September 29, 2022


With more record temperatures in the forecast for parts of the country, public health experts are warning that children more prone to heat illness than adults are — even more so when they’re on the sports field, living without air conditioning, or waiting in a parked car.

Cases of heat-related illnesses are rising with average air temperatures, and experts say nearly half of those who get sick are children. The reason is twofold: Children’s bodies have more trouble regulating their temperatures 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 have difficulty identifying a dangerous situation or catching the early symptoms of heat-related illness in children.

“Children are not small adults,” said Dr. Aaron Bernsteina pediatrician at Boston Children’s Hospital.

Jan Null, a meteorologist in California, recalled being amazed at the effect of heat on a car. It was 86 degrees one July afternoon more than two decades ago when an infant in San Jose was left in a parked car and died of heatstroke.

Null said a reporter asked him after the death, “How hot could that car have gotten?”

Null’s research with two emergency physicians at Stanford University finally gave a surprising answer. Within an hour, the temperature in that car could have exceeded 120 degrees Fahrenheit. Their work revealed that a quick task can be dangerous for a child left behind in the car — even for less than 15 minutes, even with the windows cracked, even on a mild day.

As record heat it is done more oftenposing serious risks even to healthy adults, the number of cases of heat-related illness has risenbetween children. Those most at risk are young children in parked vehicles and teenagers returning to school and participating in sports on the hottest days of the year.

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

Heat-related illnesses occur when exposure to high temperatures and humidity, which can be intensified by physical exertion, overwhelms the body’s ability to cool itself. Cases range from mild, such as benign heat rashes in infants, to more severe, when the body’s core temperature rises. This can lead to life-threatening cases of heatstroke, diagnosed when the body’s temperature rises above 104 degrees, potentially causing organ failure.

Prevention is the key. Experts stress that drinking plenty of water, avoiding the outdoors during hot midday and afternoon hours and taking it slow when adjusting to exercise are the most effective ways avoid getting sick.

Children’s bodies need more time to increase sweat production and otherwise acclimate to a hot environment than adults, research shows. Young children are also more susceptible to dehydration because a greater percentage of their body weight is water.

Infants and younger children also have more trouble regulating their body temperature, in part because they often don’t recognize when they need to drink more water or take off clothes to cool down. 1995 study showed that young children who spent 30 minutes in a 95-degree room saw their core temperatures rise significantly higher and faster than their mothers—even though they sweat more than adults relative to their size.

Pediatricians advises caregivers to watch how much water do children consume and encourage them to drink before they ask. Thirst indicates that the body is already dehydrated.

A girl drinking water
By the time a child says they feel thirsty, their body may already be dehydrated.

Getty Images


They should also dress children in light-colored, light clothing. limiting time outdoors during the hottest hours. and look for ways to cool off, such as visiting an air-conditioned place like a library, taking a cool bath, or going for a swim.

To the address the risks to student athletesthe National Athletic Trainers Association recommends that high school athletes acclimate by gradually building their activity over the course of two weeks when they return to their sport for a new season — including slowly increasing the protective gear they wear.

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

Warning signs and solutions

Experts note that a flushed face, fatigue, muscle cramps, headache, dizziness, vomiting and profuse sweating are among the symptoms of heat exhaustion, which can develop into heatstroke if left untreated. Call a doctor if symptoms worsen, such as if the child seems disoriented or unable to drink.

Taking immediate steps it is critical to cool down a child experiencing heat exhaustion or heatstroke. The child should be taken to a shady or cool place. Administer cool fluids with salt, such as sports drinks. and remove any sweaty or heavy clothing.

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

Although the deaths of children in parked cars have been well documented, the tragic events they keep happening. According to federal statistics, 23 children died from vehicle heatstroke in 2021. Zero, which collects its own datasaid 12 children have died so far this year.

Caregivers should never leave children alone in a parked car, Null said. Take steps to prevent young children from getting into the car themselves and becoming trapped, including locking the car while it is parked at home.

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

The good news, Null said, is that simple behavioral changes can protect children. “This is 100% preventable,” he said.

Ahead danger

People who live in low-income areas fare worse when temperatures rise. Access to air conditioning, which includes being able to afford the electricity bill, is a serious health issue.

Study of heat in urban areas released last year showed that low-income neighborhoods and communities of color face much hotter temperatures than wealthier, white residents. In poorer areas in summer, temperatures it can be up to 7 degrees Fahrenheit warmer.

The study authors said their findings in the United States reflect that “the legacy of the red line looks big,” referring to a federal housing policy that refused to insure mortgages 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 effects, policies that directly codify existing land-use inequality and reinforce urban planning choices that magnify urban heating in the present,’ they concluded.

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

The center collaborates with frontline health clinics to help their mostly low-income patients meet the effects of climate change on health. Federally supported clinics alone provide care to about 30 million Americans, including many children, he said.

Bernstein also led recently a nationwide study which found that from May to September, days with warmer temperatures are associated with more visits to children’s emergency hospitals. Many visits were more directly linked to the heat, although the study also showed how high temperatures can worsen existing health conditions, such as neurological disorders.

“Children are most vulnerable to climate change through the way these climate shocks reshape the world they grow up in,” Bernstein said.

Helping people better understand the health risks of extreme heat and how to protect themselves and their families is among the public health system’s big challenges, experts said.

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

However, the alerts are not related to health effects, he said Kathy Baughman McLeod, director of the Adrienne Arsht-Rockefeller Foundation’s Center for Resilience. By the time temperatures rise to the level that a weather alert is issued, many vulnerable people – such as children, pregnant women and the elderly – may already be experiencing heat exhaustion or heatstroke.

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

The system combines metrics like air temperature and humidity with public health data to categorize heat waves and, when severe enough, give them names – making it easier for people to understand heat as an environmental threat that requires preventative measures.

The categories are determined through a metric known as excess deaths, which compares how many people died on the day of the predicted temperature against an average day. This can help health officials understand how severe a heat wave is expected to be and make informed recommendations to the public based on risk factors such as age or medical history.

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

Giving people better ways to perceive heat is critical, he said.

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


KHN (Kaiser Health News) is a national newsroom that produces in-depth health journalism. Along with Political Analysis and Polling, KHN is one of the three main operating programs in the KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization that provides health information to the nation.



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