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With the height of summer upon us, health experts urge parents and adults in charge of children playing outside to be cautious about excessive heat risks.

Even when temperatures are not extreme, active youngsters can over-heat. Faye Doerhoff, M.D., an emergency room physician at SSM Cardinal Glennon Children’s Medical Center and professor at Saint Louis University School of Medicine, says that – fortunately – heat-related deaths from most fun summer activities are rare, but kids who are outside enjoying summer activities can easily experience symptoms of heat illness.

Understanding the physiology of why children are at risk can help parents understand the need to be careful. The biggest risk factor, Dr. Doerhoff explains, is that children younger than about age four do not sweat nearly as readily as do adults. Of course, sweating is the body’s main way of reducing heat, removing heat from the surface as the water evaporates.

 In addition, little kids have a larger surface area of skin-to-body mass. “Their heads are larger, and they’re really soaking up the sun when out of doors,” Dr. Doerhoff adds.

Kids who are overweight are at additional risk – a major concern because of the high incidence of obesity in children. Heavier children may retain heat longer, Dr. Doerhoff explains.

 Little bodies also just generate more heat than do larger adults when they exercise. Kids who are having fun are also not inclined to stop what they’re doing to get a drink.

“Children who are running and playing don’t have a mindset to take a break and drink,” Dr. Doerhoff says. “That must be the responsibility of the parent or supervising adult.”

Heat illness begins with “heat exhaustion,” the first stage of heat illness.

Early symptoms include muscle cramps, nausea and fainting. If not reversed, the condition can progress to “heat stroke,” a medical emergency in which the body loses its ability to control temperature.

Taking breaks when kids are engaged in vigorous outdoor play or sports—and drinking plenty of fluids—can allow kids to enjoy summer activities safely. Dr. Doerhoff says that plain water provides adequate hydration. Sports drinks, which contain salt and sugar, are okay too but probably do not help hydrate kids more quickly.

One caveat, Dr. Doehoff notes, is that infants should not be given water. When infant hydration is a concern, infants should be given an oral re-hydration solution such as “Pedialyte,” which contains water and salts to replenish fluids and electrolytes. Giving plain water to an infant, Dr. Doerhoff continues, can reduce sodium in the baby’s blood to the point of inducing seizures.

Among active kids, those participating in summer sporting events and practice sessions need to take extra precautions. Dr. Doerhoff says that the uniforms worn in playing football particularly increase heat risks because of the added layer of insulation.

“Kids in a sandlot game are wearing shorts and T-shirts, but kids are also practicing football earlier now in the summer and some wearing full padding, which is necessary for safety but is a situation where some of our most tragic heat-related deaths have occurred,” she says.

Another dangerous scenario: family reunions and church picnic where kids are not dressed lightly, but in their Sunday best.  “Kids often go there in dress-up clothes; so parents need think ahead of time and have kids remove layers when it’s hot and activities get very active.”

A surprisingly risky situation is kids enjoying a pool. “Kids are splashing and able to reduce some of the heat because the water evaporating on the skin serves as a way to cool down,” Dr. Doerhoff says. “But because they feel cooler by being in the water, they may not be drinking and so can become dehydrated.”

Dr. Doerhoff also suggests parents pay attention to news reports about the heat index — the combination of heat and humidity that slows down how fast perspiration evaporates, reducing the body’s ability to cool.

In the rare instance that heat exhaustion progresses to heat stroke, adults must call 911 immediately. Dr. Doerhoff explains that in heat stroke, the brain stops regulating the body’s temperature, which can quickly rise to 105 or more, resulting in brain damage and, if not reversed by emergency steps to cool the body, in death.

This onset of heat stroke is what occurs in the most tragic of all heat-related cases, the deaths of infants and toddlers in hot cars. Dr. Doerhoff repeats the often-stated precaution that cars can heat to very dangerous temperatures within minutes, and children and infants simply must never be left unattended in a car.

Dr. Doerhoff provides insight into how these tragic deaths occur so quickly. Within five minutes in a car in the hot sun, temperatures often rise to the point of causing a child to lose consciousness. “There’s no crying to alert anyone that the child is in trouble.”

Fortunately, car-related deaths are uncommon, but there have at least 12 deaths so far this year nationally, usually on days when temperatures were only moderately hot – upper 80s to low 90s.

The circumstances of deaths of infants and toddlers in cars have varied, including toddlers climbing into parked cars to play. Parents can’t be too careful, Dr. Doerhoff says, including keeping cars locked where young children may be playing and never leaving a baby in a car seat in a parked car—never, Dr. Doerhoff emphasizes.

Parents need to plan ahead so kids can safely enjoy a warm summer day.

“The parent or supervising adult needs to have a plan ahead of time. They have to have the mindset from the get-go to force children to drink adequate fluids, and every so often to take a break,” Dr. Doerhoff says.

Kids have summer fun on their minds – not hydration, Dr. Doerhoff adds. “So parents have to think for their kids about hydration and the need for cooling breaks – because kids are not able to do it for themselves.”

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