Children and Heat Safety

Hopefully you've heard of some of the recent deaths after leaving children locked in a car on a hot day: Cooper Harris, Benjamin Seitz, and many others. Some of these stories are a little old, but these stories happen every summer. In fact, roughly 35 children die in hot cars every year. Thirty-five. Countless other pets and elderly individuals also die each year.

Why does this happen? It could be intentional. It could be an accident. It could be lack of awareness. I'm hoping for the latter two, and want to hopefully change thinking.

First and foremost, children should never be left in a car (or anywhere, really) unattended. There's a whole host of things that can go wrong, and without quick intervention, many of these can lead to serious injury or death.

Now, let's speak generally about what heat does to us.

Our bodies produce heat constantly. This leads to a body temperature around 98.6 degrees F (37 degrees C). Actually, your body temperature fluxuates during the day, and is lowest around 2-3 am. If your temperature drops below 36 degrees C (96.8 F), you are considered hypothermic. If your temperature is over 38 degrees C (100.4 F), you are considered to have an elevated temperature. If this is due to an infection or inflammation (a reset in the body's 'normal'), we call it a fever. If it is due to a breakdown in the body's ability to cool, we call it hyperthermia.

When the body's temperature is above it's normal set point (about 37 degrees C in children without a fever), the body responds by sweating. From experience, I'm sure you've noted that you start to sweat even in temperatures below your own body temperature. As I said before, the body produces its own heat, and has to get rid of this heat to the environment. This is fairly easy when the environment is 'room temperature', but as the temperature starts to climb (or there is more body heat to get rid of, as in exercise), it becomes more difficult to do so, and sweating is one way this is done. Sweating gets rid of excess body heat because the water takes the heat with it as it evaporates off the skin. (This is why wiping sweat off can actually make you feel hotter, and why a cool mist can make you feel cooler).

When it is hot outside (>90 degrees F/32 degrees C), and the humidity is high, it can impede the ability for sweat to evaporate, and thus the body to cool down. When the body temperature starts to go up, it means bad things for the person.

Heat exhaustion occurs when the core body temperature is still below 104 degrees F (40 degrees C), and the person is awake and alert. They may complain of dizziness/lightheadedness, headache, rapid heart rate, fast breathing, tiredness, and so forth. But, importantly, they are still able to appropriately answer questions. Heat exhaustion is considered the precursor to heat stroke. This person needs to be moved to a cool place, be given water, and allowed to rest. If symptoms do not improve in 20-30 minutes, they should be brought to the Emergency Department for further evaluation.

Heat stroke is characterized by a core body temperature greater than 104 degrees F (40 degrees C), and an abnormal level of consciousness--the person is not awake or is not able to appropriately answer questions. This is a medical emergency, as it can very rapidly result in multi-organ failure.

You'll notice that heat stroke is defined by the temperature. However, there is a difference between having a fever and being hyperthermic to the point where you are at risk for heat stroke. In fact, rapid cooling with ice packs, water, etc does not help in cases of fever, which is why they are given two separate terms (fever vs. hyperthermia), despite having the same characteristic (elevated core body temperature).

What a fever does to a child is raise the body's set point to higher than 98.6F. Thus, when they have a fever, they may not be sweating, because the body is trying to stay hot. It is when you 'break' the fever and they start to come down to their normal temperature that they start to sweat. People tend to get worried for 'high' fevers, up above 103 degrees F, but the body cannot really produce temperatures above 105 degrees F on its own, and children with fevers, even high fevers, do not have the same complications as children with heat stroke. The take home from this point is that if your child has a high fever, you should bring them to see the physician just in case it is not a fever and to make sure that you are treating the infection appropriately.

So, what can be done to prevent heat exhaustion and heat stroke?

Since most often, these occur when children are outside playing sports (exertional heat stroke), it is important to incorporate several breaks, and emphasize adequate hydration (with a sports drink solution, since sweat causes the loss of some important electrolytes) during play.

As for the origin of this article--the publicity of automotive heat deaths in children--you should not be leaving a child in a car during the warmer months. It can get very hot inside the vehicle, even if it is only left for a few minutes. If the vehicle is in the sun, it can get even warmer. Leaving the windows cracked is not enough to prevent this rise in temperature. Putting up a sunshade may delay the time for the temperature to rise slightly, but not enough to safely leave a child in the car.

Just don't do it. Take your child with you, even if they are sleeping. Especially if they are sleeping. I would rather your child annoy you in the store than for you to live with the devastation of losing your child.