Heat Emergencies in Children and Adolescents
By: Camellia Austin, FNP-C
Although the official start of summer is June 21st, we are already experiencing temperatures nearing 90 degrees Fahrenheit in and around the Asheville, NC area. For the month of June, the average heat index is 86, increasing to 92 degrees for July. The heat index is also known as the “real feel” temperature and can vary widely between individuals based on various factors. Children are especially susceptible to the heat index as their bodies have more surface area compared to their size, they typically sweat less, and they often have a higher activity level, increasing metabolism and heat production. Being in direct sunlight can increase the heat index up to 15 degrees Fahrenheit.
Important steps to prevent heat-related illness
Restrict activity when the heat index indicates dangerous conditions.
If your child has recently had a febrile or gastrointestinal illness, restrict or limit their participation in sports and exercise until they have fully recovered.
Pre-hydrate for 1-2 days before vigorous exercise events, especially when these are scheduled outdoors during hot/humid months.
Ensure scheduled breaks for hydration at least every 20 minutes during physical activity.
Children ages 9 to 12 typically need 3 to 8 ounces of fluids every 20 minutes.
Adolescents often require up to 1 to 1.5 liters each hour.
Fluid intake has been shown to increase by up to 90% when offering flavored water with carbs and sodium chloride when compared to unflavored water.
Wear loose, light-colored, absorbent clothing consisting of a single layer.
Heat acclimatization (repeated, limited daily heat exposure which increases in length and intensity of activity each day) provides the best protection, but takes up to 2 weeks in school-aged children.
Signs/symptoms of heat illness in children
Core body temperature of elevated.
Mental status changes: dizziness, mild, or temporary confusion.
Rapid breathing, fast heart rate.
Nausea, vomiting, weakness, headache, fatigue, or diarrhea.
Heat rash: Itchy, may be red, pink, or skin colored. Usually raised.
What to do if you suspect pediatric heat illness
Immediately move to a cooler environment and stop physical activity (shade, air conditioning).
Assist the child into a lying position with legs elevated.
Offer chilled fluids by mouth that contain salt (Gatorade, Pedialyte, etc.)
Do not cool too rapidly for minor heat issues.
Heat cramps: Same as above, plus have someone passively stretch the muscle for the child
Heat rash: Remove sweaty, restrictive clothing and replace with light, loose clothing to lessen sweating. May give cool bath. Heat rash resolved on its own typically. If itching is bothersome or persists, in addition to the cool bath and loose clothing, caregivers may apply cool compresses, calamine lotion, and/or 1% over the counter hydrocortisone cream (avoid face and genitals).
Heat exhaustion typically resolves with the above actions in less than 30 minutes.
Call our office if you suspect your child is experiencing heat exhaustion. Our staff is always ready to support your child and family by providing reassurance, medical expertise, and interventions when appropriate.
Heat stroke requires that you call 911 right away if you see any of these signs:
Dry skin (loss of sweating), is a classic heat stroke sign.
Mental status changes such as loss of consciousness, slurred speech, hallucinations, or seizures.
Core body temperature of 104° or higher
Persistent signs or symptoms that do not rapidly improve after moving to a cooler area.
You may use water or ice to cool the child down rapidly until their core temperature is 102°
Heat stroke will require aggressive treatment at a hospital. There are ongoing risks that must be addressed past the immediate emergency.
Reference: Ishimine, P. (2022). UpToDate. Heat illness (other than heat stroke).
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