Heat Stroke, Heat Exhaustion and Heat Cramps

Tips on Preventing, Recognizing and Protecting our Children from Heat Stroke, Heat Exhaustion and Heat Cramps

By Rosemarie C. Lister, MPH

Every August we hear of both youth and professional sports players experiencing heat exhaustion and even heat stroke. Some important factors to remember is that children do not always feel thirsty and yet they need to continue to drink to keep themselves hydrated before, during and after their activity. It is also important for them to articulate their needs. If they are on the field and they are experiencing symptoms of heat illness, they need to communicate that to their coaches, parents and doctor right away. Parents and coaches are encouraged to read the following information and discuss with their children.

The following information has been gathered from both The American Academy of Pediatrics, The Center for Disease Control and Prevention and the Mayo Clinic to help prevent, recognize and protect our children from the dangers of heat stroke, heat exhaustion and heat cramps. Again, please discuss with your children and always contact your doctor whenever you have concerns. Together, we can do our best to keep our children safe in excessive heat.

Facts from the American Academy of Pediatrics:
Children do not tolerate extreme temperatures as effectively as adults due to producing more metabolic heat and having lower sweating capacity which reduces their ability dissipate body heat. The higher the temperature and humidity, the greater the effect on the child. Children frequently do not feel the need to drink enough to replenish fluid loss during prolonged exercise. This may lead to severe dehydration. A major consequence of dehydration is an excessive increase in core body temperature. Therefore, the dehydrated child is more prone to heat-related illness than the fully hydrated child. Although water is an easily available drink, a flavored beverage may be preferable because the child may drink more of it.

The AAP recommends the following for children and adolescents:

1. The intensity of activities that last 15 minutes or more should be reduced whenever humidity and temperature are above critical levels. One way of increasing rest periods on a hot day is to substitute players frequently.
2. At the beginning of a strenuous exercise program 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. When such a period is not available, the length of time for participants during practice and competition should be curtailed.
3. Before prolonged physical activity, the child should be well-hydrated. During the activity, periodic drinking should be enforced (eg, each 20 minutes 5 oz of cold tap water or a sports drink for a child weighing 88 lbs and 9 oz for an adolescent weighing 132 lbs, even if the child does not feel thirsty. Weighing before and after a training session can verify hydration status if the child is weighed wearing little or no clothing.
4. 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.

Facts from the CDC and National Center for Environmental Health:
People suffer heat-related illness when the body's temperature control system is overloaded. The body normally cools itself by sweating. But under some conditions, sweating just isn't enough. In such cases, a person's body temperature rises rapidly. Very high body temperatures may damage the brain or other vital organs. Several factors affect the body's ability to cool itself during extremely hot weather. When the humidity is high, sweat will not evaporate as quickly, preventing the body from releasing heat quickly.

Heat stroke is the most serious heat-related illness. It occurs when the body becomes unable to control its temperature: the body's temperature rises rapidly, the sweating mechanism fails, and the body is unable to cool down. Body temperature may rise to 106°F or higher within 10 to 15 minutes. Heat stroke can cause death or permanent disability if emergency treatment is not provided. Warning signs of heat stroke vary but may include the following:

• An extremely high body temperature (above 103°F)
• Red, hot, and dry skin (no sweating)
• Rapid, strong pulse
• Throbbing headache
• Dizziness
• Nausea
• Confusion
• Unconsciousness

If you see any of these signs, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the victim. Do the following:

• Get the victim to a shady area.
• Cool the victim rapidly, using whatever methods you can. For example, immerse the victim in a tub of cool water; place the person in a cool shower; spray the victim with cool water from a garden hose; sponge the person with cool water; or if the humidity is low, wrap the victim in a cool, wet sheet and fan him or her vigorously.
• Monitor body temperature and continue cooling efforts until the body temperature drops to 101-102°F.
• If emergency medical personnel are delayed, call the hospital emergency room for further instructions.
• Get medical assistance as soon as possible.

Heat exhaustion is a milder form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids. The warning signs of heat exhaustion may include the following:

• Heavy sweating
• Paleness
• Muscle cramps
• Tiredness
• Weakness
• Dizziness
• Headache
• Nausea or vomiting
• Fainting

The skin may be cool and moist. The pulse rate will be fast and weak, and breathing will be fast and shallow. If heat exhaustion is untreated, it may progress to heat stroke. Seek medical attention if symptoms worsen or last longer than one hour. The following steps may cool the body:

• Drink cool, nonalcoholic beverages.
• Rest.
• Take a cool shower, bath, or sponge bath.
• Seek an air-conditioned environment.
• Wear lightweight clothing.

Heat cramps are muscle pains or spasms – usually in the abdomen, arms, or legs – that may occur in association with strenuous activity. People who sweat a lot during strenuous activity are prone to heat cramps. This sweating depletes the body's salt and moisture. The low salt level in the muscles causes painful cramps. Heat cramps may also be a symptom of heat exhaustion.

If medical attention is not necessary, take the following steps:

• Stop all activity and sit quietly in a cool place.
• Drink clear juice or a sports beverage.
• Do not return to strenuous activity for a few hours after the cramps subside because further exertion may lead to heat exhaustion or heat stroke.
• Seek medical attention for heat cramps if they do not subside in 1 hour.

Heat rash is a skin irritation caused by excessive sweating during hot, humid weather. It can occur at any age but is most common in young children. Heat rash looks like a red cluster of pimples or small blisters. It is more likely to occur on the neck and upper chest, in the groin, under the breasts, and in elbow creases. The best treatment for heat rash is to provide a cooler, less humid environment. Keep the affected area dry. Dusting powder may be used to increase comfort.

Some additional tips from Safe Kids USA:

• Raise the child's legs 8-12 inches if heat illness occurs.
• Dark-colored urine can be another sign of heat exhaustion
• Drink 12 ounces of fluid (such as water) 30 minutes before the activity begins.
• Children under 90 pounds should drink 5 ounces every 20 minutes during the activity. Children over 90 pounds should drink 9 ounces every 20 minutes during the activity.
• Have mandatory fluid breaks - don't wait for the child to tell you he/she is thirsty.
• Children should drink fluids after physical activity to make up for fluid loss.
• A child's gulp equals a 1/2 ounce of fluid so generally, your child should drink about 10 gulps for every 20 minutes of play.

According to The Mayo Clinic, children may be more susceptible to dehydration if they rarely exercise, are overweight or obese, sick, taking certain supplements or medications, such as cold medicine and has a previous heat-related illness. Symptoms of dehydration can include dry, sticky mouth, thirst, headache, dizziness, cramps and excessive fatigue. The more we can keep our kids hydrated and keep informed on the dangers of excessive heat, the more we can reduce the risk of the above heat related illnesses.

References:

Center for Disease Control and Prevention: Frequently Asked Questions (FAQ) About Extreme Heat August 15, 2006 Content source: National Center for Environmental Health (NCEH)/Agency for Toxic Substances and Disease Registry (ATSDR), Retrieved July 2011 extremeheat /FAQemergencycdc.gov

American Academy of Pediatrics: Climatic Heat Stress and the Exercising Child and Adolescent Pediatrics Vol 106 No. 1 July 2000 Committee on Sports Medicine and Fitness Retrieved July 2011; aap.org

Safe kids USA; Dehydration and Heat Illness Prevention Tips Children's National Medical Center; retrieved July 2011; safekids.org

The Mayo Clinic: Dehydration and youth sports: Curb the risk The Mayo Clinic Staff; Retrieved July 2011; mayoclinic.com/health/dehydration