Higher, faster, further - and younger!

At the age of 13 on Everest, at nine on the Aconcagua: Now and again, children and young people climb the highest mountains in the world. But: Does that really make sense at this age?

A contribution by Holger Förster - first published in the trade journal bergundstieg

People are increasingly looking for extremes. The goals are becoming more and more daring and what was considered unthinkable a short time ago is being done today and even exceeded tomorrow. The practical sense and purpose often falls by the wayside - it's about self-realization and about exceeding your own limits. The possibilities for this are manifold and offer themselves in many areas of life. The sport is socially highly regarded and top performances achieved there are gladly accepted, risks and side effects gladly accepted - by the actors as well as by the spectators. Mountains and distant, sometimes inhospitable areas have an additional stimulus, so that trekking and high-altitude mountaineering offer something extreme for adventurers. In order to deal with what may already be something everyday, come faster, higher, further then even younger. 

What headlines does it make again and again when Tylor Armstrong stands on Aconcagua at the age of nine or Jordan Romero at the age of 13 on Mt. icy height five fingers lost to frost. Is that now admirable and worth imitating or reprehensible? 

In top-class sport, it is usually necessary to start specific training at an early age, sometimes in kindergarten, in order to be among the best in the world in early adulthood. Ideally, the children are accompanied by an interdisciplinary, professional team and yet there are often spectacular failures with long-term consequences. The rights of children to grow up unharmed are often consciously subordinated to the possible great success. In the case of failure and failure, however, reproaches come, not least from the young athletes themselves. Ideally, a team is required which can deal with the delicate, very dependent child child in a highly responsible and far-sighted manner and repeatedly weigh up the ratio of benefits to risks. Unfortunately, there are often no such support models in top-class sport, and so many youngsters suffer. For trekking and high-altitude mountaineering, in addition to these general considerations, there are also environmental peculiarities that cause great problems for adults and even more so for children. 

At the age of 13, Jordan Primero was the youngest person to stand on the highest mountain in the world, Mount Everest. Image Romero

At the age of 13, Jordan Primero was the youngest person to stand on the highest mountain in the world, Mount Everest.

Image Romero 

Topics that need to be considered are briefly discussed below and can serve as a decision-making aid when it comes to taking children to great heights: reduced oxygen content, temperature, humidity, energy-liquid balance, alpine experience, physical and socio-psychological resilience as well as medical On-site supply. 

Decreased oxygen content 

From an altitude of 2500 meters, a reduced oxygen partial pressure can be expected. This then results in a reduced oxygen content in the blood, measured as oxygen saturation, combined with adaptive reactions by the body such as an increase in breathing and heart rate. There may be disturbances in the regulation, which can be traced back to an individual sensitivity, but also because of existing previous illnesses and especially because of incorrectly chosen altitude tactics (ascent speed, absolute altitude, sleeping height). In addition, the cold, lack of fluids and exhaustion are often aggravating. All altitude illnesses occur regardless of performance, gender and largely age; the only determining factor is the level and extent of pre-acclimatization and how to deal with it correctly. 

The first symptoms of acute altitude sickness can begin within half a day, in terms of various defined diseases: 

Acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) or high altitude brain edema (HACE)

The symptoms of acute mountain sickness, AMS, can be more or less clearly assigned, especially in small children. It is primarily about general symptoms that can be recognized by changes in sleep, play, and eating behavior. Additional symptoms such as headache, gastrointestinal problems and dizziness can occur in various forms. In scores specially developed for small children (e.g. Lake Louise Symptom Score), a probability can then be calculated according to which an AMS must be assumed. The score is filled out by the caregivers who are most likely to judge a change in behavior and thus be able to differentiate it conspicuously from normal. From the age of about eight to ten years one can then assume that the children can also communicate their symptoms to the environment in a targeted manner, although there are no clear symptoms for AMS and there is a lot of leeway in the differential diagnosis. The probability of developing an AMS in children is similar to that in adults at 2500 meters approx. 15 percent, increasing up to approx. 50 percent at very high altitudes. The therapy of choice is descending, uncompromising and rapid. There is no predictive parameter as to whether a child will get AMS or not. 

The best strategy to avoid AMS is to use adapted climbing tactics: above 2500 meters, only 300 meters gain in sleeping height per day plus a day's break every 1000 meters. In addition, of course, you have to pay attention to complete health, especially in the respiratory tract. It is recommended that children under the age of six do not go to heights above 4000 meters or that the sleeping height is kept below 2500 meters.

Regarding high altitude pulmonary edema, HAPE, it should be noted that there is no real data on this in children as it occurs very rarely. Children who already live at great heights, who descend into the valley and then come up again, are apparently particularly affected.

Otherwise, children are just as affected as adults, with the peculiarity that children are more likely to get respiratory infections, which significantly increase the risk of HAPE and must therefore be taken seriously. The symptoms of HAPE are coughing, shortness of breath even at rest with a higher breathing rate, limited resilience and clearer breathing noises. The therapy of choice is again rapid descent, oxygen and possibly also, life-saving medication. The effect of this has not been scientifically proven by studies due to the small number of cases and is therefore based exclusively on medicine for adults.

