Heat-related illness is a spectrum, ranging from mild conditions like heat rash to life-threatening heatstroke. Early recognition and intervention with prompt cooling measures can save lives.

“Education on stages, risk factors and prevention strategies is key. Ensuring that coaches, parents and trainers are aware of and can recognize the signs and symptoms of heat-related illness is crucial, given its time-sensitive nature,” said Brit L. Anderson, M.D., pediatric emergency medicine physician with Norton Children’s Emergency Medicine, affiliated with the UofL School of Medicine.

Stages of heat-related illness

Heat-related illness progresses from minor symptoms to life-threatening conditions.

Mild heat-related illness typically involves symptoms such as heat rash, heat cramps or edema. It is generally self-limiting and requires rest and hydration.

Heat exhaustion symptoms include elevated body temperature (up to 104 F), dizziness, nausea, tachycardia, fatigue, and possible brief confusion or syncope. Treatment involves rest, cooling measures, hydration and electrolyte correction, as needed. Most cases resolve with rest and environmental modifications.

Heatstroke is a medical emergency. Defining features involve a core body temperature of 104 F or higher with central nervous system dysfunction, such as seizures, delirium or coma. Complications can include multiorgan failure, cardiovascular complications, coagulopathy and irreversible cellular damage. Immediate management involves evaporative cooling measures with fans and misting, ice packs or cold water, plus IV fluids and intubation as necessary.

Risk factors for heat-related illness

Environmental: High temperatures and humidity increase risk for heat-related illness.

Behavioral: Overexertion or “over-motivation” among athletes and coaches may ignore signs of heat illness.

Medical conditions: Acute viral infections or chronic illnesses can cause overheating.

Medications: Patients taking beta-blockers, diuretics, selective serotonin reuptake inhibitors (SSRIs) or attention-deficit/hyperactivity disorder (ADHD) medications may have increased risk.

Clothing: Heavy or tight-fitting gear can impede heat dissipation.

Exertional heatstroke is usually seen in athletes, military or outdoor workers due to increased metabolic heat production. Youth football players are particularly at risk in the summer months.

Classic heatstroke is more common in patients with limited ability to regulate their environment, such as infants and children with increased health care needs. (This includes children left in hot cars. Always remind parents to check the back seat.)

Prevention strategies: A Key Opportunity for Education

Pediatricians must educate families, athletes and coaches on heat illness prevention measures, such as:

• Gradual acclimatization: A 14-day period of increasing activity levels and protective equipment use is recommended for young athletes.
• Environmental considerations: Schedule practices in cooler times of the day and ensure access to shade, hydration and cooling stations.
• Proper lifestyle choices: Drinking plenty of fluids, eating balanced meals and getting adequate sleep can help prevent illness.
• Monitoring high-risk populations: Babies and children with disabilities who may be unable to communicate their discomfort are at higher risk. Additionally, patients who live in historically redlined neighborhoods experience disproportionate heat-related health impacts.
• Vehicle Safety: Never leave children alone in a car, even for a short time. Encourage families to keep vehicles locked when parked at home to prevent children from entering them unsupervised and becoming trapped—a common and preventable cause of pediatric heat stroke.

“As extreme heat events become more common, we need to consider the myriad effects that increasing heat has on child health,” Dr. Anderson said. “By staying informed and educating others, health care providers can help prevent severe outcomes.”