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Lisa Ryan, MD (Guest):  Hi. I’m Lisa Ryan and I’m a Washington University Pediatrician and I work at Woods Mill Pediatrics in St. Louis. And I’m also a Mom Doc at St. Louis Children’s Hospital.

Melanie Cole (Host):  Welcome. This is Mom Docs, the podcast from St. Louis Children’s Hospital. I’m Melanie Cole. And today, we’re talking about heat exhaustion and heat stroke. Dr. Ryan, it’s a pleasure to have you join us today. What happens in our body when we are exposed to extreme temperatures? What happens to the body as a result of exposure to extreme heat?

Dr. Ryan:  Our body is only set to handle a certain amount of heat. So, once it gets too high, the body essentially shuts down. That’s typically going to be at about 105 degrees, our body just can’t handle it. It doesn’t have any way of cooling us back down. And the internal organs essentially just get damaged and then no longer work.

Host:  So, who is at greatest risk for these kinds of things? We think about older people, but children really are at a good risk as well. Are there certain children for whom we have to worry about this more than others?

Dr. Ryan:  Pretty much the younger you are, the higher risk you are just because their bodies tend to heat up faster.

Host:  So, then tell us a little bit about what it is. Tell us about heat exhaustion and heat stroke and what’s the difference between those two?

Dr. Ryan:  Well heat stroke is probably a step beyond heat exhaustion. Heat exhaustion might be when you have maybe been outside for a long time, maybe you are not drinking enough water. Maybe you get a little dehydrated. You start to get tired, fatigued. Maybe you start to feel some confusion. Your body might be really sweaty. It might eventually get to the point where it’s really no longer sweating because your body is not cooling off. And then that’s when you are heading into the heat stroke where we are risking the damage to the internal organs.

Host:  Okay. So tell us signs and symptoms. Because I think that’s one of the most important things, we’re going to discuss today is what parents should be on the watch out for when their kids are playing sports in the heat or they are out playing or they’re doing any of these things where they are not really around water.

Dr. Ryan:  Yeah, that’s a great question. So, first off, would be you want to look at the sweat. Your child is going to be really sweating a lot at first and then might get to the point where they are not sweating as much, and they are just kind of cool and clammy. They might feel faint. They might feel dizzy. Really tired all of the sudden. Their pulse might be really rapid, and they could be experiencing maybe muscle aches or abdominal cramps. They might feel like they are going to vomit. They might actually vomit. Headaches, those are the sorts of things you are going to see.

Host:  So, when does it become an emergent situation and before that happens, what can we, as parents do?

Dr. Ryan:  Well pretty much you want to just try and cool the child down. So, if you start noticing any of those symptoms, if your child is just not looking quite right, I think the first thing I’d do, you mentioned like if you are at a sporting event; if they are looking really sweaty, if they are looking really tired and confused all of the sudden; pull them off the field. Make sure they get something to drink right away, really anything you have for them to drink is going to be good. But if you have something that has some electrolytes in it, a juice or a Gatorade might be just a little bit better. And then you just want to cool them down. Get them to the car, turn on the air conditioning, maybe pour water on them, that sort of thing.

Host:  Okay and then when do we know that it’s time to take them whether it’s Urgent Care or the ER or our Primary Care Provider, what do we do next?

Dr. Ryan:  Well kind of see how they respond. I mean are they coming back around, are the symptoms getting a little be worse, are the symptoms continuing? I’d say always err on the side of caution. If you think your child needs to be evaluated by all means do so. You can always call your child’s doctor but if you’re really concerned, no one is going to fault you for going to the Emergency Room.

Host:  Well that’s certainly good advice. Is there anyway to prevent it? We hear about dehydration being a contributing factor. Does drinking more water help with this? I’m a mom as well and when I would go to my kids’ sporting events, I would bring a big cooler full of ice and towels and I’d keep them in this water and so that the kids could – they all put them on their heads in between their matches and things. Is there anything else we can be doing?

Dr. Ryan:  Well I think those are all great ideas to start with but it’s really – it’s a matter of staying hydrated and it’s not even so much staying hydrated at the game but kind of staying hydrated all the time. Walking into the game already with a hydrated status is going to be much better than really trying to drink as much as you can while you are there. So, really teaching our kids to drink fluids frequently and not just to drink when they are thirsty. Just to really be drinking all of the time. We throw out this 8 class a day thing and I don’t know if that necessarily applies to everybody, but really drinking to the point where you are not getting thirsty. My son will tell me how he goes to school and he doesn’t need to use the bathroom all day and I wonder, the first thing I am asking him is why aren’t you drinking enough water.

Host:  So, I really – how much water?

Dr. Ryan:  Like I said, I don’t think there’s a real specific amount for everybody. But just really making sure that you are not feeling thirsty throughout the day.

Host:  And what else? What about clothes? Because some of these sports Dr. Ryan, they’re in pretty heavy clothing. Is there anything we can do about that and equipment as well?

Dr. Ryan:  Oh that’s hard. That’s so frustrating. We talk about wearing lightweight clothes, wearing light colored clothes and that’s really difficult sometimes with some of these uniforms. If there is any way to put the heavy clothing on right before the game starts, take it off as soon as you can, I think that’s really the best thing you can do. And then making sure you are wearing sunscreen too with it.

Host:  Oh, that’s a really good point that you just made. So, wrap it up for us. Give us your best advice about heat stroke, heat exhaustion, keeping our little kiddos safe and really what you want parents to know about when this is really an emergent condition.

Dr. Ryan:  Sure. So, prepare in advance. Make sure that we’re practicing – we have good practices all the time in terms of fluid intake. Make sure that we’re drinking lots of water all of the time. Make sure that we are preparing this game by dressing in clothes that are as lightweight as we can, as light colored when we can. Making sure that we’re wearing sunscreen all the time, that we are reapplying it frequently. If we are able to wear hats, that’s a great idea. If there’s any way we can bring things into the shade, get out of the hot sun, take frequent breaks. That’s going to be the best thing we can do. And then just being on the lookout for signs when things might be going bad. Is your child sweating excessively? Is he complaining that he is super thirsty? Is he really tired? Is he fatigued? Is he not focused? Is he complaining about muscle pain, muscle cramps? Then that’s the time we’re going to try and cool him down, get him hydrated and if he’s not doing better, that’s when we’re going to seek medical attention.

Host:  Thank you so much Dr. Ryan for joining us today. For parents, that was such important information. Thank you again. And that concludes another episode of Mom Docs with St. Louis Children’s Hospital. Please visit our website at www.woodsmillpeds.wustl.edu and for more advice and articles you can check out the Mom Docs website at www.ChildrensMD.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other St. Louis Children’s Mom Docs podcasts. This is Melanie Cole.