How to tell if your child is over-heated

If you’ve been watching the news, you will know that there are heat-wave alerts around the country. In my area, our heat index is in the 90s.

Unfortunately, it is VERY easy to unknowingly become over-heated, and kids are especially susceptible. See today’s instagram post for a story about a patient who had this happen.

For parents, knowing the signs of heat illness & when to be concerned is important, especially because children and the elderly are especially vulnerable to heat injury.

What is heat illness?

When our bodies make too much heat, or are exposed to too much heat, they cannot adequately cool themselves down.

And if the environment is humid, then the mechanisms that our bodies rely on for cooling (such as evaporation) become less efficient.

This is especially true when the temperature is >90-95 F (32-35 C) and the humidity is >75%, so in these conditions we need to be extra vigilant about heat injury.

Kids are at higher risk:

Due to their anatomy and physiology, kids are at higher risk for overheating than adults.

• They have higher body surface area — so they can absorb heat more quickly in hot environments

• They don’t lost heat (sweat) as efficiently

• They have a higher basal metabolic rate

• They can get dehydrated more easily

• Younger kids, especially, are less able to recognize and communicate warning signs - which means it is extra important for parents to be watching them

Preventing heat injury

There are measures you can take to pro-actively to prevent heat injury. Here are a few:

• Minimize time spent in temps >90F (eg outdoors/limit sporting activities in this weather, or in a hot car)

• Avoid sunlight during the hottest part of the day (10am - 3pm)

• Wear appropriate clothing (single layer of absorbed, loose fitting clothing in light colors, UPF 30-50). Layer methods of sun protection (sunscreen, hat, time in the shade, etc). Click here for product recommendations. Remember: sun protection is not the same as heat protection!

• Hydrate, hydrate, hydrate. Click here for dehydration information to watch for.

• Layer methods of sun protection (sunscreen, hat, time in the shade, etc)

Is heat injury serious?

Heat illness can range from relatively minor reactions (such as heat rash) all the way to heat stroke, which can be fatal. I like to think about it in four separate categories, as below.

Over-heating

Over-heating is the first stage of heat illness, and it is usually fairly mild. Especially in younger children, who may not be aware of the need to communicate if they’re feeling over-heated (or may be too young to do so), watch for non-verbal signs that they’re too hot. These can include:

• Flushing

• Sweating excessively

• Thirst

• Heat rash (see here for pictures and tips)

• Decreased urine output or other signs of dehydration

• Dizziness

• Core body temperature may or may not be elevated

What to do:

• Get out of the heat: go into natural shade, or an air conditioned room/car

• Rest and minimize further physical activity which will in turn minimize further heat production and stress on the body

• Consider touching base with your pediatrician if you're concerned, esp for younger infants

• Push electrolyte-containing fluids (see here for which are best and how much you need to give)

The Pediatrician Mom Tip: We do not recommend fever-reducing medications. the body is not over-heating because of a change in the “set-point” of the body temperature, which is what happens with you have a fever. So the fever-reducer will not decrease the body temperature. Additionally, because heat injury is associated with dehydration, the stress on the kidneys and liver when trying to metabolize medications like Acetaminophen or Ibuprofen may be increased.

Heat Cramps

Heat cramps are a result of dehydration and sweating leading to electrolyte abnormalities, which can cause cramping of the muscles. Some people don’t think of heat cramps as a different category, but I think it is a useful way to think about it as a red flag that things are moving past just being over-heated.

Many of the symptoms are similar to above, but in addition you may see muscle pain (especially large muscles such as the abdomen, arms or legs) or a sudden increase in fussiness from a young child.

What to do:

• In addition to the same interventions as above, consider:

• Gentle massage of affected muscles

• Sometimes IV fluids are needed

Heat Exhaustion

Heat exhaustion is the next stage. At this point, the body has over-heated enough that it can no longer easily cool itself down — so this is inherently more serious.

Symptoms may include some of:

• The body temperature may be elevated, but likely is still going to be below 104F ( 40C)

• Rapid shallow breathing

• Rapid heart beat, sometimes the pulse can feel weak

• Muscle cramps

• Nausea or vomiting

• Heavy sweat

• Thirst

• Signs of dehydration including excess thirst and severe sweating. The skin many be hot or cold and clammy.

• Dizziness, headache, a sensation of light-headedness when standing

• Still relatively normal cognition, sometimes mild confusion but returns to normal quickly with cooling

What to do:

Seek medical care ASAP. In the meantime:

• Get out of the heat: go into natural shade, or an air conditioned room/car

• Rest/minimize further physical activity to minimize heat production

• Remove excess clothing

• Cool down quickly: cool bath/shower, spray, fan, cool packs to neck, groin, armpits

• Push cool electrolyte-containing fluids

• May need IV fluids, bloodwork, imaging, etc

The Pediatrician Mom Tip: Do NOT give fever-reducing medications.

Heat Stroke

This is the most extreme form of heat injury and is a result of the body no longer being able to control internal temperature. The body temperature rises rapidly and normal physiologic functions to cool it down (such as sweating) no longer work. This is very serious - potentially fatal - and these patients need emergent treatment.

Symptoms may include some or all of:

• Core body temperature is elevated, often above 104F (40C)

• Altered mental status (confusion, hallucinations, delirium, sometimes fainting/loss of consciousness)

• Rapid shallow breathing

• Rapid heart rate, weak pulse

• Nausea and vomiting

• Skin may be flushed or may be pale, cool and clammy

• Seizures

What to do:

Seek medical care ASAP. In the meantime:

• Follow the same measures as above under heat exhaustion.

• Do not give fever-reducing medication.

• These patients often need to be admitted to the ICU.

Heat injury is serious, but it is also preventable.

Make sure you keep an eye not just on your children, but also any elderly in your family or neighborhood, and pets.