Signs & Symptoms Of Heat Exhaustion And Heat Stroke In Kids

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Heat cramps, heat exhaustion, or heatstroke occur due to increased body temperature. You may notice symptoms of overheating (hyperthermia) in your child when the body fails to cool itself.

Heat cramps are mild and cause intense painful muscle spasms during exercise in hot weather and are usually corrected by rest and consumption of electrolytes. Heat exhaustion shows other physical symptoms of increased body temperature and requires cooling techniques to return to average body temperature. Whereas, heatstroke is a severe heat-related illness that occurs when body temperature is above 104°F (40°C) and requires emergency medical care (1).

Read this post to know more about the causes, signs, symptoms, risk factors, complications, diagnosis, and treatment of heat-related illnesses, such as heat cramps, heat exhaustion, and heatstroke in children, and the ways to prevent them.

Causes Of Heat Exhaustion And Heatstroke In Children

The normal body temperature is maintained by mechanisms of heat loss or heat gain, depending on the ambient temperature. The process of maintaining normal body temperature is called thermoregulation.

During summer, the body regulates its temperature through the secretion of sweat, which evaporates to lower the body temperature. Any failure in thermoregulation by heat loss during hot and humid conditions may result in increased body temperature, resulting in heat cramps, heat exhaustion, or heatstroke.

The following factors may reduce heat loss and often cause heat exhaustion or heat stroke in children (2).

  • Strenuous activities in hot and humid weather conditions
  • Exercise in children not conditioned to the exercises or the environment
  • Dehydration
  • A tight and thick layer of clothing
  • Certain medications (eg: diuretics) or existing illness (eg: diabetes or spinalcord injuries)

Risks And Complications Of Heat Exhaustion And Heatstroke In Children

Alterations in thermoregulation of the body due to environmental or other factors are the major causes of heat exhaustion in most children. The following factors may increase the risk of developing heat-related illness (3).

  • Infants and younger children under four years of age have a higher risk of an immature temperature regulation system.
  • Certain medications, such as antihistamines, anti psychotics, diuretics, etc. may affect the body’s heat regulation.
  • Overweight and obesity may cause retention of more heat.
  • Sudden increase in the ambient temperature, like in the case of heatwaves, may cause heat exhaustion.
  • High humidity could cause heat exhaustion in higher temperatures due to reduced evaporation of sweat.

Heatstroke is the major complication of heat exhaustion, and it can be life-threatening if the body temperature reaches 40°C (104°F) or more. Heatstroke is a medical emergency since it increases the risk of brain and organ damage.

Symptoms And Signs Of Heat Exhaustion And Heatstroke In Children

Heat cramps are a milder form of heat-related illness, and may result in (4):

  • Painful muscle cramps
  • Thirst
  • Profuse sweating
  • Fatigue

Heat cramps can be controlled by rest and drinking fluids with electrolytes. If left untreated, this may lead to heat exhaustion or heatstroke.

Heat exhaustion signs and symptoms may include (2):

These signs and symptoms may develop suddenly or gradually based on the body temperature. If you notice any symptoms of heat exhaustion in your child, reduce body temperature as soon as possible to avoid heatstroke.

Signs and symptoms of heatstroke in children may include (1):

  • Body temperature of 40°C (104°F) or above
  • Lack of sweating
  • Confusion
  • Rapid heartbeat
  • Fast breathing
  • Flushed skin
  • Appearing weak
  • Nausea
  • Vomiting
  • Diarrhea
  • Loss of consciousness

If the child has any of the above symptoms, seek emergency medical care to avoid complications.

Diagnosis Of Heat Exhaustion And Heatstroke In Children

Measurement of body temperature is enough to determine heat exhaustion or heat stroke in children. Rectal temperature may be measured for confirmation.

The following tests may be ordered to confirm heatstroke in children (3).

