When Summer Makes You Sick:
Dealing with Severe Heat Intolerance
Most families look forward to the dog days of summer, but for some children with heat intolerance it can be the most difficult time of the year. This article will help make summer more enjoyable for all children by providing some tips for managing heat intolerance.
Heat intolerance can be a complication of many conditions, and also may be a side effect of medications commonly used in children with complex medical issues. Common conditions causing heat intolerance include the following:
- Dysautonomia and other autonomic disorders; children are unable to regulate the “automatic” functions of the body, such as regulating body temperature
- Anhidrosis or hypohydrosis; the inability to sweat
- Thyroid or other endocrine problems
- Multiple sclerosis and other autoimmune diseases that lead to autonomic problems
- Brain injuries, spinal cord injuries, and other neurological conditions that lead to autonomic problems
- Heart and cardiac conditions
Medications, especially anticholinergic drugs that dry children out and reduce sweating, are common causes of heat intolerance. These may include Glycopyrrolate, Oxybutynin or Scopolamine. Allergy drugs, drugs for high blood pressure or beta blockers, amphetamines, and certain seizure drugs are also known to cause heat intolerance.
In its milder forms, heat intolerance may present as discomfort, fatigue, dizziness, or flushing. Some children may sweat profusely and become dehydrated, while those with impaired autonomic nervous systems may not sweat at all.
Severe forms of heat intolerance often cause an actual rise in body temperature above 99F. Children also may experience tachycardia (a fast heart beat) and breathe fast or have difficulty breathing. They may have nausea, vomiting, or cramps. Some become disoriented or confused, while others may become agitated. Without intervention, heat intolerance can become life threatening for these children.
Preventing Heat Intolerance
The most important key to dealing with heat intolerance is prevention. Preventing symptoms from ever starting is critical, because once symptoms begin, they can continue for hours or days in some children.
There are many commonsense strategies for preventing mild heat intolerance in children:
- Stay in the shade
- Wear light-colored clothing that breathes
- Stay in air-conditioned environments on very hot and humid days
- Keep hydrated by drinking (or tubing) lots of cold or cool fluids
- Avoid overly hot and sunny places
- Limit outside activity to the cooler mornings and evenings
- Limit activity and exercise
- Take frequent breaks from both activity and the heat
- Use a fan
- Use a cold washcloth
- Use a spray bottle or mister to keep cool
These strategies, however, are not likely to be sufficient for children with more severe symptoms. These children may benefit from more aggressive cooling therapies.
Products for Cooling
Any child with moderate to severe heat intolerance should have a cooling vest. There are many different styles available, but they tend to fall into two categories: evaporative and ice/cold pack vests.
Evaporative cooling vests are best for children with moderate heat intolerance who do not have central lines. They are significantly less expensive and lighter weight for children to wear. To use, the vest must be soaked in water (or put in the washer) and then towel-dried. Beads inside the vest absorb the water and keep the child cool.
Ice/cold pack vests are vests that can hold regular ice packs or special phase-change cold packs that do not sweat as they warm up. They are the ideal type of vest for children with moderate to severe heat intolerance or children with central lines. Both types of vests contain pockets designed to hold flexible ice or cold packs. In general, the phase-change cold packs are superior for children because they are lighter weight, do not sweat, and only cool to a temperature that is safe for a child’s skin. The number of ice or cold packs placed in the vest can be varied depending on the weather and the child’s needs.
Cooling vests in child sizes may be purchased from the following companies:
Some brands are now even available on Amazon. It is also possible to sew your own cooling vest with pockets for ice or cold packs.
Additional evaporative cooling products including everything from hats to bandannas and towels and wraps. These are widely available through a variety of merchants.
Other options include using a hot/cold water bottle filled with cold water. Some stuffed animals are available with removable hot/cold packs that can be used for cooling as needed. Another good option is a simple clip-on or wearable fan. Cool on the Go is a personal cooling system that works particularly well for children in wheelchairs.
Finally, products like the Chillow, a cooling device that can be used with a pillow or on a wheelchair seat, are great for additional cooling.
If your child does overheat, immediately remove him or her to the closest cool, shady environment, preferably inside with air conditioning. Monitor vital signs closely, and towel or bathe your child with cool water. Focus the cold on the neck, armpits, and groin if possible. Administer cool or cold fluids by whatever method the child can tolerate (orally, by feeding tube, or by IV).
If the child’s temperature continues to rise or his or her vital signs become unstable, call paramedics for assistance.
Note that many children who are heat sensitive are also sensitive to cold, and may easily become hypothermic unintentionally. Try to cool these children slowly, if at all possible.
Summer Fun Despite the Heat
Many children, including those with severe heat intolerance, are able to participate in a wide variety of summer events using cooling vests and other cooling products. While they may need to stay inside on the hottest days, cooling technology has evolved to the point that many more days can be spent outside enjoying the day.