Hot enough for you? Especially in the summer, it's important to remember that children are more susceptible to heat-related ailments than adults. Kids have a larger surface area relative to their body weight, which means they absorb heat faster. It takes them longer to cool down because their sweat glands are not as developed — or as numerous — as they will be later in life. And kids don't get thirsty the way adults do, which leaves them prone to dehydration.
This month, Dr. Lewis First, head of pediatrics at Vermont Children's Hospital at Fletcher Allen Health Care, offers tips for recognizing and treating heat cramps, heat exhaustion and heat stroke.
KIDS VT: What are heat cramps?
LEWIS FIRST: Heat cramps occur without a fever, typically after exercise in extreme heat. When kids sweat, they can lose fluid and salt, which causes a metabolic imbalance. The first place kids feel it is in their muscles — their calves, thighs and occasionally their belly — which will start cramping.
KVT: How do parents treat heat cramps?
LF: This one is easy. Stop them from exercising, bring them inside or to a cool place, have them drink plenty of fluids and massage the cramps, and they're usually good to go within a couple of hours. In fact, the cramps usually subside within a couple of minutes.
Heat cramps don't preclude children from going outside the next day. It's actually a good opportunity to teach kids about the importance of staying hydrated.
KVT: What is heat exhaustion?
LF: Heat exhaustion is a combination of high environmental temperatures and dehydration. This means that heat is building up in the body without the ability to lose it through sweat. Typically, heat exhaustion is marked by a fever of 100 to 104 degrees.
A child with heat exhaustion will appear weak and fatigued, their skin will feel clammy, and they may experience nausea, vomiting, weakness and a headache.
KVT: How do you treat heat exhaustion?
LF: Get the kids inside or into the shade, remove or loosen their clothing, and encourage them to slowly but steadily drink cool liquids. If they can't drink because they're too nauseated, that's a reason to seek emergency care — they'll need intravenous fluids. They should be bathed in cool — but not cold — water. If the water's too cold, they're going to shiver, which will generate even more body heat.
As long as their temperature is below 105 degrees, the body is still trying to compensate and get rid of the heat. If you don't treat heat exhaustion while the temperature is in that range, it could progress to heat stroke.
KVT: What is heat stroke?
LF: Heat stroke is a true medical emergency. The body essentially gives up and can no longer regulate its internal temperature. So the person will stop sweating and continue to heat up.
KVT: How do parents tell the difference between heat exhaustion and heat stroke?
LF: Basically, the child's body temperature will be above 105 degrees with heat stroke. Whether the temperature is taken orally, rectally or in the ear, if it reads above 105, the child is verging on heat stroke.
The child will have very hot, flushed and dry skin. They'll become incredibly dizzy, confused and may have a seizure. They'll also have a throbbing headache and may be unresponsive to the point of losing consciousness.
If this occurs, bring them inside immediately, sponge them down with cool water and call 911 because an emergency facility will need to do appropriate cooling. When someone has heat stroke, it is not appropriate to give him or her cool liquids to drink. They're not in control of their swallowing mechanism and may vomit and then aspirate the liquid into their lungs.
KVT: Does it matter if kids are hydrated with plain water or sports drinks?
LF: The American Academy of Pediatrics is fine with the use of cool water. Most kids who are under 90 pounds need four to six ounces of water before they go out, and for every 20 minutes of exercise or activity. If they're over 90 pounds, they need about nine to 12 ounces every 20 minutes.
Ordinarily, I'm not a big fan of flavored sports drinks for kids because of all the sugar and other additives in them. But the advantage of sports drinks in high-heat situations is that they have a salty flavor and will make kids thirstier, and thus drink more.
KVT: How can kids exercise safely in the heat?
LF: Especially in hot and humid conditions, athletic workouts should take place in the morning or late afternoon, when the sun is not at its peak. Coaches should slowly increase activities during the first two weeks of hot-weather practice and not have kids put on heavy equipment and uniforms until their bodies are better acclimated to exercising in the heat.
They should then be sure the kids hydrate every 20 minutes. One idea is to weigh kids before and after each vigorous 20-minute workout to make sure they are not losing too much weight too suddenly due to dehydration. Adequate hydration should be instituted before heat exhaustion or heat stroke occurs.
Finally, coaches and parents should know how to recognize heat exhaustion and heat stroke, and have a suitable first-aid and emergency-transport plan should a heat illness occur.