With the sticky, hot summers we experience here in Washington, I have been thinking about and seeing many heat-related illnesses. In my last column, I wrote about "heat rash"; this month, I will be writing about the more serious problems of heat exhaustion and heat stroke. As I experienced firsthand after helping to care for an overheated and dehydrated young girl when I quickly (well, I planned for it to be quick) stopped by my daughter’s soccer camp to drop something off, this can be a significant issue during the summer and early fall. Outdoor play in oppressive temperatures can lead to heat illness; as young athletes begin intense training for their fall sports teams, the risk grows even higher.
Staying properly hydrated and inside during the peak hours of noon to 6 p.m. on very hot days are key tips to avoid heat illness. If a child or teen is outside and active during these peak hours, frequent breaks in the shade and more aggressive hydration can help them manage the high temperatures. When hydrating, it is important to drink fluids (noncaffeinated) not just during the periods of outdoor activity, but also before and after. A good rule of thumb is to drink 24 ounces 2 hours before exercise and then another 8 ounces right before. It sometimes can be hard to drink that much, so you can encourage parents to give their children a full water bottle to carry around when getting ready in the morning. During my daughter’s week of soccer camp in 95 weather, we also filled an extra water bottle for her to sip on in the car on the way over and again on the way home. During exercise, an additional 8 ounces every 20 minutes is optimal. Recommend to children and teens that they drink at each break until they are no longer thirsty, and then a little bit more.
Generally, for hydration before and after, and for shorter periods of exercise, water is best. Electrolyte sports drinks can be a useful adjunct if the temperatures are very high or if the child or teen is strenuously exercising for an hour or more. Many of these drinks are filled with sugar, however, and so 8 ounces every 20 minutes would be way too much. I recommend alternating with water, or offering one of the low-sugar/low-calorie electrolyte drink options. In our own house, we have discovered a great sports drink that the kids and I like the taste of that comes in small tablets you can dissolve in water and has no calories.
Equally as important, if despite every precaution, a child or adolescent begins to show signs of heat exhaustion – dizziness, nausea, vomiting, muscle cramps, decreased sweating, or headache – it is important to immediately remove them from the heat and help them to get cooled off and hydrated.
Moving inside, removing any heavy sports equipment, and patting their skin with cold water on a towel can help alleviate the symptoms of heat illness. Very frequent small sips of fluid should be started for rehydration. If she doesn’t begin to feel better relatively quickly – or is showing even more serious signs such as rapid breathing, behavioral changes, seizures, or syncope – parents and coaches should be encouraged to immediately seek further medical care as overheating can progress to heat stroke and become quite serious.
As pediatric providers – and even in my case as the parent of a young soccer player – we can play an important role in helping families, schools, camps, and teams prevent serious heat-related illness. Equally importantly, we want to encourage healthy, active, outdoor activity, and our advice can help families plan for this safely.
A terrific time to provide this counseling in a proactive way is when filling out the voluminous numbers of school and sports forms we all get every summer and fall. As you sign off on your patient’s sports physical, it only takes another minute or 2 to discuss the importance of staying hydrated and taking frequent breaks in the shade while practicing. Summer days and fall athletic practices get busy, and it can be easy to not realize right away if a child is not drinking enough or pushing too hard. It can be helpful to remind parents how serious heat illness can be. Athletes will be much less productive, and the trip to the amusement park a lot less fun if a child or teen is sidelined with heat illness. Safe participation in outdoor activities is everyone’s goal, and pediatric providers can easily and quickly support that.