Category: Pediatrics
Keywords: environmental, climate change, heat, pediatrics (PubMed Search)
Posted: 6/13/2025 by Kathleen Stephanos, MD
(Updated: 7/17/2025)
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As the weather warms up, remember that pediatric patients have some physiologic factors that increase their risk of heat related complications. Approximately 37 infants die in cars annually, with risk of vehicular related heat illness starting with outdoor temperatures as low 72°F (32°C). Approximately 9,000 high school athletes require treatment for heat related illness annually with approximately 2 deaths per year.
Physiology:
Infants and young children have physiologically limited thermoregulation. They also may lack developmental abilities to impact their environment (they cannot ask for water, remove clothing or a seat belt, or move themselves to a cooler environment).
Older children take longer to acclimate to environments than their adult counterparts- requiring 10-14 days to adjust to work outs in higher temperatures (a gradual approach of increasing gear over time has been recommended for outdoor sports requiring padding or heavy equipment)
Management:
Heat exhaustion/stroke- focus on cooling the patient with temperatures being monitored with a core measurement. In teens and older children this can be done in a similar manner to adults- with removal of clothes, emersion therapy for heat stroke. In infants and young children, some experts favor evaporative management over emersion due to reflex bradycardia as well as patient compliance.
There are no recommended medications for use during heat stroke. Benzodiazepines may be utilized to present shivering or to treat seizures only if needed.
Prevention:
For athletes steps should include encouraging hydration (flavored drinks have been shown to increase consumption and improve hydration), developing strategies for acclimatization for athletes, and have materials present (ice baths) to intervene quickly for players with symptoms. For infants and young children car alarms or reminders, and practicing placing a needed item in the back seat can prevent parents from inadvertently leaving a child in a car.
Mangus CW, Canares TL. Heat-Related Illness in Children in an Era of Extreme Temperatures. Pediatr Rev. 2019 Mar;40(3):97-107. doi: 10.1542/pir.2017-0322. Epub 2019 Mar 1. PMID: 30824495.