PSN Issue | Parenting Special Needs Magazine

Cool Rules: Preventing Heat Stress In Special Needs Children

By: Anara Midgett

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Cool Rules: Preventing Heat Stress In Special Needs Children

Heat Stress is something all parents need to be concerned about during the hotter months, but, some Special Needs can make our children extra susceptible to heat related illness. Parenting Special Needs’ Cool Rules will help you understand how some Special Needs children are vulnerable to heat effects and help you to prevent heat related illness. And since kids will be kids and sometimes you can’t control everything we’ll also show you how to recognize the signs of developing heat stress and know how to safely treat it.

Heat related illnesses (aka heat stress) include heat cramps, heat exhaustion, and heat stroke. Heat stress can occur with or without exertion in hot or humid temperatures. It can start abruptly or develop over the course of several days. While overheating and dehydration are the primary causes, it is usually a combination of these two factors that lead to heat illnesses. Children are more prone to heat related illness than adults by design. Children’s bodies produce and store more heat than adults but children also sweat less than adults. The body cools itself as it sweats and that sweat evaporates so children are naturally warmer yet less efficient at self-cooling. Children’s bodies also do not store fluid as well as adults so dehydration can occur quicker, even without physical activity.

In addition to sharing these risk factors for heat stress with all children, other concerns can make your Special Needs child more vulnerable to heat illness. Medical conditions and medications can interfere with the body’s ability to cool itself or to maintain a fluid/electrolyte balance. In some cases, preventing and treating heat stress can be a challenge requiring medical supervision. Children who are in poor physical condition or not acclimated to the heat can feel the effects of warmer weather quickly. All children are dependent upon their caregivers to supply their liquids and prevent overheating; but impaired communication, decreased body awareness, intellectual challenges or behavioral issues can make some Special Needs children even more dependent upon having their needs anticipated and met.

Two Essential Heat Stress-Busters: Prevent Dehydration and Overheating

Dehydration is caused by a loss of fluids and essential minerals and salts (electrolytes). Even mild dehydration can interfere with the body’s ability to self-cool. Always pre-hydrate before a big day outdoors. Don’t stop encouraging extra liquids once the activity is over. You want to replace fluids and electrolytes lost during the day in order to prevent setting the stage for heat stress.

Gradually introduce your child to the heat by going outside for short amounts of times and increasing time and activity as tolerance grows. You should see your child produce more sweat sooner as they become acclimatized (this also means more fluids will be needed to replace what is lost with the increased sweating.) “It’s not just the heat, it’s the humidity” is really true. Once the relative humidity reaches 60%, sweat begins to stick to the skin instead of evaporating. A major part of the body’s cooling mechanism is lost. Be extra alert for signs of heat stress on humid days, especially if there is no wind.

Ask summer programs about their heat stress policies before the session begins. Discuss situations like un-air conditioned buses or length of time spent outdoors that could be a potential threat to your child’s health. If your summer plans include theme parks, contact Guest Services and ask how they can help you keep your child safe and cool during long, hot days. And practice these Cool Rules while you and your family are enjoying summer fun:

Cool Rule #1: Understand Your Child’s Medical Conditions

Medical conditions that effect metabolism such as Heart Disease, Heart Defects or Cystic Fibrosis increase the risk of dehydration.

Fluid restrictions can make it difficult to judge how much to hydrate without causing fluid overload.

Neurological conditions can interfere with appropriate sweating or the body’s ability to regulate temperature.

If your child was sick recently it is possible that they might already have some dehydration from reduced appetite, fever, or the effects of vomiting and diarrhea.

While exercise usually lowers blood sugar levels, if your Diabetic child does not exercise regularly, is being active at a different time of day than usual, is indulging in the fun foods often associated with outdoor activities, or has poorly controlled blood glucose levels then his blood glucose levels can rise. Increased urination and increased thirst is a sign of elevated blood sugar.

Children with medical conditions such as anhidrosis (lack of ability to sweat) or hypohidrosis (reduced ability to sweat) can become severely overheated very quickly at temperatures that might feel mild to you.

Speak to your child’s physician before the weather turns hot if he has a medical condition that might require a special plan for hydration.

Cool Rule #2: Understand Your Child’s Medications & Treatments

A medication can contribute to dehydration if

It increases metabolism.

It decreases appetite, upsets the stomach, or has diarrhea as a side effect.

It increases urination (a diuretic).

A medication can contribute to overheating if

It decreases sweating.

It increases metabolism.

