Temperatures are soaring.
Memorial day means the beginning of the summer season. It seems like a good time to update this post that we ran a couple of years ago. There are some important additions, especially for teen athletes.
As many of you can attest, the hot weather hasn’t waited for summer this year.
Not only is it hotter earlier than usual, but it is more extreme.
Even places that are used to hot weather are seeing heat waves that are sadly breaking all kinds of records.
We are anticipating that most of the country will likely be dealing with temperatures over 90 degrees, many over 100, as the norm.
The important number is actually the heat index. This is calculated based on the temperature and the humidity. Humidity does make things worse. If you are in a place with high humidity the sweat doesn’t evaporate as quickly and this keeps the body from releasing heat as fast as it may need to. If you want to calculate the heat index of where you are, you can use this link.
Even in San Francisco, where we often are blessed with our lovely fog, we have more hot days than I can ever remember.
Being overheated can have serious consequences, especially in young babies.
Symptoms of heat exhaustion might include:
Fevers 100-104
Clammy skin
Muscle cramps
Nausea
Dizziness
Lethargy
If not tended to, this can lead to heat stroke, which can be deadly! Signs of Heatstroke include:
A temp at near or above 104 (fever reducing meds are not useful in this circumstance)
Flushed skin
Elevated heart rate
Weakness
Dizziness
Loss of consciousness
Medical intervention is essential!
A quick word about intense exercise in the heat (pay attention, teen athletes):
Most kids are not going to develop anything this serious from a hot day at the playground, but older kids, teens, and adults can occasionally get into trouble when they push themselves really hard in extreme heat. This is especially true during sports practices, intense hikes, boot camps, or suddenly trying to “power through” after not being acclimated to the heat yet. It’s most commonly seen on the first or second day of practicing a new sport.
When muscles overheat and break down too quickly, it can lead to something called rhabdomyolysis (“rhabdo” for short). This can actually damage the kidneys. Warning signs can include severe muscle pain or cramping, unusual weakness, swelling, vomiting, dizziness, or urine that looks dark brown like cola.
You’ll know you’re at risk for this if you reach the point where it feels like “my muscles have physically stopped being able to do this” and you decide to power through nonetheless. If that’s the sensation, it’s important to listen to your body. The most severe rhabdo victims are the ones that try to “power through” on a hot day.
The best prevention is not trying to be a hero in triple-digit weather. Take lots of breaks, hydrate before you feel thirsty, replace electrolytes if you are sweating heavily, and avoid the hottest part of the day whenever possible. Coaches, parents, and athletes should all know that pushing your body in extreme heat is usually not the right answer.
If someone seems confused, collapses, has severe muscle pain, or develops dark urine after heavy activity in the heat, they need medical attention right away.
Hydration is an essential part of preventing heat related complications.
It is important to replenish the fluids as well as the electrolytes that you lose when you are hot and sweaty. Pedialyte or similar electrolyte drinks may be better than plain water. Breast milk is perfect (of course). Even if your baby seems to be nursing well, if it is very warm out, keep an eye on the number of wet diapers! You may need to sneak in some extra fluid.
Nursing moms need to remember that they are losing fluid every time they feed their babies. It is essential to replace that as well as adding extra, so drink up! Perhaps start your day with one of the large water bottles that measures the amount. Fill it at the start of the day and it makes it much easier to track your intake.
Someone who is dehydrated will have:
Less urine, and the urine will be dark
Low energy
Dry mouth
No tears
Even if they are no longer in diapers, pay attention to how often your child is peeing and look at the color. Darker, infrequent urine might be your first clue that they need to be drinking more.
Ideas for staying hydrated:
Set a timer on your phone as a reminder that it is time for everyone to take a sip.
Maybe have an iced-tea party.
Pedialyte comes in popsicle form which can be a big hit.
Other good hot weather treats are watermelon and some mildly salty snacks.
Frozen breast milk can make a wonderful ‘milk-sicle’
Ideas for staying cool at home:
Heat tends to rise, the coolest room in the house might be downstairs.
Families may end up sleeping on the living room floor if it is less oppressive. Make it an adventure and call it camping.
Keep the shades down during the day.
Have a fan going if you are lucky enough to have one. Make sure the fan is placed in an area where curious kids can’t poke their fingers in there. Even better, get one of the fans that is toddler safe. For those of you without fans, put your order in now. Often in the midst of a heatwave there are none available. It is worth owning at least one so you are prepared for the next heatwave.
Baths are great. Unless the water is obviously dirty, don’t drain it and you can get in and out throughout the day.
Keep wet washcloths in the freezer and offer the frozen clothes throughout the day. Sponges are also fine to freeze.
There are cool little ‘cooling towels’ that can make a big difference. Once you wet them, they stay nice and chilly for hours.
If you have a yard or a place to put it, investing in one of the little plastic wading pools can give your kids hours of cooling fun. (even if it is very shallow, remember that adult supervision is required.
Dress in minimal lightweight clothing.
Come up with some fun indoor activities that don’t require a lot of running around. Lots of kids love water play. Cover an area with a plastic sheet (a shower curtain is a great cheap option). Fill a plastic bin with water and then there are unlimited options (including cleaning the bin with a big sponge!)
