Which is more dangerous - heatstroke or heat exhaustion?

First and foremost, it is important to define what heatstroke and heat exhaustion are, as the terms are often confused. Heatstroke (also called sunstroke) is caused by overheating of the organism, in which the body's thermoregulation fails and the body is unable to dissipate excess heat. This leads to a build-up of heat in the body and a rise in body temperature above 40 °C. The heat spreads through all the organs, the functioning of which can then be threatened. Severe heat damage to the body leads to circulatory failure, a drop in blood sugar and the development of convulsions. Bleeding into the skin and mucous membranes, progressive failure of the kidneys or liver, and swelling of the brain are also common complications. Therefore, it is good to know that full-blown heat stroke is an acute, often life-threatening condition, especially in children!

Heat exhaustion is a special form of overheating that results from excessive exposure to direct sunlight. It is more often suffered by fair-haired people with a small amount of skin pigment. It is caused by direct sunlight without adequate protection, such as hats or head covers. Symptoms usually appear after a few hours, usually at night. In severe cases, blood clotting of the meninges and swelling of the brain may occur. Thus, in general, heat exhaustion is more common in children, but heatstroke is more dangerous.

Are young children who do not protect their heads at higher risk of getting heat exhaustion?

Heat exhaustion can develop quickly in children. This is due to underdeveloped body thermoregulation and thin, sensitive skin and fine hair, and often the inexperience of the child or parent to judge the appropriate time to be in the sun. In the thrill of play without head protection, children are also often unaware of the sensation of thirst and easily develop heat exhaustion, which begins to manifest after a little while.

Why is heat exhaustion so dangerous for children?

In addition to getting burnt, prolonged exposure to the sun without head protection can cause vomiting, dehydration, low urine production, hypotension, fever and in severe cases, it can cause brain swelling with disturbances of consciousness and convulsions.

When do you need to see a doctor?

It is important to remember that children develop heatstroke more quickly than adults. Young children are more susceptible to dehydration and overheating because their thermoregulation may not be fully developed. First aid consists of cooling the body. However, cool an overheated body gently. A cold shower is not a suitable remedy. By such intensive cooling, you can quickly bring a child from one extreme of overheating to a cold. It is preferable to rub the child's skin with lukewarm water. Place the child in a cool ventilated room, loosen their clothes and give them lukewarm drinks - preferably a rehydration solution or an ionic drink. Common paediatric analgesics can be given for headaches.

If despite first aid efforts, the symptoms of heat exhaustion do not improve within 24 hours or if they are unable to take fluids, develop disorientation, confusion and neck tingling, medical attention should be sought immediately.

In case a child has heatstroke, what can parents do to help? What are the useful remedies and forms of relief?

In case of heatstroke, it is necessary to get the affected child to a cooler environment (out of the reach of sunlight), to ensure the supply of fluids and cooling, in the form of cold compresses applied to the head.

Of the beverages, plain water, black tea, ionic or mineralised beverages or possibly a rehydration solution are particularly suitable. A Fever can be relieved by analgesics, and sunburn with products containing panthenol and vitamin E. If the fever does not subside within 24 hours, or if the burn is accompanied by loss of consciousness or neck tremors, again a doctor should be sought out immediately.

How much fluid should a child drink in 24 hours?

A child's body needs more fluids compared to adults because it is made up of a higher proportion of water. The best way to find out how much your child should drink is a simple calculation based on the child's weight and age. For every kilogram of weight, it is generally advisable for a child to drink at least 60 ml of fluid. For example, if your child weighs 18 kg, they should drink about one litre of fluid per day. According to age, the need is higher for young children and lower for adolescents  

• >2 years: 80-120 ml/kg per day 
• Between 3-5 years: 80-100 ml/kg per day 
• Between 6-10 years: 60-80 ml/kg per day
• Between 11-14 years: 50-70 ml/kg per day

On hot days or with heavy physical exertion causing the child to sweat, the requirements are 2-3 times higher.  

Is clothing and protection good prevention?

Yes, definitely - head protection should be accompanied by at least a cap with a visor to protect the eyes, or a hat with a brim to protect the ears and neck. Sunglasses to protect the eyes, including from reflected sunlight, are a must. This should also be worn while bathing in water.  

If a child gets heat exhaustion often, or on several occasions, can it be more dangerous? 

Repeated symptoms of heatstroke, i.e. skin burning, vomiting, dehydration, and possibly varying degrees of brain swelling with disturbances of consciousness and convulsions, definitely have a negative effect on the child's condition and overall development.

What preventive measures can you take on hot days?

Hot temperatures and high humidity, excessive sun exposure or inadequate hydration are causes of heat exhaustion and heatstroke in the summer. Therefore, it is useful to pay attention to prevention and avoid these dangerous consequences. Clean water, mineral water or chilled weak teas are particularly suitable. Liquids should not be iced or too sweet. Increased amounts of fruit, salads and cold soups should be included in the diet. Clothing should ideally be made from lightweight materials, loose fitting and in light colours as it helps to prevent overheating. When indoors, ensure that the air conditioning is set correctly and should be no more than 5 to 7 degrees lower than the outside temperature. It is sometimes better to use a smaller fan or a conventional fan to cool down. A lukewarm shower several times a day during tropical days can help maintain the body's thermal balance.

Dr. Petr Žáček, MBA, paediatrician at Canadian Medical

You can find the full article on:  žena-in.cz.