Chemotherapy and medication with a photosensitivity warning increase the risk of sunburn which can lead to both overheating and dehydration.

Call your pharmacist and ask her to review your child’s medications for heat stress risk factors.

Cool Rule #3: Hydrate, Hydrate, Hydrate

Encourage fluids before, during and after outdoor play regardless of activity level.

Enforce frequent drink breaks, preferably in the shade.

Sneak in fluids by offering foods that have a high liquid content like fresh fruit, popsicles, jello, yogurt and fruit sauces.

Prepare your own low sugar frozen snacks to cool and rehydrate.

Avoid caffeine and sugary drinks as they can increase urination and cause dehydration.

Thirst is actually a sign that the body is becoming dehydrated. “But I’m not thirsty” means you’re staying on top of your child’s hydration.

If your child is tube fed, ask his doctor for guidelines on how much and what type of extra fluid you should give if your child will be exposed to hot weather.

If your child cannot communicate his needs or you know there will be problems surrounding making him drink extra fluids then create a hot weather hydration plan with a physician or therapist.

Peeing less often, dark or strong smelling urine, or crying without tears are warning signs of dehydration.

Cool Rule #4: Replace Electrolytes

Bananas, oranges, potatoes and green leafy vegetables are natural electrolyte replacers.

Salty foods replace lost sodium and can also encourage drinking.

Do not use sports drinks intended for adults – they can cause diarrhea and create dehydration.

If your child is diabetic or has cardiac or kidney issues then speak to his doctor about when and how to safely replace electrolytes.

Cool Rule #5: Cool Off Often

Pack portable umbrellas and canopies so you have back up shade for long days out.

If possible, take longer meal and rest breaks in air conditioning.

Construction workers and motorcyclists have used cooling accessories such as special vests, hats, and bandanas for years and many parents purchase or make their own similar cooling garments. Check with your child’s physician before you use a cooling garment.

Compression garments can trap heat and interfere with sweat evaporation. Limit using compression garments in hot weather and plan on removing it regularly for cooling breaks.

Combination compression/weighted garments are available. Some parents replace the weights with freezer packs to create a cooling pressure garment.

Portable fans that clip on or attach to keychains are easy to find during summer months. Make sure fan blades are soft and safe for little fingers.

Portable misting fans provide the important combination of moisture and evaporation that the body needs to cool. Give your child time to adjust to being “spritzed” to avoid unnecessary drama when you’re out.

Chill baby wipes or hand wipe packets in the cooler or fridge to cool and clean sweaty little faces.

Cool Rule #6: Block the Sun

Even mildly sunburned skin cannot properly cool the body or maintain fluid balance.

Apply sun block thirty minutes prior to going outside then reapply according to the label directions – even if it is an all day, waterproof formula.

Dress children in loose fitting clothing with a tight but breathable weave, dark colored clothes (light colors allow UV rays to penetrate), or clothing that has been treated with UV blockers.

If your child will wear a hat and sunglasses then use them during outside play.

Limit outdoor activities between 10 am and 4 pm, when the sun is at its most intense.

Practice sunburn prevention every time your child is outside. Clouds might seem to block the sun’s intensity, but 80% of Ultra Violet (UV) rays can still penetrate and burn skin.

Bring a clip-on or sand umbrella but remember that water, sand and concrete reflect the sun up and sunburn still occurs in the shade.

If your child’s skin is pink and warm and doesn’t return to its normal color and temperature with rest and cooling then he is sunburned. Outdoor exposure needs to end for the day.

Cool Rule #7: Monitor Water Sports

Playing in water is not the same as drinking water. This is a good thing since water = toilet in kid’s math. Frequent hydration breaks are still necessary.

Water reflects UV rays, even on cloudy days. Sunburn happens more quickly in and near the water.

Wet clothes are less effective at blocking UV rays than dry clothes.

If the water temperature is less than the air temperature increased urination and dehydration can occur, even on a hot day or while wearing a full or partial wetsuit.

Keep It Cool, Baby: Preventing Heat Stress in Infants

Infants are at very high risk for dehydration and heat related illness because their little bodies are even less efficient at self cooling and storing fluids than children’s. Sun block should not be used in infants less than six months of age and even mild sunburn in an infant under the age of one should be checked by a physician. Breastfed babies might not be comfortable with skin to skin contact when you’re both sweaty and overheated. Place a piece of lightweight fabric between you and the baby if she acts too uncomfortable to nurse. Infants might change their feeding patterns to frequent, small feeds and sleep more when it’s hot, then feed longer at night. But, watch carefully to make certain that your infant is not so sleepy she cannot wake up, is refusing to eat, or is so irritable that she cannot be comforted. You should still see 6-8 wet diapers a day, and her urine should still be clear to pale yellow and odorless. Infants can go from a little heat stressed to dangerously heat stressed very quickly so keep that baby cool, fed, and out of the sun.