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An extended heat wave may require a little bit more screen time than you like; don’t stress about it. Try to be clear that there are some ‘hot weather’ rules that can be a little more relaxed.
If you don’t have air conditioning, see if you can find local places where you can hang out for a cooling break. Malls and libraries are often good options.
If you do go outside...
Beware of hot metal. Make sure you test the temperature of any slides or metal equipment before you let your child play on them. We have had patients get burns on their fingers from pressing a metal doorbell, so we are not kidding around. Seatbelts can be pretty bad as well! Metal can get very hot.
Shade is best, but if you are in the sun, make sure your kids have a big floppy hat, sunglasses and sunscreen.
Don’t forget about your pets. Make sure they have plenty of water (add some ice cubes.) If possible when walking them, keep to grass. Extremely hot pavement can actually burn their paws.
Also…never ever leave kids and pets in the car. This is especially critical when the weather is hot. Folks with some modern cars do have pet comfort settings (but it’s not okay to leave kids in there).
Keep in mind that in many hot areas of the world, the cultures have embraced the concept of the siesta. They take a collective break during the hottest part of the day. That sounds like a plan that most parents would be soundly in favor of…. Now we just have to get the kids on board.
Remember that heat is the normal for babies in many countries
Bay Area parents, this section is especially for you. We see a lot of anxiety around the idea that babies must exist only in a perfectly climate-controlled environment between exactly 68 and 72 degrees at all times or else catastrophe will strike. Deep breath.
Yes, we want babies to be comfortable and safe. Yes, overheating is something to take seriously, especially for newborns. But it is also important to remember that babies are born and raised all over the world in a huge range of climates. There are babies in Cambodia. There are babies in India. There are babies in Arizona in August. Not all of them have AC. Humanity has not survived exclusively in homes with central AC and a Nanit room-temperature alert.
What we are generally trying to do is optimize comfort and reduce risk, not maintain laboratory conditions. A room drifting up to 75 degrees for part of the afternoon does not mean your baby is suddenly unsafe. A baby taking a stroller walk on a warm day is not automatically in danger. Parents can become so anxious about achieving the “perfect” temperature that they lose sight of the bigger picture and stop trusting their own observations.
The most important thing is how your baby actually looks and behaves. Is your baby feeding okay? Making wet diapers? Reasonably alert when awake? Not flushed, lethargic, or drenched in sweat? Those clues matter more than obsessively refreshing the weather app every seven minutes.
Try to think in terms of flexibility and common sense rather than precision engineering. Dress babies lightly in the heat. They can even be naked. Avoid direct sun exposure. Use fans safely. Offer feeds frequently. And remember that a loving, attentive caregiver matters a whole lot more than whether the nursery briefly hit 75 degrees.
Other heat-related considerations:
Fungal diaper rash
With increased heat and sweating, fungal rashes can become a problem. Fungus loves damp dark warm places, so a sweaty diaper area (or underwear area for potty-trained kids…or adults) is the perfect breeding ground for fungal rashes. Fungal rashes in diapers can look like discrete red dots, occasionally coalescing into lumpy bumpy raised patches. Unfortunately, this can mimic the red papules of hand-foot-and-mouth. Dr. Ted has seen kids with diaper rashes sent home from daycare to get assessed for hand-foot-and-mouth. For any concern for a fungal rash, air out the diaper area and add over-the-counter Lotrimin three times a day. It’s extremely safe and well tolerated at all ages. You can also add some apple cider vinegar to the bathwater, which is antimicrobial and balances the pH (white vinegar is probably fine, but skip the balsamic).
Swimming considerations
The excessive heat warming fresh waters has created some unfortunate growth of naturally occurring bacteria, such as pseudomonas. Pseudomonas can present in a couple of ways. It can live in poorly controlled hot tub waters, creating a red spotty rash called hot tub folliculitis, but more importantly it can cause an excruciatingly painful swimmer’s ear. Luckily, pseudomonas can’t grow outside of wet environments, so drying the ears fully after swimming will not allow the bacteria a place to grow. We do not recommend Q-tips as they can traumatize the eardrum. Try using Debrox drops after swimming to dry out the ear, and any bacteria inside won’t be able to grow.
Blue green algae
If you’re going to any rivers or lakes, check your local resources to make sure there aren’t any dangerous blooms. He is the website for California, but it is easy enough to google wherever you are.
This is important for your pets as well as the humans.
Dr Ted’s Tidbits: Time to nerd out with science!
Young infants don’t regulate their body temperature very well, so this puts them at greater risk. “Heat regulation in newborns is fascinating. We rely on sweating to get rid of heat. Water from our skin absorbs heat and carries it away with evaporation (see Nurse Judy’s bit of this, above), but newborns don’t make a lot of use of those valuable sweat glands for at least the first couple of weeks. Newborns also have an immature part of the brain that regulates body temperature called the hypothalamus. Without input from the hypothalamus, babies rely on outside forces to control their core temperature. In particular, babies are bad at cooling themselves off. So if you’re in a place with a heat index over 90, it’s important to be proactive about keeping your baby from overheating.
