You can prevent hyperthermia.
Being active in the summertime sun can lead to heat-related illness in kids. Many factors may increase body temperature, or prevent the body from cooling down properly. When compared to adults, children and adolescents have anatomical differences that increase the risk for even life-threatening, heat-related illness. Kids produce more heat and have higher resting metabolic rates than adults. Younger children have a high body surface area, resulting in a greater amount of heat absorption in hot environments. Kids also sweat much less than adults, and are less likely to replenish fluids during play or exercise. Heat-related illness ranges from minor to severe, needs to be treated aggressively, and has many early warning signs. Some signs of heat exhaustion and heatstroke can overlap.
When the body temperature is above normal, hyperthermia can occur. Signs and symptoms of hyperthermia follow.
• Increased thirst.
• Weakness or becoming very tired.
• Fainting or dizziness when standing.
• Muscle cramping, especially in the large muscle groups of the legs.
• Dry mouth and tongue.
• Nausea and vomiting.
• Irritability or agitation.
• Increased heart rate.
• Increased sweating.
• Cool, clammy-feeling skin.
• Decreased or dark-colored urine.
• Elevation of body temperature to above 105° F.
• Severe headache.
• Weakness or having difficulty walking.
• Dizziness or feeling lightheaded.
• Confusion or feeling disoriented.
• Hallucinations (seeing or hearing things that are not real).
• Rapid, shallow breathing.
• Fast heartbeat.
• Loss of consciousness or passing out; being in a comatose state.
• Seizures or uncontrolled shaking.
• Dry, flushed (red and hot) skin.
• Decreased sweating, or no sweating at all.
• Elevation of body temperature to above 105° F.
If your child shows signs and symptoms of a heat-related illness, you should:
• Call 911, and seek emergency medical care immediately. Have a friend go and get help while you stay and cool down your child.
• Take your child into a cool, shady area or into an air-conditioned building or car, if possible.
• Remove any unnecessary clothing to help cool down your child. Clothing retains heat, and slows the cooling process.
• Have your child lie down, with her feet elevated slightly.
• If your child is alert, place her in cool bathwater or in the shower. If outdoors, spray your child with the mist from a garden hose.
• Place cold packs or cool cloths on your child’s neck and armpits, groin, hands and feet to help cool him down. Have him sit in front of a cool fan.
• If your child is alert and talking, give her frequent sips of cool, clear fluids, such as water or sports drinks. Avoid caffeine, as it can make dehydration worse.
• If your child is vomiting, turn her onto her side to prevent choking.
• Avoid giving your child fever-reducing drugs, such as acetaminophen or ibuprofen, until you discuss it with your provider.
Prevention Is Key
Many factors contribute to the risk of heat-related illness. The internal heat-regulating systems in kids are still immature, yet they must regulate a larger body surface area than adults. Conditions such as rising temperatures, direct sun, high humidity, being overweight, excessive physical exercise, clothing or sports equipment that causes excessive heat retention, certain medications, dietary supplements, underlying medical issues and dehydration can increase body temperature rapidly.
To prevent overheating and dehydration:
• Before any outdoor activity, drink plenty of fluids, especially water or sports drinks. General hydration guidelines suggest 100 mL to 250 mL (3 to 8 oz) every 20 minutes for 9- to 12-year-olds, and up to 1 to 1.5 L (34 to 50 oz) per hour for adolescents.
• Take frequent breaks to cool down, and drink more fluids during play, even when not thirsty. Sometimes, kids may be so busy having fun, they forget to stop and drink. Thirst is an early sign of dehydration.
• Offer Popsicles, ice-cold drinks and slushies — which kids enjoy — to keep them hydrated.
• Watch for decreased urine output. If it has been several hours since your child’s last trip to the bathroom, it’s likely he’s not drinking enough fluids. Urine should be clear or light yellow .
• Avoid direct ultraviolet (UV) sunlight and midday heat. Your child is most vulnerable to a heat-related illness between 10 A.M. and 4 P.M., when the sun is most intense. Try to exercise early in the day or when the sun is going down. Remember, kids can still get sunburned and overheated in the shade if it’s hot enough. About 75 percent of the sun’s rays can penetrate the clouds. Be extra-vigilant at higher elevations where UV light is more intense.
• Organized athletic activities should be limited or restricted during days with a high heat index. Team coaches should offer more hydration breaks (before, during and after the activity), ensure that there are shady areas in which to cool down/rest, and substitute players often during practices and games. Kids who are ill or are recovering from a fever or a stomach illness should not participate until they’re completely well, with normal hydration returned.
• Wear loose, single-layered, light-colored clothing to aid the evaporation of sweat. Light-colored clothes reflect heat, while dark clothes absorb it. Cotton clothing will help you keep cool. Don’t forget a hat to shade the face and neck.
• Kids burn easily. Apply SPF-30 sunscreen with UVA and UVB sun protection to unprotected skin 30 minutes before going out. Re-apply every two to three hours, especially after swimming.
• Teach kids to come indoors immediately if they feel overheated.
• Never leave your child in the car unattended. Cars can heat up to dangerous temperatures. Even with the window partially down, the car temperature can reach 125° F in just a few minutes.
Remember, heat-related illnesses in kids are usually preventable. Make sure your children drink plenty of fluids, and monitor their time and activity in the summer heat!
Robin D. Schier, DNP, APRN, CPNP, AC/PC, is a board-certified primary and acute care PNP in Houston, TX. She is an Assistant Professor of Nursing at the University of Texas Health Science Center at Houston, and is currently practicing in the Emergency Center at Texas Children’s Hospital.