Recognize and Properly Treat Signs of Heat Stress

Heat illness can happen quickly or develop over the course of several days of heat exposure without proper rehydration. Improper treatment of heat stress can cause skin and organ damage, and if it continues to progress, death can occur. Even mild signs of heat stress that respond to treatment means the day’s activities are over as it can take hours for the body to recover from dehydration and overheating. Heading back into the game can lead to a rapid progression into heat stroke, a life threatening condition. Your child should spend the rest of the day properly rehydrating someplace cool and sheltered from the sun. If your child has heart disease, kidney disease, diabetes, or known inability to properly sweat then call his doctor as you begin treating suspected heat stress of any kind.

Level 1: Heat Cramps

These are usually in the abdomen or legs and are a sign of dehydration and electrolyte imbalance

Level 2: Heat Exhaustion

As dehydration and electrolyte imbalances worsen and as your child’s body temperature begins to climb as high as 102, heat exhaustion develops. Your child might have one or more of the following symptoms:

Heavy sweating or moist and cool skin

Paleness

Heat cramps

Tiredness or weakness

Dizziness

Headache

Nausea or vomiting

Fainting

Rapid, shallow breathing

Do’s and Don’ts of Treating Heat Cramps and Heat Exhaustion

DO: Move the child to an air conditioned environment. If this is not possible then find a cool, shaded location.

DO: Loosen or remove clothing.

DO: Begin rehydrating with water or clear juices. Also make sure that the child has an opportunity to replace the salts and minerals (electrolytes) that are lost while sweating.

DO: Use gentle stretches and ice packs if your child complains of leg cramps.

DO: Use a cool shower, sponge bath, or water from a hose to cool the skin.

According to Dr. Don Arnold, M.D., M.P.H., a Pediatric Emergency Medicine Physician at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tennessee, “The best way to cool a child quickly is the ‘wet and windy’ approach. Using cool or cold water or compresses in conjunction with a fan to literally blow the heat off of the child’s body will bring their temperature down faster-- even faster than immersion in a cold bath.”

DO NOT: Give ice cold drinks as they do not absorb as easily as cool drinks and can cause stomach cramps.

DO NOT: Give sugary drinks, caffeinated beverages, or adult sports drinks as this can worsen dehydration.

DO NOT: Use rubbing alcohol, ice water or ice baths.

DO NOT: Give medicines like Tylenol or Motrin then delay treatment while waiting for them to lower your child’s body temperature.

DO NOT: Massage leg cramps.

DO NOT: Put ice packs directly on skin without a protective fabric layer between the ice and the skin.

DO NOT: Delay calling 911 if symptoms do not get better after an hour of cooling, rest, and rehydration or if symptoms worsen.

Level 3: Heat Stroke

Heat Stroke is a life threatening medical emergency. Even one or two of these symptoms means your child needs immediate, professional, medical intervention. His body temperature can rise to 106 degrees in less than 15 minutes as the body’s ability to self cool shuts down. Seizures, coma and death can quickly occur. Call 911 and begin rapidly and safely cooling your child while waiting for the ambulance. Stay on the line with a physician or 911 operator for immediate guidance if the situation worsens. Symptoms of heat stroke include:

NOT SWEATING

Red, hot, dry skin

An extremely high body temperature (above 103°F)

Loss of consciousness

Rapid and unusually strong pulse

Shallow, noisy breathing

Throbbing headache

Dizziness or confusion

Nausea, with or without vomiting

Do’s and Don’ts of Treating Heat Stroke

DO: Cool the child rapidly following the guidelines above.

DO: Call 911 immediately.

DO: Place a vomiting child on his side.

DO NOT: Give the child any fluids to drink or any food to eat.

DO NOT: Put anything in the child’s mouth if he starts having seizures.

DO NOT: Assume erratic, inappropriate or hyperactive behavior is a response to a stressful or stimulating environment if your child is at risk for heat stroke.

DO NOT: Delay calling 911 because you want to check your child’s temperature or because you checked your child’s temperature and it didn’t seem that high. There are many reasons for an inaccurate temperature.