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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Avoiding Heat-Related Illness

September 12, 2013

By Henry H. Bernstein D.O.

It's back-to-school time once again! Besides the schoolwork, this means that children of all ages will be signing up and trying out for all kinds of sports. Over 50% of high school students participate in athletics. In addition, lots of communities have a wide variety of athletic activities for kids outside of school.

Although summer fun has come to an end, most children still will be active and doing lots of exercise, which is soooo healthy. However, whether your child is involved in organized sports or just playing outdoors in the yard, it is important to know about the dangers of heat-related illness. Even with the cooler fall weather, children can get overheated when they exercise.

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What Is A Heat-Related Illness?

Heat-related illnesses include heat exhaustion and heat stroke. (Heat exhaustion is more common.) They happens when the body cannot get rid of all the heat it makes. Normally we do this in two ways: radiating the heat into the air (the same way a radiator works to heat a room) and evaporation (drying) of sweat. When the air is too hot, radiating heat doesn't work very well. So the body depends on evaporation of sweat. But if a child gets dehydrated because he loses more fluids then he takes in, he can't use sweating to cool off. When someone loses the ability to cool their own body down, heat exhaustion occurs.

Symptoms of heat exhaustion include muscle cramping, weakness, severe tiredness, headache, dizziness, nausea and vomiting. If immediate steps are not taken to reduce body temperature, heat exhaustion can worsen to become heat stroke, which can cause sudden changes in mental status, ranging from being confused to actually being in a coma. High body temperatures can damage other internal organs, including the heart and blood vessels, and may lead to death.

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Healthy Conditions for Exercising

In very hot weather, parents and coaches should encourage children to exercise outdoors in the mornings or late afternoons when possible. Keep in mind that humidity (how much water is in the air) at the time of exercising is more important than the actual outdoor temperature. Higher levels of humidity make it harder for the body to cool off. Encourage your child to wear exercise clothing that is lightweight and made of cotton or synthetic material that allows any sweat to evaporate easily.

Heat-related illness is more common in children who are obese, in poor physical condition, have chronic medical conditions, or are sick with a fever.

Before a child participates in athletic activities, check with the pediatrician to be sure there are no special concerns. Your child should have a physical exam within the preceding year.

Make sure that there is an emergency plan in place and coaches and teachers know whom to contact in case of an emergency. Be aware of what steps will be taken if your child is ill, including what medical care will be provided, by whom, and where.

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Preventing Heat-Related Illness

Staying well hydrated, making sure a child takes in as much fluid as she loses, is the best way to keep your child healthy while she is exercising. Dehydration, not taking in as much fluid as is lost) is what causes heat-related illnesses. Without taking in the right amount of fluid, the temperature inside the body starts to go up and children’s muscle strength and performance go way down. Even a mild degree of dehydration will decrease performance and could place your child at risk of developing heat-related illness.

In addition, children often do not drink enough to make up for the water lost during exercise because they say they are not thirsty. It turns out that thirst is NOT a good marker for knowing someone needs to replace fluids lost with exercise. A child does not become thirsty until fluid levels in the body are way down.

Here are some steps you can take to be sure that your child is properly hydrated:

  • Fluids should never be restricted during any athletic event or practice.


  • Be sure your child is taking in the right amount of fluid. For most children, this means drinking 8 ounces before starting any physical activity and then taking breaks every 15 to 20 minutes during the activity to drink another 8 ounces each time (drinking 5 ounces at a time is acceptable for children who weigh up to 88 pounds).


  • Cold water is adequate for replacement of water loss in sports lasting less than one hour. If the exercise lasts longer than an hour, such as with football practice, it is best for a child to drink a sports beverage (for example, Gatorade or PowerAde) which has some sugar and electrolytes (salts) in it that the body needs.


  • Juice and soft drinks should not be used because they may cause an upset stomach and make it harder for the body to absorb water.

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Treating Heat-Related Illness

If a child is showing signs of a heat-related illness, here are steps you can take to help, which are adapted from the American Academy of Pediatrics:

  • Move the child to a less humid or cooler area.
  • Take off any extra clothing.
  • Make her drink a sports drink.
  • Cool her off with a fan.
  • She should NOT go back to regular activities that day.

If symptoms are more severe or you think a child may be suffering from heat stroke, take her body temperature and call a doctor or ambulance immediately. While you are waiting for help to arrive, you can cool her off by sponging her with room temperature (not cold!) water and blowing a fan across her skin. You can also put ice packs on her neck, armpits or groin. Do not place the child in an ice bath or use an “alcohol rub,” because these can actually make it harder for the body to get rid of the excess body heat properly.

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Henry H. Bernstein, D.O., is a senior lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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