Red Flags & Next Steps

⚠️ Warning Signs

• •Unusually tired through easy runs
• •Times are flat or declining despite consistent training
• •Pale skin, brittle nails, cold hands/feet
• •Craving ice or non-food items (pica)
• •Girls: heavy or irregular periods

✅ What To Do

1. 1.Ask family to request a serum ferritin test (not just CBC)
2. 2.Share the Iron Protocol tool (/tools/iron-protocol) with parents
3. 3.If ferritin is below 20 ng/mL → refer to physician for supplementation
4. 4.If ferritin is 20–35 → suggest dietary changes and retest in 8 weeks
5. 5.Do NOT recommend supplements yourself — refer to a medical provider

⚠️ Warning Signs

• •Pain that worsens with running/jumping, improves with rest
• •Persistent shin, foot, or hip pain lasting more than 5 days
• •Pain that is worse in the morning
• •Second or third stress fracture in the same athlete
• •History of low calcium/vitamin D intake or restricted eating

✅ What To Do

1. 1.Stop or modify training immediately — do not "run through" bone pain
2. 2.Refer to athletic trainer for evaluation
3. 3.Notify parents and recommend physician visit
4. 4.Request bone density screening if recurrent (2+ stress fractures)
5. 5.Screen for under-fueling — the #1 predictor of stress fractures is low energy availability

⚠️ Warning Signs

• •Sudden or gradual performance decline over 2-4 weeks
• •Complaining of "heavy legs" or "no pop" in workouts
• •Taking longer to recover between reps or between workouts
• •Getting sick more often than teammates
• •Mood changes: irritability, withdrawal, or loss of motivation

✅ What To Do

1. 1.Have a private, non-judgmental 1-on-1 conversation
2. 2.Ask about meals: "Walk me through what you ate yesterday"
3. 3.Check if they are skipping breakfast, lunch, or pre-practice snack
4. 4.If under-fueling is suspected, share fueling tools and notify parents
5. 5.If performance continues to decline, refer to physician for labs

⚠️ Warning Signs

• •Avoiding team meals, eating alone, or making excuses not to eat
• •Talking about "eating clean," "cutting weight," or needing to be leaner
• •Visible weight loss — especially if performance is also declining
• •Excessive exercise beyond what the program prescribes
• •Wearing baggy clothes to hide body, avoiding weigh-ins or body conversations
• •Teammates or parents express concern about the athlete's eating

✅ What To Do

1. 1.Do NOT comment on the athlete's weight or body — even positively
2. 2.Have a private conversation focused on performance and health, not weight
3. 3.Use phrases like: "I've noticed you seem tired / your times have dropped — is everything okay?"
4. 4.Notify parents using safe, non-blaming language
5. 5.Refer to a licensed mental health professional and/or RDN who specializes in eating disorders
6. 6.Do not attempt to diagnose or treat — your role is to notice and refer

⚠️ Warning Signs

• •Consuming energy drinks (Monster, Celsius, etc.) before practice or meets
• •Using pre-workout supplements designed for adult bodybuilders
• •Relying on caffeine instead of actual meals for energy
• •Anxiety, jitteriness, or rapid heart rate during training
• •Difficulty sleeping at night due to afternoon/evening caffeine

✅ What To Do

1. 1.Set a clear team policy: no energy drinks at practice/meets
2. 2.Explain WHY in terms they care about: "Caffeine dehydrates you and can cause cramping"
3. 3.Address the root cause: they're using stimulants because they're under-fueled
4. 4.Help them replace the energy drink with actual food (pre-practice snack)
5. 5.If multiple athletes are doing this, send a parent email about it

⚠️ Warning Signs

• •Consistently getting less than 7 hours of sleep
• •Falling asleep in class, on the bus, or during team meetings
• •Phone use past midnight regularly
• •Unable to complete workouts that were previously manageable
• •Mood swings, emotional outbursts, or apathy about the sport

✅ What To Do

1. 1.Talk to the athlete about sleep habits in a non-judgmental way
2. 2.Set team norms: "We recommend phone down by 9 PM, lights out by 9:30"
3. 3.Educate parents: sleep is the #1 legal performance enhancer
4. 4.Consider reducing training load temporarily if fatigue is severe
5. 5.If sleep issues persist alongside other red flags → refer to physician

⚠️ Warning Signs

• •Noticeable weight loss during the season (clothes fitting looser, face thinner)
• •Weight gain that the athlete seems distressed about
• •Frequent comments from the athlete about their body
• •Training load increased but food intake did not increase to match
• •Post-illness or post-injury weight change that doesn't recover

✅ What To Do

1. 1.Do NOT weigh athletes or comment on weight changes directly
2. 2.Focus conversation on performance and energy: "How are you feeling in workouts?"
3. 3.If weight loss + performance decline → screen for under-fueling
4. 4.Notify parents privately and without blame
5. 5.If you suspect an eating disorder, refer to a professional immediately
6. 6.Document your observations and referral in case follow-up is needed