‘Children are not small adults’ and need special protection during heat waves

After more than a week of record-breaking temperatures in much of the country, public health experts are warning that children are more susceptible to heat illness than adults — even when they’re on athletic fields, without air conditioning, or waiting in parked cars.

The incidence of heat-related illnesses is increasing with average air temperatures, and experts say about half of those who get sick are children. The reason is twofold: Children have more trouble regulating body temperature than adults, and they rely on adults to protect them from overheating.

Parents, coaches and other caregivers, who may experience the same heat very differently than children, may struggle to identify a dangerous situation or catch the early signs of heat-related illness in children.

“Children are not small adults,” says Dr. Aaron Bernstein, a pediatric hospitalist at Boston Children’s Hospital.

Jan Nall, a meteorologist in California, recalls being surprised by the effects of heat on cars. It was 86 degrees on a July afternoon more than two decades ago when a child in San Jose was left in a parked car and died of heatstroke.

Nall said a reporter asked him after the death, “How hot can it get in a car?”

Knoll’s research with two Stanford University emergency doctors finally produced a startling answer. Within an hour, the temperature in the car could exceed 120 degrees Fahrenheit. Their work revealed that quick work can be dangerous for a child left in a car — even for less than 15 minutes, even with a cracked window, even on a mild day.

Record heat is becoming more frequent, posing serious risks even to healthy adults, with heat-related illnesses among children on the rise. Those most at risk are young children in parked vehicles and teenagers going back to school and playing sports on the hottest days of the year.

More than 9,000 high school athletes are treated for heat-related illnesses each year.

Heat-related illness occurs when exposure to high temperatures and humidity, which can be exacerbated by physical exertion, overwhelms the body’s ability to cool itself. Cases range from mild, such as benign heat rash in children, to more severe, when the body’s core temperature rises. This can lead to life-threatening instances of heatstroke, diagnosed when body temperature rises above 104 degrees, potentially leading to organ failure.

Prevention is key. Experts emphasize that drinking plenty of water, avoiding the outdoors during hot afternoons and early afternoons, and taking it slow while adjusting to exercise are the most effective ways to avoid getting sick.

Children’s bodies take longer to increase sweat production and otherwise adapt to warmer environments than adults, research shows. Young children are also more susceptible to dehydration because a large percentage of their body weight is water.

Babies and toddlers also have more trouble regulating their body temperature, as they often don’t recognize when they should drink more water or remove clothing to cool down. A 1995 study found that infants who spent 30 minutes in a 95-degree room had significantly higher and faster core temperatures than their mothers—even though they sweated more than adults their size.

Pediatricians advise caregivers to monitor how much water children consume and encourage them to drink before they ask for it. Thirst indicates that the body is already dehydrated.

Their children should wear light-colored, light-weight clothing; Limit outdoor time during the hottest hours; And look for ways to cool off, such as going to an air-conditioned place like a library, taking a cool bath or going swimming.

To address the risk to student athletes, the National Athletic Trainers Association recommends that high school athletes return to their sport for the new season by gradually building up their activities over two weeks — including gradually increasing any amount of protective equipment they wear. .

“You gradually increase that intensity over a week to two weeks so your body can get used to the heat,” says Kathy Dieringer, president of the NATA.

Warning signs and solutions

Experts say facial, fatigue, muscle cramps, headache, dizziness, vomiting and profuse sweating are among the symptoms of heat exhaustion, which can turn into heatstroke if left untreated. Call a doctor if symptoms worsen, such as if the child seems disoriented or cannot drink.

It is important to take immediate steps to cool a child experiencing heat exhaustion or heatstroke. Take the child to a shaded or cool place; Cold fluids should be drunk with salt, such as sports drinks; And remove any sweaty or heavy clothing.

For teenagers, soaking in an ice bath is the most effective way to cool the body, while young children can be wrapped in cold, wet towels or lukewarm water and placed in front of a fan.

Although the deaths of children in parked cars are well documented, tragic incidents still occur. According to federal statistics, 23 children died from vehicle heatstroke in 2021. Nall, who collected his own data, said 13 children have died so far this year.

Caregivers should never leave children alone in a parked car, Nall said. Take steps to prevent small children from getting into the vehicle and becoming trapped, including locking the vehicle while it is parked.

More than half of pediatric heatstroke in vehicles occurs because a caregiver accidentally leaves a child behind, he said. While in-car technology has become more common to remind adults to check their back seats, only a fraction of cars have it, requiring parents to come up with their own methods, such as leaving a stuffed animal in the front seat.

The good news, Nall said, is that simple behavioral changes can protect kids. “It’s 100% preventable,” he said.

A one-way risk

People living in low-income areas fare worse when temperatures rise. Access to air conditioning, which includes the ability to carry electricity bills, is a serious health concern.

A study of heat in urban areas published last year found that low-income neighborhoods and communities of color experience much higher temperatures than wealthier, white residents. In poorer regions during the summer, temperatures can warm as much as 7 degrees Fahrenheit.

The study’s authors said their findings reflect that “the legacy of redlining is huge” in the United States, referring to a federal housing policy that denied mortgage insurance in or near predominantly black neighborhoods.

“These areas have less tree canopy, more roads, and higher building density, which means that, in addition to their other racial consequences, redlining policies directly enshrine into law policies that reinforce existing inequalities in urban land use and urban design choices that exacerbate urban heat in the present. ” they concluded.

This month, Bernstein, who leads Harvard’s Center for Climate, Health, and the Global Environment, co-authored a commentary in JAMA arguing that advancing health equity is critical to taking action against climate change.

The center works with front-line health clinics to respond to the health impacts of climate change on their predominantly low-income patients. Federally supported clinics alone provide care to about 30 million Americans, including many children, he said.

Bernstein recently led a nationwide study that found that from May through September, days with high temperatures were associated with more visits to children’s hospital emergency rooms. Many of the visits were more directly linked to heat, although the study also pointed out how high temperatures can exacerbate existing health conditions such as neurological disorders.

“Children are more vulnerable to climate change because of how these climate shocks reshape the world in which they grow up,” Bernstein said.

Helping people better understand the health risks of extreme heat and how to protect themselves and their families is among the main challenges for the public health system, experts say.

The National Weather Service’s heat alert system is based primarily on the heat index, a measure of how hot it feels when air temperature is factored in relative humidity.

But the warnings aren’t related to health effects, said Cathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation Resilience Center. When temperatures rise to a level where a weather warning is issued, many vulnerable people – such as children, pregnant women and the elderly – may already be experiencing heat exhaustion or heatstroke.

The center has developed a new heat warning system, which is being tested in Seville, Spain, historically one of the hottest cities in Europe.

The system marries metrics like air temperature and humidity with public health data to classify heat waves and, when they’re severe enough, name them — making it easier for people to understand heat as an environmental threat that requires prevention.

The categories are determined by a metric known as excess deaths, which compares how many people died in a day compared to the predicted temperature versus the average day. This can help health officials understand how severe heatstroke can be and make informed recommendations to the public based on risk factors such as age or medical history.

The health-based alert system will allow officials to target caregivers of children and seniors through school systems, preschools and senior centers, Baughman McLeod said.

It’s important to give people a better way to conceptualize heat, he said.

“It’s not dramatic. It doesn’t tear the roof off your house,” said Baughman McLeod. “It is silent and invisible.”

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