Parents' and Coaches' Guide to Dehydration and Other Heat Illnesses in Children (continued)

Heat Exhaustion

Heat exhaustion is a moderate heat illness that occurs when a child continues to be physically active even after he or she starts suffering from ill effects of the heat, like dehydration. The child’s body struggles to keep up with the demands, leading to heat exhaustion.

Signs and Symptoms

• Child finds it hard or impossible to keep playing
• Loss of coordination, dizziness or fainting
• Dehydration
• Profuse sweating or pale skin
• Headache, nausea, vomiting or diarrhea
• Stomach/intestinal cramps or persistent muscle cramps

Treatment

• Move child to a shaded or air-conditioned area.
• Remove any extra clothing and equipment.
• Cool the child with cold water, fans or cold towels (replace towels frequently).
• Have child lie comfortably with legs raised above heart level.
• If the child is not nauseated or vomiting, have him or her drink chilled water or sports drink.
• The child’s condition should improve rapidly, but if there is little or no improvement, take the child for emergency medical treatment.

"When can I play again?"

A child should not be allowed to return to play until all symptoms of heat exhaustion and dehydration are gone. Avoid intense practice in heat until at least the next day, and if heat exhaustion was severe, wait longer. If the child received emergency medical treatment, he or she should not be allowed to return until his or her doctor approves and gives specific return-to-play instructions.

Parents and coaches should rule out any other conditions or illnesses that may predispose the child for continued problems with heat exhaustion. Correct these problems before the child returns to full participation in the heat, especially for sports with equipment.

Exertional Heat Stroke

Heat stroke is a severe heat illness that occurs when a child’s body creates more heat than it can release, due to the strain of exercising in the heat. This results in a rapid increase in core body temperature, which can lead to permanent disability or even death if left untreated.

Signs and Symptoms

• Increase in core body temperature, usually above 104°F/40°C (rectal temperature) when the child falls ill
• Central nervous system dysfunction, such as altered consciousness, seizures, confusion, emotional instability, irrational behavior or decreased mental acuity

Other possible indicators include:

• Nausea, vomiting or diarrhea
• Headache, dizziness or weakness
• Hot and wet or dry skin
• Increased heart rate, decreased blood pressure or fast breathing
• Dehydration
• Combativeness

Treatment

If there are no on-site medical personnel:

• Call emergency medical services for immediate transport to the nearest emergency medical facility. Begin cooling the child while waiting for and during transport to the emergency facility.

If there are on-site medical personnel:

• Locate medical personnel immediately. Remove extra clothing or equipment. Begin aggressive whole-body cooling by immersing the child in a tub of cold water. If a tub is not available, use alternative cooling methods such as cold water,
  fans, ice or cold towels (replaced frequently), placed over as much of the body as possible.
• Call emergency medical services for transport to the nearest emergency medical facility.

"When can I play again?"

No child who has suffered heat stroke should be allowed to return until his or her doctor approves and gives specific return-to-play instructions. Parents should work with the child’s doctor to rule out or treat any other conditions or illnesses that may cause continued problems with heat stroke. The child should return to physical activity slowly, under the supervision of an ATC
or other qualified health care professional, especially for sports with equipment.