High altitude cerebral edema, HACE, is rare, like HAPE, because only a few children reach extreme heights, e.g. B. in adults, the probability of developing HAPE or HACE is 0,2 to 2 percent, depending on the population and altitude. The symptoms are similar to AMS plus behavioral problems of a greater extent up to hallucinations, unsteady gait and ultimately impaired consciousness. The therapy is to be assessed similarly to a HAPE, albeit less effective. If getting down quickly helps with HAPE, it has less influence on the further course of HACE, so that the death rate is up to 100 percent. Altogether, a form of altitude sickness can be expected even on tours in the Alpine region of up to 4000 meters and must be taken into account as a serious risk when planning the trip. This applies even more to the responsibility towards minors. 

On tours where you arrive by plane and where the start at 4000 to 5000 meters poses problems for altitude acclimatization, the risk for an AMS increases significantly. Since there are no medical parameters that can predict altitude sickness, there is always an incalculable risk that increases with altitude. 

environmental influences 

With increasing altitude, the temperature drops by about 6 degrees per 1000 meters. Children have poorer thermoregulation, due to a large body surface in relation to body mass, ie they lose more body heat than adults, especially in wind and wet. Accompanying adults are therefore required to ensure that there is an objectively good supply of warmth (wind protection, dry clothes ...) if the children often do not make verbal statements in this regard. Hypothermia is a medical problem in itself and also an additional risk for the development of altitude sickness. 

The air humidity also decreases absolutely with increasing altitude and thus with cooling of the air. This leads to more fluid loss through breathing, especially under stress and increased breathing activity. Children have an increased respiratory rate with increased dead space, which in turn means more fluid loss through breathing. In children, therefore, more attention must be paid to ensuring that they are adequately hydrated and that they are urged to drink before they begin to feel thirsty. 

With increasing altitude, the UV radiation increases, which can lead to serious damage, especially in the sensitive skin of children, acute as sunburn and as a long-term consequence in the form of skin cancer. As with all the other environmental factors, the challenge here is recognizing the danger. The accompanying adult acts as an external sensor, fed with age-specific information, in order to take preventive countermeasures at an early stage. Particular attention should also be paid to banal infections, which run harmlessly in our part of the world, with quickly available medicine up to infusions or operations. This medicine, which we take for granted, is no longer available on a trekking tour or high-altitude mountaineering in distant lands - you have to take with you what you want. A simple gastrointestinal infection on an expedition tour can therefore be life-threatening and children are more at risk of contracting an infectious disease for a variety of reasons. But they also have fewer buffer options than adults, which makes rapid and good therapy even more important. The risk can be minimized by taking appropriate medication and medical equipment along with knowledge of the correct use and dosage in children.

Another important point is the psychosocial stress on a high-altitude tour. Especially on tours lasting several days to several weeks, the child's soul has to deal with a lot that has to be processed. Lots of new impressions from distant countries, foreign customs, daily routines and people, just like on vacation, only that you can't get out of the car so easily - you have to go with and through and deal with this stress differently depending on your basic nature. In addition, there is the stress of performing in an inhospitable environment in cold, wet, wind etc. It can and should also be trained in smaller preliminary tours, and the option of canceling the big tour or carrying it out without a child if problems arise. 

Ultimately, it is about the physical requirements to master the demands of a high-altitude tour. If on a trekking tour it may be enough to be able to walk well and persistently, it is important to have very good previous alpine experience in rock, snow and ice when climbing in high altitude in the Alps, in the Himalayan region, etc. This alone requires years of training at low altitudes. It is therefore very advisable to seek out sports medical support on the one hand and specific alpine support on the other. 

As in all other areas, there are talents among the children and young people who meet all these requirements and are therefore able to achieve extreme performance very early on, as reported at the beginning. There are talents in music who show world-class achievements from kindergarten through elementary school age. In swimming, in ballet, in gymnastics, in figure skating, etc. there are top performances that adults rarely achieve. All these children and adolescents subordinate their lives to their profession, supported by more or less ambitious adult caregivers. Physical and psychological consequential damage also happens here and is accepted for success. High altitude alpinism is probably no exception, even though the risks are objectively much greater. Not only possible long-term consequences, but also the acute risk of death should always flow into the decision to lead a child or adolescent to great heights. (Almost) anything is possible and children can endure a lot, but responsible adults should also ask themselves the question: Do children have to endure everything they can endure? 

About the author

Dr. Holger Förster is a pediatrician, sports doctor with a further focus on alpine and altitude medicine. For more than 40 years he has competed in the middle distance and is medical world champion, national champion and Austrian senior champion. He has two children and four grandchildren and is an enthusiastic alpinist.

Dr. Holger Förster is a pediatrician, sports doctor with a further focus on alpine and altitude medicine. For more than 40 years he has competed in the middle distance and is medical world champion, national champion and Austrian senior champion. He has two children and four grandchildren and is an enthusiastic alpinist.

About the magazine bergundstieg

Bergundstieg is an international magazine for safety and risk in mountain sports and illuminates the topics of equipment, mountain rescue, rope technology, accident and avalanche knowledge. Bergundstieg is published by the Alpine Associations of Austria (PES), Germany (DAV), South Tyrol (AVS) and Switzerland (Customer Service).

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Credits: Cover picture Thomas Senf


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