screening-in-children-and-adolescents-with-type-1-diabetes-mellitus?anchor=H9#H9