Doctors’ Notes


Heat-Related Illnesses

Heat illness is one the most common causes of noncardiac related deaths in active children. The notion that children are “young and can handle the heat” actually could not be further from the truth. The pediatric population is at a higher risk of suffering from the effects of dehydration and heat illness. While heat related illnesses can easily occur, they can also be easily prevented.

Some Tips to Beat the Heat

  • Gradually increase activity intensity and duration. Studies show that it may take children up to 2 weeks to become acclimatized to warm weather.
  • Wear one layer of light-colored, loose-fitting clothing.
  • Ensure your child is properly hydrated prior to starting activity. During times of extreme heat, practice and games should be modified to allow for regular hydration breaks.
  • A general rule of thumb for ensuring hydration during activity is Children 10 years of age and younger should drink until they don’t feel thirsty, then drink an additional half a glass. Older children and adolescents should use the same guidelines, but drink a whole extra glass.
  • Cool drinks, ranging for 50-59 degrees Fahrenheit, are recommended for rehydration.
  • For activities lasting less than one hour, plain water is adequate for fluid replacement.
  • If activities last longer than one hour, or if your child is involved in multiple events in one day, fluid replacement should include carbohydrates, sodium, and potassium. These are all standard elements in sports drinks.
  • Measuring a child’s weight before and after activity can provide valuable feedback on level of hydration. If a child is lighter after activity, then it is likely that he/she is dehydrated and needs to continue to replace fluids. A weight loss of only 2-3% of body weight can begin to affect a child’s performance and physiological function.
  • If a weight gain occurs after an activity, then hydration amounts should be reduced.
  • There are various types of heat illness. Below are some signs and symptoms to watch out for as your child participates in activities in the summer sun.

Heat Cramps

Intense muscle spasms that usually develop after a child has lost fluid and salt from large amounts of sweating. These cramps often happen when exercising in heat but can also occur in cooler environments such as hockey games. Children who sweat a lot or have a high concentration of salt in their sweat may be more likely to get heat cramps.

Signs /Symptoms: Intense muscle pains and cramps

Treatment: Stop activity, stretching and massaging the affected muscle while consuming high sodium foods/drinks.

Return to Play: Children can return to activity when the cramp is resolved and he/she acts ready to participate. If cramping persists or worsens, seek evaluation at an Emergency Room.

Heat Exhaustion

Moderate heat illness that occurs when a child continues to be physically active even after stating to suffer ill effects of the heat.


  • Child finds it hard to continue to play
  • Loss of coordination, dizziness, or fainting
  • Dehydration
  • Profuse sweating
  • Headache, nausea, vomiting diarrhea
  • Persistent muscle cramps


  • Move child to a shaded or air conditioned area
  • Remove all extra clothing /equipment
  • Cool child with cold water, fans or cold towel
  • Give chilled water or sports drink
  • Child’s conditions should improve rapidly, but if there is little or no improvement, take the child to the emergency room for evaluation

Return to Play: A child should not return to activity until all symptoms are resolved. Avoid intense activity for the rest of the day and longer if the heat exhaustion was severe. If your child was evaluated in the emergency room, he/she should not return to play until cleared by a doctor.

Heat Stroke

Severe heat illness that occurs when a child’s body creates more heat than it can release. This results in a rapid increase in core body temperature, which may lead to permanent disability or even death if not treated.

Signs and Symptoms:

  • Core body temperature greater than 104 (rectal ) when child falls ill
  • Central Nervous system dysfunction, altered consciousness, seizure, confusion, emotional instability, irrational behavior and decreases mental acuity
  • Low blood pressure
  • Nausea, vomiting
  • Hot and wet or dry skin

Treatment, no on-site medical personnel:

  • Call 911 for immediate transport to Emergency Room
  • Begin cooling the child while waiting and during transport.

Treatment, with on-site medical personnel:

  • Locate medical personnel immediately to begin cooling child. Remove all equipment and extra clothing and begin aggressive whole body cooling by immersing child in tub of cold water. If tub is not available, use alternative cooling methods.
  • Transport to Emergency Room

Return to Play: No child who has suffered heat stroke should return to activity until evaluated by a physician and receiving specific return criteria. Return to activity should be slow and under the supervision of a qualified health professional.

Travis Lewis, a Kids Plus Provider, is a certified Athletic Trainer and a certified Physician Assistant.