Heat Exhaustion

Dear Lisa,

My friend’s child was sent home from camp today sick. His mother told me that he had heat exhaustion. How does a child get heat exhaustion? Is there anything that I can do to prevent my child from getting it? Is there something they did at camp that could have caused it?

“What is heat exhaustion?”

Dear “What is heat exhaustion?”,

Heat exhaustion is one of the heat related illnesses caused by an accumulation of body heat. It can develop when children are exposed to extreme heat or strenuous exercise. The incidence of heat related illness in the United States is 17.6 to 26.5 cases per 100,000 people.(1) Risk factors for heat exhaustion include children with a fever or illness, dehydration, hot environment, young age, use of certain medications (neuroleptics or sedatives), ingestion of alcohol, use of over the counter supplements with creatine or ephedrine, excessive activity, prolonged heat exposure, and not being acclimated to a hot environment. (2) Activities that put children at risk for developing heat exhaustion include; accidentally leaving a child in a hot car, excessive exercise in the heat, exercising when a child has a temperature and prolonged sauna exposure.

When the body overheats it compensates by shunting the circulation to the extremities so that the excess heat can be removed through sweating. When the body loses a large amount of fluid, it no longer can produce sweat. Because the body cannot produce sweat, it is not able to lower its core temperature. (3) As a result the body becomes too hot and symptoms of heat exhaustion ensue.

The symptoms of heat exhaustion include elevated temperature, dry hot skin, mental status changes such as dizziness or lethargy, nausea and vomiting. If the symptoms go untreated a child may develop heat stroke which is a life threatening condition. Signs of Heat Stroke include; a temperature over 104 degrees Fahrenheit, a fast heart rate, quick breathing, vomiting, diarrhea, headaches, abdominal pain, dizziness, seizures and coma. Heat stroke is a medical emergency. Any child showing signs of heat stroke should seek medical attention immediately.

If your child shows signs of being overheated you should first take him out of the heat and remove excess clothing. Cool him down by giving him something cold to drink. Sponge his body with cool water, making sure that he does not shiver, because this would cause the body temperature to elevate. (4) Children with signs of heat related illness should be evaluated by their health care provider.

The best treatment is knowing the cause of heat related illnesses and taking measures to prevent them. Make sure children don’t exercise when they have a fever or gastroenteritis. Teach teenagers the dangers of drinking alcohol, and using creatine or ephedrine. Do not let children go into saunas and never leave children unattended in a car, especially with the windows rolled up. Children should avoid excessive exercise in extreme heat. Children who exercise in the heat should always be monitored by an adult. Make children take fluid breaks when exercising in the heat. A 40 kg child should drink 150 ml of cold liquid every 30 minutes while exercising in the heat. (4) Children should avoid wearing heavy clothing when exercising and instead wear light weight clothing.

(1)Jones, TS, Liang AP, Kilbourne EM. Morbidity and mortality associated with the July 1980 heat wave in St. Louis and Kansas City, Mo. JAMA. 1982;247:3327-3331.
(2)Dawson G. Unusual case of heat stroke in a young boy. The Clinical Advisor. 2006;March:50-5.
(3)Bouchama A, Knochel JP. Heat Stroke. N Engl J Med. 2002;346:1978-1988.
(4)Betz C, Hunsberger M, Wright S. Family Centered Nursing Care of Children,2nd ed. 1994; Philadelphia: W.B. Saunders Company:315.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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