When working during the summer months, I can always tell when sports camps are in session by the swarms of athletes with heat illnesses who start coming into the office. When I was working in the ER, those same kids would be brought in by ambulance - often having just collapsed on the field. The story is always the same. They were participating in a round robin or a tournament or a string of games. They took a few breaks here and there and thought they were drinking enough fluids but couldn't really recall how much or what kind of fluid. For some kids, they couldn't even recall if they had breakfast!
First would come a pasty mouth then perhaps thirst. They were obviously sweaty because it was "a billion degrees" out as most teen athletes like to tell me. "Who has time to drink" is what I often hear. Some would note an increase in the sweating before it would kind of stop. That is about when they'd begin to feel sick to their stomachs and get dizzy. Some would notice their skin over heating, others not.
If I really push a kid to recall the series of symptoms, one or two may recall a cramp before the cascade of other symptoms. But, many don't have cramps in the heat.
Beet red doesn't even begin to describe the appearance of their faces with sunburns like you've never seen on a few. But, even those without sunburns just felt hot!
While waiting for me in the air conditioned office, drinking a sports drink or sucking a sports-drink popsicle if they didn't feel like drinking, they'd often start to feel a bit better. And, if not, that was when I decided they needed the ER and a big, big bolus of cool IV fluids.
I don't wait with heat-related illnesses. Those kids are so hot and so dehydrated, we scoop and send! My colleagues at the ER often joke because about half the time the kids are better between the AC in the office and ambulance and all the fluids we've collectively gotten into them. Sometimes we'll have the paramedics run a line if they have the time but it can be a challenge to get a line into a kid so dehydrated.
Why the worry? Read on.
Heat: Not So Great for Bodies
When dehydration progresses and bodies become overheated, nothing functions wells. All the internal systems of the body literally begin to shut down. It is like a computer overheating - the body goes on overload from the hit and systems just progressively stop working. Ideally, you would catch the process at the dehydration stage but that isn't always possible and a number of heat-related conditions can develop quickly:
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Heat cramps
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Heat syncope(passing out)
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Heat exhaustion
- Heat Stroke
Heat Cramps are muscle cramps that can be very uncomfortable. They often develop in the legs, stomach and arms. Treatment includes getting the child to a cool location, stretching out the muscle, and drinking a lot of fluids, particularly a sports drink since replacing sodium is very helpful in stopping the cramp. Many sports experts also feel that eating salty foods will help such as pretzels. Incidentally, predrinking with sports drinks as well as drinking sports drinks during a hot game may be protective against developing heat cramps due to the sodium in the drinks.
Heat Syncope is when a person passes out after having been standing for a long while or when moving from sitting to standing quickly. Kids need to be properly hydrated to stand for long times and if in games and they are not drinking, that is a set up for passing out. If a child does faint, they usually wake up right away after they pass out. Keep the child lying down in a cool place and drinking until they feel better. If they child doesn't wake up right away, call 911. In my experience, kids who pass out from heat-related dehydration tend to need more fluids than they can take in orally so they often need to come to the ER. If a child can't drink well and stand up without being dizzy, call an ambulance to get the child to an ER where they can cool down better and get some cool IV fluids.
Heat Exhaustion and Heat Stroke are both require medical attention. Heat exhaustion requires urgent care while heat exhaustion requires emergency care.
Heat Exhaustion is all the symptoms of dehydration in a child who looks exhausted and tired and has a temperature, but less than 104. The child is often profusely sweating to attempt to cool down. This child is on the way to heat stroke so needs to be cooled down ASAP and in an emergency room. Keep the child in a cool place and drinking until you can get the child to medical attention. Unlike heat stroke which does require an ambulance, if the child is able to drink ok and walk without being too dizzy, a parent can drive the child to the nearest emergency room. But, if there are any concerns, call your pediatrician for advice or 911.
Heat Stroke is always a 911 call. A child with heat stroke with have an off the chart fever (104 or higher), mental status changes, and perhaps even seizures. If awake, the child may be truly delirious and not making any sense at all. It is very frightening to witness. Unlike heat exhaustion, this child won't be sweating - there is no more fluid to sweat out. These kids need to be treated by an emergency room team and cooled very carefully with chilled IV fluid and ice. While waiting for the ambulance, remove some of the child's clothes and if you have ice, place the ice under the child's neck and armpits to start cooling down the child's body. If you have a spray bottle, spraying with cool water on the skin can help and offering fluids if the child is awake enough to drink useful. But, this may not be possible. When in doubt, just wait for the emergency team.
How To Hydrate and Exercise In The Heat
The American Academy of Pediatrics suggests the following tips for the child exercising in the heat to avoid heat illnesses:
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The intensity of activities that last 15 minutes or more should be reduced whenever high heat and humidity reach critical levels.
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At the beginning of a strenuous exercise program or after traveling to a warmer climate, the intensity and duration of exercise should be limited initially and then gradually increased during a period of 10 to 14 days to accomplish acclimatization to the heat.
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Before prolonged physical activity, the child should be well-hydrated. During the activity, periodic drinking should be enforced, for example, each 20 minutes, 5 oz of cold tap water or a flavored sports drink for a child weighing 90 lbs, and 9 oz for an adolescent weighing 130 lbs, even if the child does not feel thirsty.
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Clothing should be light-colored and lightweight and limited to one layer of absorbent material to facilitate evaporation of sweat. Sweat-saturated garments should be replaced by dry garments.
- Practices and games played in the heat should be shortened and more frequent water/hydration breaks should be instituted.
When In Doubt, Drink and Get Some Shade
So, this is the run down of all the heat-related emergencies. Watch for heat alerts on the news and be very cautious about kids exercising in bulky uniforms when it is very hot outside. If the weather experts tell us it is too warm out to go for a walk, it is likely too warm to play sports. Many programs will curtain their activities in such settings, if not, you curtail your child's activities. Your child's health and safety come first. All these heat illnesses are completely preventable if the child is well hydrated and not over heated. So, if there is a warning, don't tempt fate.
Gwenn Schurgin O'Keeffe, MD is a pediatrician living in the Boston area and the founder and Editor-In-Chief of www.Pediatricsnow.com.
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