Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Pedi-U – Summertime Fun and Illness and Death

On this Pedi-U podcast, Dr. Lou Romig, Dr. Peter Antevy, Chris Cebollero, Russell Stine, Kyle David Bates, and I discuss pediatric heat emergencies.[1]

How much of a problem are heat emergencies? Can’t we just give them a Gatorade and have them sit in the shade and cool off? If the price of oil were increasing as quickly as the death rate from heat emergencies is increasing, we would see politicians grandstanding about special investigations into speculators and manipulation and there would be lynch mobs.

OK, we do have that with the price of oil. But there is a similar increases in the deaths of children, but there does not appear to be any similar effort to try to stop this continuing increase in the heat-related deaths of children?




Nationally, an estimated 54,983 (95% CI=39995, 69970) patients were treated in U.S. emergency departments for exertional heat-related injuries from 1997 to 2006. The number of exertional heat-related injuries increased significantly from 3192 in 1997 to 7452 in 2006 (p=0.002), representing a 133.5% increase. The overall exertional heat-related injury rate per 100,000 U.S. population more than doubled from 1.2 in 1997 to 2.5 in 2006 (p=0.005).[2]

Go listen to the podcast.

Patients aged ≤19 years accounted for the largest proportion of exertional heat-related injuries (47.6%).[2]

This is definitely an important pediatric care problem.

The majority of exertional heat-related injuries were associated with performing a sport or exercising (75.5%) and yard work (11.0%).[2]

EHI (Exertional Heat-related Injuries) suggests some sort of physical activity and we tend to assume that this is some extreme exertion. That is a mistake.

We need to consider the environment and the physical condition of the person exposed to that environment.

If a child is left in a car seat in the back of a car, is that child at high risk for Exertional Heat-related Injuries?


If you disagree, I assume that you do not have any children. Try to get a child to sit still when you strap the child into a car seat. We need to distract the child from the restraint. The same would be true for adults, if we were to strap them into car seats of the style used for children.

The child is in a warm environment. That environment is rapidly becoming hot, then extremely hot.

Sitting in the sun for only 10 minutes, the time it takes to get a cup of coffee at Starbucks, we can expect the temperature will rise by about 20 degrees. If it is in the 80s, with a nice comfortable breeze, the temperature in the car will rise to over 100 degrees in 10 minutes. We are comfortable outside of the car, but the child is trapped inside the car inside the oven where we left him/her to baking.

This child is no Thanksgiving turkey, where we are worried about cooking to the proper temperature to kill off salmonella. This is just a family member, who will be dead long before any salmonella would.

Oh, but I cracked the window to let the heat out.

Save that pathetic epitaph for someone more gullible than me.

“Cracking” the windows had little effect[3]

The child is uncomfortable.

Uncomfortable people squirm and try to get away from what is making them uncomfortable.

This is exertion.

The child will keep trying this until the child is exhausted. Physical activity to the point of exhaustion is what is happening. go run a marathon in this kind of heat. That is the kind of activity that this child is engaging in – right up until collapse.

This is exertion.

Children’s thermoregulatory systems are not as efficient as an adult’s and their body temperatures warm at a rate 3 to 5 times faster than an adult’s.[3]

So, not only are these children less capable of dealing with heat, but we are putting them in an environment that magnifies the heat they are exposed to.

Children that have died from vehicular hyperthermia in the United States (1998-2010) have ranged in age from 5 days to 14 years. More than half of the deaths are children under 2 years of age.[3]

But –

There is some good news.

The majority of patients (90.4%) were treated and released from the emergency department.[2]

If we cannot prevent the heat stroke (or whatever degree of illness), then many do seem to be able to be safely discharged from the emergency department.

This is not like discharging a patient from the trauma center the same day.


With heat emergencies, this does NOT mean that there was no real emergency.


This just means that children can recover quickly with prompt and aggressive treatment.

Go listen to the podcast.


Read the Fact Sheet.


[1] Summertime Fun! Episode 9
Podcast with learning objectives

[2] Exertional heat-related injuries treated in emergency departments in the U.S., 1997-2006.
Nelson NG, Collins CL, Comstock RD, McKenzie LB.
Am J Prev Med. 2011 Jan;40(1):54-60.
PMID: 21146768 [PubMed – indexed for MEDLINE]

Free Full Text PDF Download from Prepared Patient Forum

[3] Hyperthermia Deaths of Children in Vehicles
by Jan Null, CCM
Department of Geosciences, SFSU
Updated June 13, 2011
Fact Sheet