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What is Heat Stroke

Warm weather brings with it most of the joys of summer, and also a few additional risks for active children and teens. Heat-related illness is the term doctors use for the several different conditions that heat and activity can cause. All of these conditions are related to each other, and they range in severity from mild heat cramps to severe and life-threatening heat stroke.

At the root of heat-related illness is dehydration and the body’s sensitive thermostat. As the body works to cool itself by sweating and breathing faster, it loses water. The water loss causes dehydration. Dehydrated muscles tend to get cramps, called “heat cramps.” More severe dehydration can lead to dizziness, light-headedness, and even fainting. This is called “heat syncope” (sink-oh-pea). With still more heat and dehydration comes heat exhaustion, in which the person has several symptoms at once: severe thirst, flushing skin, profuse sweating, nausea, dizziness, and weakness. At this point the body’s thermostat is still working hard to bring down body temperature. If the person does not get out of the heat and get fluids, s/he risks the dangerous condition called “heat stroke.”

The bodies of heat stroke victims actually begin to try to get still warmer, as the natural thermostat breaks down. Signs of heat stroke therefore look a little like signs of being too cold: pale, cool, dry skin, goose bumps, and shivering. Body temperature begins to rise rapidly. At this point muscle tissue can begin to break down, causing kidney damage. Severe cases of heat stroke can cause shock, brain injury, and death.


What is the biggest concern?

The biggest concern in most cases of heat-related illness is to break the cycle of heating and dehydration. This helps to prevent the condition from getting worse and worse over time. In the long run, we want to prevent the illness from progressing to the stage of heat stroke. It is usually fairly easy to do this, and to learn to prevent heat-related illness in the future.


Heat Stroke treatment

If a child or teen has developed heat cramps, faintness, or signs of heat exhaustion, the most important thing to do is get him or her out of the heat. Loosen or remove clothing, move the child into the shade or into an air-conditioned space, and provide some breeze with a fan if possible. Please avoid immersing the child in cold water all at once; this can actually raise the body temperature. A lukewarm sponge bath in front of a cooling fan is very helpful. Please do not give any pain or fever medication until after you have spoken with your doctor.

Hydration is very important. Encourage your child to drink lots of non-sugary liquids. Sports drinks such as Gatorade® and others are good sources of just the right mixture of water and minerals. It is best to avoid caffeine-containing liquids, which cause the child to urinate more and lose more fluid. It can take many hours to fully rehydrate someone who has suffered from heat-related illness, so be sure to continue encouraging your child to drink extra fluids at least until bed-time. You’ll know you have given enough fluids when your child starts to need to urinate frequently, and when the urine becomes light in color.

Please have your child rest quietly for the rest of the day when s/he has had a heat-related illness. Because these illnesses are progressive, it is a bad idea to allow a child to go back out into the heat until s/he is fully recovered. This usually takes a day. If a child returns to a hot place on the same day and is active, s/he takes a big risk of getting a more serious heat-related illness.

If your child had heat exhaustion or heat stroke, s/he probably got some IV fluids in a hospital. Doctors usually observe patients with these conditions for several hours before sending them home. Even after discharge, please continue to offer plenty of liquids and keep your child in a cool and shaded area for the rest of the day.

People with early heat-related illness are thirsty and may seek to eat salty foods. As long as there is an unlimited supply of water to go along with the food, this is not a problem and may actually help. Please do not give your child or teen salt tablets to prevent heat-related illness. These can be very dangerous if someone takes too much salt. The best prevention of these conditions is to try to avoid them, and to recognize the signs and symptoms early enough to head them off.


Symptoms of Heat Stroke

Most children who rest and drink plenty of fluids for the remainder of the day on which they got sick do fine. Sometimes, though, heat-related illness can be more severe than we originally thought, or other complications can develop. Here are some things to look out for:

  • Becoming excessively sleepy or difficult to wake up
  • Becoming very irritable or cranky
  • Becoming disoriented or confused
  • Cool, pale skin, goose bumps, or shivering
  • Asking for hot beverages or warm blankets
  • Vomiting
  • Pain in the lower back or abdomen
  • Dark red or brown-colored urine
  • Any of the original symptoms returning or getting worse rather than better

If any of these occur, please be sure to call your doctor’s office right away. If your child or teen is difficult to awaken or seems unconscious, go directly to the emergency room.


Other points of concern

Once your child or teen has fully recovered, feels well, and looks normal, s/he can return to normal activity. Most doctors recommend that kids not return to activity in the heat until at least the following day, however. Please work together with your child to help him or her recognize the early warnings his or her body is giving about dehydration and heat illness. Please ask your child to take a break at least once an hour if s/he is out in the heat, to get into the shade and drink some fluids. You may want to give older children and teens a water bottle or container with Gatorade® or another sports drink in it. It’s best to encourage drinking at least 2 cups every hour for an active school-aged child, and as much as four cups an hour (or more) for an active teenager. Wearing a loose-fitting hat or cap can keep the direct sun off the child’s head, and this can help a lot. If there is a lake, pond, or pool where your child will be during the day, please encourage him or her to take a dip once in a while. Of course, please be sure there’s adequate adult supervision and a lifeguard.


Other Conditions that Might Be Present with Heat Stroke

Children who get heat-related illness can get severe sunburns as well, if they have been in direct sunlight for long. Please remember that children’s skin is much thinner and more delicate than adults’, and requires more protection. Don’t forget the sunscreen with a high SPF rating for a day out in the heat. If a child has another illness, such as a cold or other problem, s/he may be more likely to get a heat-related illness. It’s best to keep a child in the shade or a cool environment without too much exertion until any other illness clears up. When kids are sick with a cold or a stomach bug, they usually don’t drink even as much as they normally do, and they aren’t likely to be able to keep up with their increased fluid needs on a hot day.

Teenagers often forget to eat breakfast when they are busy and active. Low blood sugar, a hot day and some dehydration can cause fainting and nausea. Please be sure your child remembers to eat as well as drink before going out for a day in the sun. Teenagers who take the drug “ephedra” to “enhance performance” may be a higher risk of heat related illness. If you think your teen may have taken or be taking this substance, please talk about it with your child’s doctor.