Preventing Heat Related Illness
How can I protect my children from heat related illnesses?

Dr. Brenda James, San Juan Health Partners Pediatrics shares information on Preventing Heat Related Illness
Summer in the Four Corners is an exciting time. There are many activities to take part in. Whether you are fishing, boating, camping, riding horses, playing sports, attending pow wows, enjoying hikes or the playground, we all need to be cognizant of heat related illnesses. People of all ages are at risk because we live in an arid region. Last summer we had several days where temperatures exceeded 100°F.

Unfortunately, every year children of all ages are evaluated in clinics and the emergency room for heat related illnesses. Many of these could have been prevented by precautions and monitoring time spent in the heat.

Children are more at risk because they have a greater surface area to body mass ratio than adults. This means that children can actually produce more heat and sweat compared to adults. They are less likely to drink adequate fluids as they don’t know how much to drink and are preoccupied with their activity. Infants, young children, medically fragile children, and children with cognitive disabilities rely on their caretakers to regulate their environments through provision of a cool environment and adequate fluids.

Heat related illnesses can occur on a spectrum. Early identification of symptoms can prevent potentially deadly conditions and prompt recognition and treatment can save lives.

Heat cramps
Heat cramps are muscle pains or spasms occurring in the extremities or abdomen during strenuous activities when a person is sweating and depleting the body of fluid, or if they are exposed to prolonged high temperatures.

• Go quickly to a cool shaded place.
• Provide water or an electrolyte-enriched beverage to drink frequently.
• Massage the affected muscle for relief.
• Wait several hours after the cramping subsides before return to strenuous activity.
• Seek medical attention immediately for mental status changes, persistent cramping greater than one hour or worsening symptoms.

Heat exhaustion
Our body functions like a thermostat. When we are cold, we shiver and this allows for our muscles to warm up. Likewise when we are hot, we perspire and evaporation of our sweat allows us to cool down. Remember, infants and children sweat less than adults and can have more difficulty cooling down on their own.
Heat exhaustion occurs when the body has lost an excessive amount of water and salt contained in the sweat. This causes the body to become cold, pale, and clammy. Cramping muscles, more sweating, fatigue, and weakness evolve. Headache, nausea, vomiting, dizziness, fainting, shallow and rapid breathing, and a rapid but weak pulse are also serious symptoms.

• Same as for heat cramps. If the patient is able to drink, provide plenty of fluids. If they are vomiting or too nauseous to drink then seek immediate medical attention and treat as an early heat stroke.
• Obtain a rectal temperature. If it is elevated to more than 103°, then treat as an early heat stroke. Do not delay treatment if a thermometer is not available.
• Cool the patient down immediately with a cool shower, or sponge baths.
• Seek immediate medical attention if symptoms worsen and continue beyond one hour.
Heat stroke
Heat stroke is a severe form of the body’s inability to regulate temperature. The core body temperature can reach up to 105°F or higher within minutes. Perspiration is not adequate, and the body begins to retain heat rather than release it. Symptoms are hot, red, and dry skin, rapid strong pulse, headache, nausea, dizziness, confusion, and in some cases unconsciousness.
• Have someone call 911 while you began to cool the patient.
• Move them to a cool area.
• Remove all clothing if possible.
• Get cool water onto the skin as much as possible.
• Fan the patient to help with evaporation.
• Take the temperature every few minutes and continue these cooling efforts until the temperature reaches 101°F or less.
• Heat stroke victims are very sick. They are confused, weak, and unable to swallow effectively. Therefore, having them drink fluids is not usually recommended.
• In rare cases, a person can have a seizure, vomit, or have difficulty breathing. It is very important to monitor their breathing.

The best defense against heat related illness is prevention. Tips include:
• Drink more fluids than you usually do. Don't wait until you're thirsty to drink. Make sure that your urine output is frequent. This is especially important for young children and infants. They should have plenty of wet diapers, and their urine should not be dark. Infants and young children might not be able to tell you that they are cramping, instead they might be irritable, cry with less tears, or have a dry mouth. Medically fragile children or children with developmental delays should also be monitored closely.
• Have plenty of non-carbonated electrolyte-rich fluids readily available.
• Don't drink fluids that contain alcohol, large amounts of sugar, or large amounts of caffeine. These will actually cause you to lose more body water. Very cold drinks can sometimes cause stomach cramps or nausea.
• Stay in cool areas during the hottest parts of the day, 10:00 a.m. to 3:00 p.m.
• Wear lightweight, light colored, loose fitting cotton clothing. Infants do not need extra blankets or layers of clothes.
• NEVER leave anyone in a closed, parked vehicle, even with the windows rolled down. Make sure all passengers have left the car when you reach your destination by checking the passenger seats when exiting your vehicle.
• Teach children not to play in, on, or around cars. Always lock car doors and trunks, and keep keys out of children's reach.
• Make sure your child safety seat and safety belt buckles are not hot before securing your child in the safety restraint system.
• Make sure there are trained personnel and facilities to respond quickly to heat illness at all youth sports activities or where they will be participating in vigorous exercise. The American Academy of Pediatrics has a policy statement that offers recommendations to minimize the risk of heat related illness in children and adolescents who are in sports related activities. The website is

Have a wonderful and safe summer and please contact your physician if you have any other questions, and don't forget to wear sunscreen and reapply frequently.