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HEALTH

What parents need to know about keeping kids safe in a heat wave

Kim Bellware, Jiselle Lee
Washington Post

As schools empty and beaches and playgrounds fill, the prolonged heat wave baking swaths of the country this week poses significant health risks to children, from newborns enjoying a shady nap to older teens exerting themselves in sports or summer jobs.

“Particularly this week, when it’s the first heat wave of the year, this is where it can be the highest risk, because our bodies aren’t used to it,” said Jane Gilbert, the chief heat officer for Miami-Dade County.

Kids play in the water in Northeast Washington in July 2022.

But although the heat and humidity will be intense, there are still ways to get outdoors safely, health experts told The Washington Post. Drinking plenty of water, taking rest breaks and planning activities around the coolest parts of the day can go a long way to reducing heat-related health risks.

“It’s very healthy for kids to be outside,” Gilbert said. “So we don’t want to discourage that.”

Do all kids experience heat stress the same way?

Although extreme heat and humidity can dangerously stress the body regardless of age and health condition, individual factors such as a child’s hydration level, fitness and acclimatization status - how much they’ve adjusted to hotter, humid conditions - play a big part in their response to heat.

A child with pediatric asthma, diabetes or a heart condition has a higher risk of developing heat-related illnesses; heat can also worsen conditions, such as by triggering asthma attacks and raising the heart rate.

Even “healthy” children can experience heat exhaustion or heat stroke, said Rebecca Stearns, COO of the Korey Stringer Institute at the University of Connecticut.

For children who want to be active during high heat periods, Stearns said to start building a fitness routine slowly, because it takes one to two weeks to acclimatize to hotter conditions.

“Hopefully kids are maintaining a general level of fitness over the year,” Stearns said. “Don’t jump-start a program this week.”

What are the warning signs of extreme heat distress?

Heat stroke, a condition where the body can’t control its temperature, can be deadly. It’s important to recognize the early signs, said Michelle Macy, a pediatric emergency medicine physician at Lurie Children’s Hospital in Chicago.

If children feel nauseous, weak or dizzy, or if they’re cramping up, they’re already progressing to the point where they’re experiencing heat illness and may need emergency care, Macy said. More severe signs can present as headaches, a fast pulse, and going in and out of consciousness.

Macy said it’s important to listen to children if they are complaining of symptoms - and to model good behavior as an adult by staying hydrated, taking breaks and wearing sun protection.

“The older mentality of, ‘Just push through this, be tough,’ are the situations we see in the ER when kids got too far and they needed to be hospitalized,” she said.

What are good heat safety protocols for kids at summer camp?

Outdoor and sleepaway camps should have detailed heat safety plans and trained staff who know how to look out for heat cramps, heat exhaustion and heat stroke, and who know what to do in each of those cases. Parents should ensure that their children’s camps have people who are educated in treating heat-related illnesses.

This summer, Camp North Star in Poland Spring, Maine, has moved outdoor physical activities to occur in the early morning. Campers will play sports such as tennis and soccer at 9:30 a.m. instead of 1:30 p.m., and there may be more water breaks, more time to swim and more indoor activities, according to co-owner Steven Bernstein, who has directed residential and day camps for more than 20 years.

“I definitely feel like this is something that is either going to stay the same or get worse,” Bernstein said. “It’s nothing that we can control, but it’s something that we have to and will continue to prepare for.”

How long are babies safe in extreme heat?

Young children face extra risks in heat waves and need close attention, said Alison Tothy, who specializes in emergency pediatric medicine at the University of Chicago’s Comer Children’s Hospital.

“Little ones can’t always tell you they’re fatigued or overheating or don’t feel well - especially toddlers and babies,” Tothy said.

Small children should have plenty of ventilation around their stroller if they’re in one, and they should be kept in the shade with tight limits on direct sun exposure. They should wear light-colored sun-protective clothing or broad-spectrum sunscreen if they’re older than 6 months.

“If they’re cranky when they shouldn’t be cranky, have abdominal pain or are not wanting to eat or drink - unusual behavior - and have been outside for a long period of time, it could be heat exhaustion,” Tothy said.

Babies don’t sweat the way older children do, but they will feel clammy and warm if experiencing heat distress. Flushed cheeks and adazed, out-of-it look are other telltale signs that a child should be checked out by a doctor.

Very young infants who can’t hydrate with water should increase breast milk or formula fluids. Toddlers don’t carry around a water bottle like big kids, so Tothy said parents should use sippy cups and straws to make it easier for little ones to stay hydrated.

Can my child safely play sports when the heat and humidity are intense?

Children need to take special care if they’re exerting themselves during what could be risky conditions, Stearns said. Before working out, athletes can try “precooling” - drinking cool fluids, resting in air-conditioned environments, wearing devices such as a cooling vest - to lower their skin and core body temperatures. Kids should also take regular and longer breaks mid-activity, get under shade when possible, and drink water.

To determine the risk level of activity during intense conditions, Stearns and other experts advise checking the wet-bulb globe temperature (WBGT), a measure of heat stress.

“We use the WBGT because it’s a metric that’s highly predictive of heat illness, and it’s more accurate than the heat index,” Stearns said.

Organizations such as the U.S. Soccer Federation and the National Federation of State High School Associations use a common chart that divides the United States into three geographic climate regions and that provides guidelines for work-to-rest ratios (and when to cancel activity altogether) based on the region’s WBGT.

Stearns said parents and coaches can use mobile apps to find the local WBGT and calculate other metrics such as fluid loss.

Are kids at risk from extreme heat while they’re indoors?

All the experts agreed: Cars are the biggest indoor threat for kids in the summer.

“The main heart-stopper moment is kids who are left in hot cars,” Macy said. “Even on cooler days, when cars are in a sun-exposed area, the heat can go up 20 degrees Fahrenheit in 10 minutes. That means, on an 80-degree day, that car is 100 degrees inside.”

The bottom line: Never leave a child in a car in the summer, even with the windows cracked.

For those whose homes lack air conditioning or ventilation, Macy advises going to local libraries or walking around an indoor mall during the daytime, if possible; at night, open the windows for air circulation. Fans, cool rags and cool baths are good for providing some relief at any point in the day.

When the weather is sweltering, there’s a temptation to guzzle any cold drink - but, Macy said, not all sources of hydration are created equal. “Years ago, we didn’t have as many energy drinks and highly caffeinated or sugared drinks kids go crazy for,” she added.

Although she discourages all sugar-packed drinks for health reasons, Macy particularly warned that caffeinated drinks have a diuretic effect. “Things that have caffeine will make your kidneys flush out more water and will get you more dehydrated,” she said.

An easy way to tell whether you’re getting enough proper hydration: Check the toilet. “If you’re noticing that your pee is not clear or light yellow and getting into darker shades,” Macy said, “that’s a sign you haven’t been keeping up [with hydration].”