Heat Stroke 101
Written by Dr. Pia Boben Fenimore
As we head into the hot summer months and especially as children begin to practice high school sports and marching band, it is important to take steps to avoid heat exhaustion and heat stroke.
Heat stroke is defined as a core body temperature higher than 104-105 degrees combined with central nervous system symptoms such as confusion, passing out, or severe headache. Heat exhaustion is the precursor to heat stroke and includes symptoms such as profuse sweating, nausea, vomiting, headache, weakness, dizziness, increased thirst, and decreased urine output.
Children are more susceptible to heat illness than adults, especially infants and young athletes. August is by far the most common month for heat illness, with two thirds of all emergency department (ED) visits for this occurring in August. Heat stroke incidence is on the rise in the United States with around 125,000 ED visits in the United States in 2023.
The heat index is the measure of temperature and humidity; it classifies environments into danger zones. Heat index can be found on the National Weather website here: https://www.weather.gov/safety/heat-tools.
Heat illness is preventable. Parents and coaches should take the following the steps to ensure their children are safe:
Get to know the heat index and restrict activities on days that are labeled Danger
Take frequent hydration breaks (see below for hydration guidance by age)
During competitions, use frequent player substitutions to allow for rest
Locate and ensure shaded areas for rest
Change practice times to earlier or later during cooler temperatures and less humidity
Allow for a complete rest and cool down after activity
Do not allow your child to play if they are ill including gastrointestinal symptoms, such as diarrhea
Hydration is critical during heat exposure. For sports, follow these rules: Children ages 9-12 should drink 4-8 ounces every 20 minutes. Adolescents should drink 40-50 ounces every hour. In general, alternating between water and electrolyte drinks such as Gatorade is a good idea to ensure electrolyte balance without giving too much sugar.
It is possible to acclimatize to heat over a period of days to weeks. This means that children and teens can slowly increase the intensity or duration of their activity level in the heat. Older children can usually acclimatize in 4-5 days, where as younger children may take 10-14 days.
Extra caution should be used if a child is on prescription medications such as Attention Deficit Disorder medications or if they take creatinine supplements. If the sport requires pads and other gear that can increase heat retention, they are at increased risk of heat illness as well.
Prompt recognition of heat exhaustion is critical to avoid it progressing into heat stroke. If a child is showing signs of heat illness:
Stop exercising
Move them to a cooler environment immediately
Give the person chilled salt-containing liquids (such as Gatorade)
If symptoms are not responding, seek advanced care
A note about babies: Because they do not have the ability to cool their body well and have a higher surface area, babies are more susceptible to heat illness and progress faster to heat stroke than older children and adults. They also sometimes do not show obvious signs of heat exhaustion and may present with just fussiness, decreased feeding, decreased wet diapers, or lethargy. When the heat index is about 75 degrees, take these steps to prevent serious complications from the heat in infants:
Avoid sun exposure
Stay indoors during peak heat
Dress them appropriately for the heat (loose, light weight, light colored clothing)
Breastfeed or bottle feed babies more frequently during hot weather (do not give babies water without consulting a pediatric provider)
Cool them down with damp cloths and fans (but not blowing directly on them)
Never leave a baby in a parked car, even with the windows open
As a pediatrician, I always want kids to head outside and be active! There are many studies that support that time outdoors helps to prevent joint problems, obesity, diabetes, anxiety, and depression. Yet, heat index and the risk of heat illness require that adults think about safety and prepare children for exposure to heat. With a few adjustments, lots of hydration, and mindful prevention, it is still possible for kids to safely participate in activities outdoors, even in the summer months!
