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PM Pediatrics
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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Little girl is taking a big gulp of water from a bottle during athletics club.

It’s getting hot out here

I just came in from a 3 mile powerwalk and I think I have heatstroke. No, just kidding, I think it might be heat exhaustion because I’m sweating. And I could use to be a little better conditioned (if you really want to know), so maybe it’s just that.

How do you know the difference? Especially in kids?

Today’s blog entry is based on:
a. a request to cover the topic of heat-related illness, and
b. the weather forecast for this week in the Mid-Atlantic which is hot and extremely humid.

I get a little nervous this time of year because I know that for a lot of kids, organized sports is STILL GOING ON with outside, weekend-long tournaments that are just setups for heat-related illness to present full force. Our kids don’t always take appropriate & plentiful breaks to hydrate and so often the schedule dictates multiple games during the hottest part of the day. So, while by far the best way to handle heat-related illness of any kind is TO NOT GET IT in the first place, let’s talk about the different types and what to do.

First, and most simply, there’s heat cramps,

which happen after a big workout typically in athletes who are used to exercising. The intense muscle pain comes on abruptly and is usually simply managed with fluid replacement and some added salt. “Treat yo-self” to a big Gatorade or other similar electrolyte drink (or 4) and the problem is mostly solved.

Heat exhaustion and heat stroke

are more of a total-body system affected continuum. Elevated temperature plus increased water and electrolyte losses combined with not enough replacement can cause progressive lethargy, weakness, increased thirst and if not addressed immediately can lead to vomiting, headache & confusion. The key feature here is that the body temperature does not typically go over about 102F. Gotta get this person into a cool environment ASAP and if they can’t get drink enough salt-infused drinks on their own they may need IV fluid replacement.

Heat exhaustion can progress to heat stroke, a true life threatening emergency.

  • Body temperature is up around 105F
  • Skin is dry and ashen
  • There are major mental status changes including unresponsiveness
  • Circulatory collapse (dangerous drop in blood pressure) can occur and the elevated temperature causes damage to the central nervous system, depending on how high and how long the temperature is elevated

Patients with these symptoms need medical care immediately, often with major support, active cooling, and electrolyte replacement. Muscle damage can also take place yielding loads of toxic metabolites in the blood in addition to the rest of the electrolyte mess the body is already facing. As I’m sure you know, death can result from this. Needless to say, something to take very seriously.

So what can you do? I have a few thoughts:

1. PREVENT, PREVENT, PREVENT. Ask the tournament officials what their plan is for hydration breaks in games & find out if there are cooling tents on site. Consider a team effort to buy one of those pop-up tents just to make sure there’s a shady place for players in between games and on the sidelines.

2. Bring lots of electrolyte-replacement drinks and bars, lots of fruit to these events. Insist on consumption.

3. Know the signs of heat-related illness and be on the lookout, not just for your child but everyone else too. Especially the headache/vomiting part.

4. If you see someone who appears to be experiencing significant heat related symptoms, call for EMS/medical help, remove their clothing, get them to a shady location/cool environment and place cool cloths on the head, hands and feet, armpits and groin areas. This will start the cooling process before help arrives.

Every year starting in early August when high school and college football practices start I always say, “I hope this is the year for ZERO heat related deaths in sports.” So far I haven’t been right. Maybe this time; I’m always optimistic.

 

 

 

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