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Keeping Children and Adolescents Cool This Summer

The Phoenix valley's three-digit temperatures have arrived, increasing the risks for heat-related illness in children. Heat-related illnesses occur when a child’s temperature gets too high either by ambient temperatures and/or physical activity. Children are at an increased risk for heat illness because their sweat rate is lower than adults, and the temperature at which sweating occurs is higher. Exertional heat illness is among the leading cause of death in young children and adolescent athletes 
A heat index of greater than 90F places an increased risk for heat stroke and/or heat exhaustion with prolonged heat exposure. A heat index of 130F or higher increases the risk for heat stroke with long heat exposure. Below are the signs and symptoms of heat-related illness:
Heat rash appears as red clusters of small blisters that look like pimples on the skin. These lesions typically occur on the neck, chest, groin, or elbow creases. If these skin changes are noticed, stay in a cool, dry place which typically resolves the rash.  Keep the rash dry, using power such as corn starch to soothe the rash.
Heat cramps are painful muscle cramping that may occur during or after exertion in hot environments. Typically these cramps involve larger muscle groups such as muscles of the legs, abdomen, or arms. Body temperature may be normal or elevated, which is why these are more aptly named exercise-associated muscle cramps (EAMC). Sweating heavily and dehydration may predispose an individual to experience these cramps. Resting, stretching, and massage will help to reduce the discomfort from these cramps. 
Early recognition of heat exhaustion is vital to reducing the progression to heat stroke. Heat exhaustion may occur when there is an inability to maintain adequate cardiac output because of strenuous physical exercise and/or excessive environmental heat. Signs of heat exhaustion include headache, nausea, vomiting, dizziness, elevated pulse rate, weakness, muscle cramps, and possible fainting. To prevent these symptoms from progressing, move to a cool environment, remove excess clothing, and place ice over the groin and armpit area. If fluids are not tolerated, the child must seek urgent care to receive intravenous (IV) hydration. 
Heat stroke can occur if the core temperature exceeds 104 F and is accompanied by central nervous system changes like disorientation, headache, behavioral changes, confusion, altered consciousness, coma, or seizure. Sports-related heat stroke is characterized by profuse sweating with exertion. Classic heat stroke has dry, hot skin and has a slower onset. If these symptoms occur, it is recommended that the child goes to the emergency department for management. 
Staying cool and hydrated is crucial to preventing heat-related illnesses. Thirst may not be the best indicator of hydration as it occurs at 2-3% dehydration. Being well hydrated before exercise and drinking water every 20 minutes during exercise is recommended. Keep this in mind when in the heat and when exercising; drink every 20 minutes: 5 ounces for those weighing 40kg and 9 ounces for those weighing 60 kg, and 10-12 ounces for those weighing more than 60kg. Water with added electrolytes and carbohydrates should be given if exercising for more than an hour. Juices or sodas are not suitable for rehydration because they do not contain enough sodium, potassium, or citrate to rehydrate. CeraSport (gluten-free) and NormaLyte are oral rehydration solutions that may be used for restoring hydration or preventing dehydration. These oral rehydration solutions contain the appropriate ratios to rehydrate or maintain hydration when excessive sweating occurs. 
Schedule your outdoor activities, if possible, when it’s coolest. Avoid sun exposure unless using an SPF. Sunburns may interfere with your body’s ability to cool itself. Look for sun protection that says “broad spectrum” or “UVA/UVB protection.” And make sure to wear lightweight, light-colored, and loose-fitting clothing.
For those children participating in sports this summer, promptly schedule your sports physical exam with Dr. Nichole Shiffler at Be Well Medical Primary Care. During this visit, a sport safe plan can be created to prevent injury and illness. 

1.     Pomerance HH. Nelson Textbook of Pediatrics. Arch Pediatr Adolesc Med. 1997 Mar 1;151(3):324. doi: 10.1001/archpedi.1997.02170400110025. PMID: 22604661.



Nichole Shiffler, NMD Dr. Nichole Shiffler is a naturopathic primary care physician and medical director of Be Well Medical Primary Care. Dr. Shiffler focuses her practice on women's and pediatric medicine. Dr. Shiffler also has an extensive history of treating irregular menstrual cycles, thyroid disease, menopause, acne, PCOS, and diabetes. She utilizes nutrition and herbal medicine to deliver an effective treatment plan to her patients. Dr. Shiffler is available for patient care at Be Well Medical Primary Care. Call (480) 219-9900 to schedule an appointment with Dr. Shiffler.

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