Fans slam FIFA’s cooling breaks. Why the U.S. World Cup team doctor disagrees

While it may not be remembered as FIFA’s most controversial decision of the 2026 World Cup, the institution of mandatory cooling breaks in all matches has been met with boos and derision, with critics saying the pauses disrupt the game’s flow and offer little benefit in air-conditioned environments.

“They’re in a dome here! Temperature-controlled, climate-controlled — why are we having a break?” fumed one England fan to a radio reporter outside the England-Croatia match in Arlington, Texas, where field temperatures inside AT&T Stadium approached a comfortable 70 degrees Fahrenheit despite an outdoor heat and humidity index near 105 degrees.

But for Dr. Bert Mandelbaum, chief medical officer for U.S. men’s soccer and vice chair of Cedars-Sinai Medical Center’s orthopedic surgery department, the breaks set an important precedent for prioritizing athlete health in extreme heat, even at the highest levels of competition.

“I do think the cooling breaks are an important part of the game. I’m really excited and happy that we are employing those,” he said by phone Tuesday morning, hours after the U.S. team’s 4-1 knockout loss to Belgium.

“Difficult weather environments bring on dehydration and can create severe exhaustion, heat exhaustion, and those [conditions] have tremendous and dire consequences,” Mandelbaum said. “Talk radio could discuss it over and over again, but from our standpoint, the real messaging should be to our communities, our club players, that this is an important part of our game, and the cooling break is how we help manage it.”

Warming climate conditions are forcing changes to human behavior all around the globe, including on the pitch.

Extreme heat kills more people each year than all other forms of extreme weather combined. Elite athletes are not immune to its effects.

As temperatures during a game rise, the circulatory system diverts blood to the skin to lower core body temperatures at the same time that active muscles require oxygen-rich blood. This places extra strain on the heart, which pumps harder to keep up with demand. Sweating players lose electrolytes faster than they can consume them, leading to muscle cramps, fatigue and dizziness.

Virtually all aspects of the game degrade in the heat, Mandelbaum said. Players’ performance, recovery ability and decision making erode. Artificial turf becomes intolerably hot, and the soil in natural grass can harden until it’s like playing on concrete. Air molecules inside the ball expand, making it a harder and faster object. Even fans risk injury: 22 people were treated for heat-related illnesses at a FIFA Fan Festival in Houston last month.

Mandelbaum directs the FIFA Medical Center of Excellence at Cedars-Sinai and was part of the FIFA Medical Committee in 2014, when the first World Cup cooling break was called during a Netherlands-Mexico match in Fortaleza, Brazil.

At the time, the sport’s governing body recommended hydration breaks if temperatures surpassed 102.2 degrees.

This year’s World Cup, hosted across the U.S., Canada and Mexico, is the hottest played since the tournament began in 1930. It has coincided with a withering heat wave in the eastern U.S. With a heat index of nearly 104 degrees at kickoff, the July 4 match in Philadelphia between France and Paraguay is believed to be the second-hottest game in World Cup history, after a 105-degree match in 1994 between Ireland and Mexico in Orlando, according to meteorologist Brad Maushart.

FIFA announced in December that this year’s tournament would be the first in which all matches must pause once in each half for hydration and cooling, regardless of temperature conditions.

FIFA President Gianni Infantino said mandatory breaks equalize playing conditions in all matches. When they haven’t been loudly booing, many fans have noticed that teams often appear to spend as much time strategizing during the pauses as they do hydrating.

Given this, “if we were to use hydration breaks only in those matches where it was too hot and not in the other matches, we would give an advantage or a disadvantage to some of the coaches or some of the teams,” Infantino told Sports News Television.

Harry Brown, a postdoctoral research associate at the University of Sydney’s Heat and Health Research Centre, expressed frustration over the universal breaks in an op-ed in the journal Nature.

“Although it might seem fair to treat all games in the same way, this blanket approach risks undermining trust in heat-safety measures. If breaks are always used, regardless of risk, they stop being meaningful and start looking like routine stoppages,” Brown wrote.

Without active efforts to lower players’ core temperatures, pausing game play may not be enough to effectively stave off heat injury, he wrote. In his own research, Brown’s team compared the effects of passive breaks against breaks with active cooling measures on the health of players participating in 90-minute soccer games in 104-degree heat and 41% humidity.

When players cooled themselves with cold drinks and icy towels during short breaks and took longer halftimes, their core temperatures and cardiovascular strain lowered considerably more than they did after only passive breaks, Brown wrote.

Other physicians argued that even an under-utilized break was better for athletes than nothing at all.

“I would say that it’s better to err on the side of having cooling breaks rather than risk not having them,” said Dr. Miho J. Tanaka, an associate professor of orthopedic surgery at Harvard Medical School who also serves as a team physician for the Boston Red Sox and the New England Revolution.

“Ultimately, an individualized screening or monitoring process may be the safest approach, but we are still far from being able to precisely identify and intervene when an individual player may be at risk,” she said. “Until we are able to do so, having standardized breaks is a step in the right direction, as long as teams and players are informed when to escalate their level of concern and take action when more aggressive measures are truly needed.”

While a cooling break is rarely medically necessary inside a climate-controlled indoor stadium, Mandelbaum said it still sends a valuable message to players around the world: If hydration breaks are a part of the sport’s biggest event, they should be allowed at every other level of play.

“Not only is [the hydration break] a good thing, it’s a necessary thing,” Mandelbaum said. “This is the world’s game … we have to figure out how to help players at all levels and ages to have the ability to thermoregulate, hydrate, how to do it well.”