  • Blood tests to assess blood gases, sodium, and potassium levels
  • Urine test to analyze the composition and concentration of the urine
  • Muscle function tests may be done to check for rhabdomyolysis (muscle injury)
  • Imaging tests such as X-ray, ultrasound, MRI or CT may be conducted to check the health of internal organs 

Treatment For Heat Exhaustion In Children

Drinking fluids with electrolytes and staying in places with cooler temperatures or under shade may reduce heat cramps in children. However, heat exhaustion and heatstroke may require more cooling methods to achieve normal body temperature.

The following home treatments may be enough to manage heat exhaustion in children (5).

  • Remove tight or extra layers of clothing; loose cotton clothes are preferable
  • Stay in cool places, such as in an air-conditioned room, or under a fan
  • Lay down and keep legs elevated from the heart level
  • Drink cool water or electrolytes
  • Try a cool bath or shower if possible
  • You may place a towel soaked in cold water on the skin

Do not give acetaminophen, aspirin, or any other fever medication to reduce body temperature if your child has heat-related illness since it may harm the child (1). 

When To See A Doctor

If your child is experiencing heat exhaustion, you may ask them to rest in a cooler place and drink cold water. If there are no other signs and symptoms of heatstroke, you may wait for an hour until they feel well. Contact the doctor if the body temperature is not returning to normal within this time.

If they are unconscious, confused, have a body temperature of 40°C (104°F) or more, or are unable to drink water, seek immediate medical care. 

Treatment For Heatstroke In Children

Heatstroke treatments may include (5):

  • Cold water immersion, which may reduce body temperature; immersing in ice water is the preferred method.
  • If cool water immersion is not possible, evaporation cooling techniques are used in the hospitals. This method involves misting cool water to the body while warm air is fanned around the child, so skin is cooled while the water evaporates.
  • Packing in ice and special cooling blankets.
  • Muscle relaxants, such as benzodiazepines, are given to prevent shivering since the body tends to shiver while cooling. Shivering may increase body temperature, and the cooling methods may not be effective. Muscle relaxants should be taken only if prescribed by the doctor.

The most important is to start the cooling process as soon as possible and to keep cooling the child down even during the transport to the hospital.

Children with heat exhaustion may return to the normal temperature range within half an hour, whereas heatstroke may require more time and medical treatment. Recovery time after heatstroke may vary based on the severity and other effects, such as internal organ damage. The complete recovery in extreme cases may take a few days to months (6).

Prevention Of Heat Exhaustion And Heatstroke In Children

The following tips may help prevent heat exhaustion and heat-related illnesses in children (5) (7).

  • Wear loose and lightweight clothing in the summer months.
  • Use sunscreens to prevent sunburn. Sunburn reduces the body’s ability to maintain a normal temperature. Wearing sunglasses and wide-brimmed hats may reduce sunburn during outdoor activities.
  • Stay hydrated enough since body temperature is maintained by sweating in hot weather.
  • Never leave a child in a parked car even if you parked in the shade.
  • Schedule outdoor activities in the morning or evening hours when the temperature is low.
  • Discuss with a pediatrician if your child has any regular medications that may increase body temperature.
  • If your child is not used to hot weather, let them acclimate gradually before beginning exercise or outdoor activities.

If your child is taking any medication, is ill,  or has a history of heat-related illness, outdoor and strenuous activities should be avoided during warm and humid conditions. In unavoidable circumstances, discuss with your child’s doctor regarding the activity and precautions to prevent heat exhaustion or heat stroke.

Heat strokes and heat exhaustion in children can be prevented with necessary precautions. You may have to pay attention to the child’s clothing and activities during the summer months. Always discuss with your child’s pediatrician regarding participation in strenuous activities while taking medications. Keeping the body cool and avoiding heat exposure in the first place are the best ways to keep heat-related illnesses away.

References:

1. Emergency First Aid for Heatstroke; C.S. Mott Children’s Hospital
2. Heat exhaustion and heatstroke; National Health Service
3. Heat exhaustion; St. Clair Hospital
4. Heat Cramps; The University of Connecticut
5. Babies and children in hot weather; The New South Wales Government
6. Heat stroke (Hyperthermia); Harvard Medical School
7. Heat-Related Illness in Children; Texas Children’s Hospital
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