Heat Exhaustion and Heatstroke in Children: How to Recognize and Respond
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This health information is reviewed by board-certified pediatricians and follows current American Academy of Pediatrics (AAP) guidelines.
Children are much more vulnerable to heat-related illness than adults. Their bodies heat up faster, they don't sweat as efficiently, and they often don't think to stop playing and drink water. In New Jersey's humid summers, heat exhaustion and heatstroke are real risks, especially during outdoor sports, playground time, and family outings.
Here's how to recognize each stage and what to do immediately.
The Three Stages of Heat Illness
Heat Cramps Painful muscle cramps, usually in the legs, arms, or abdomen, during or after physical activity in the heat. The child is still sweating and alert. This is the mildest stage and a warning sign to stop activity and hydrate.
What to do: Rest in a cool place, offer water or a sports drink, gently stretch and massage the cramped muscle. No exercise for several hours.
Heat Exhaustion This is the stage where you need to act quickly to prevent it from becoming heatstroke.
Signs of heat exhaustion: - Heavy sweating - Cool, pale, or clammy skin - Rapid, weak pulse - Nausea or vomiting - Dizziness or lightheadedness - Headache - Fatigue and weakness - Temperature may be normal or mildly elevated (up to 104°F / 40°C)
What to do: Move your child to an air-conditioned space or shade immediately. Lay them down and elevate their legs slightly. Remove excess clothing. Apply cool, wet cloths to the neck, armpits, and groin. Offer cool water in small sips if they're alert and can swallow. Call your pediatrician.
Heatstroke: Call 911 Immediately Heatstroke is a medical emergency. It occurs when the body's temperature regulation fails entirely.
Signs of heatstroke: - Body temperature above 104°F (40°C) - Hot, red skin, which may be dry (classic heatstroke) or still sweaty (exertional heatstroke in athletes) - Rapid, strong pulse - Confusion, agitation, or loss of consciousness - Seizures - Child is no longer sweating despite the heat
Call 911 immediately. While waiting: move the child to a cool area, remove clothing, and cool them aggressively with cool water or wet cloths on the neck, armpits, and groin. Do not give fluids to a child who is confused or unconscious.
Who Is Most at Risk?
- Infants and toddlers (can't communicate thirst, can't escape the heat)
- Children left in hot cars: temperatures inside a parked car can exceed 120°F within minutes, even on mild days
- Children playing sports or exercising outdoors in heat and humidity
- Children with certain medical conditions or taking medications that affect sweating
Prevention: Simple But Important
- Schedule outdoor play in the early morning or evening, avoiding peak heat (10am–4pm)
- Build in water breaks every 20 minutes during outdoor activity: don't wait until your child is thirsty
- Dress children in lightweight, light-colored, loose clothing
- Never leave a child alone in a parked car, even for a minute
- Ease into outdoor activity at the start of summer: acclimatization takes 1–2 weeks
- Watch for early warning signs and don't push through them
When to Call Hummingbird Pediatrics
Call our Robbinsville office for any suspected heat exhaustion that doesn't improve quickly with cooling and hydration. For heatstroke or a child who is confused, unresponsive, or seizing, call 911 first, then us.
Frequently Asked Questions
What is the difference between heat exhaustion and heat stroke in children?
Heat exhaustion is the earlier, more treatable stage: the child is sweating heavily, feels weak, dizzy, or nauseated, and has cool, pale, or clammy skin. Heat stroke is a life-threatening emergency: the child may stop sweating, have very hot and red skin, a temperature above 104°F, confusion, seizures, or loss of consciousness. Heat stroke requires calling 911 immediately. It is not safe to manage at home.
How do I cool down a child with heat exhaustion?
Move the child immediately to a cool, air-conditioned environment. Remove extra clothing. Offer cool (not ice-cold) water or a sports drink in small sips if they are awake and can swallow safely. Apply cool, damp cloths to the skin, focusing on the neck, armpits, and groin. Have them lie down with legs elevated. Call your pediatrician for guidance. Most children with heat exhaustion improve within 30–60 minutes with proper cooling and hydration.
Which children are most at risk for heat stroke?
Infants and toddlers are at highest risk because their bodies heat up faster and they cannot communicate that they're overheating. Children with chronic illnesses, those taking certain medications (stimulants, antihistamines, diuretics), overweight children, and athletes exercising intensely in hot weather are also at elevated risk. A child left in a parked car (even briefly) faces extreme danger from heat stroke, as car interiors can reach lethal temperatures within minutes.
How much fluid does my child need on a hot summer day?
Children need significantly more fluid on hot days. A general guide: children 1–3 years need about 4 cups (32 oz) daily; ages 4–8 need about 5 cups; ages 9–13 need 7–8 cups; teens need 8–11 cups. During outdoor activity in heat, children should drink 5–9 oz of water every 20 minutes. Don't wait for thirst; encourage regular drink breaks, as children often don't feel thirsty until they are already mildly dehydrated.
When should I take my child to the ER for heat-related illness?
Go to the ER immediately if your child has a high fever (above 103°F) with hot, dry skin and no sweating, is confused, extremely sleepy, difficult to wake, or having a seizure. These are signs of heat stroke, a medical emergency. Also seek emergency care if heat exhaustion symptoms don't improve after 30 minutes of cooling, or if your child vomits and cannot hold down fluids.
Need Personal Guidance?
This article provides general information. For questions specific to your child's health, please call our office or book an appointment online.