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On Call For All Kids: Preparing for Summer Emergencies 2020

Posted on Jul 20, 2020

With the rising cases of COVID-19, we should be staying home as much as possible; however, this does not mean we should not go outside. Joe Perno, M.D., vice president of medical affairs and the vice chairman of the Department of Medicine at Johns Hopkins All Children’s Hospital, gives recommendations for children and families to be safe during this time of the coronavirus.

Now more than ever it is important to make sure we are getting outside to get some exercise. However, it is important to be smart about it. When exercising or playing outside, consider doing so in the morning hours or evening so you can avoid the hottest part of the day. Although it is hot everywhere, a shady park is a better option than an open field. Wear synthetic lightweight clothing designed to wick sweat to the surface to allow for evaporation. Consider wearing a hat for sun protection. 

When heading outside during the summer always remember to pack three important things: 

Water, sunscreen and bug spray. 

During outdoor activities, how can children stay hydrated with the intense summer heat and humidity? 

Hydration is one of the most important things to help avoid heat exhaustion or heat stroke. It is important to remember that by the time you are feeling thirsty, you are already mildly dehydrated. It is important to drink before, during and after a sporting activity. 

A good regimen is: You must pre-hydrate before exercise/heading outside ideally with three 8-ounce cups of water or sports drink two hours before exercise then two cups 15 minutes before exercise and then one cup every 15 minutes during exercise. 

What should people be drinking: water or sports drinks? 

Typically, if exercise is less than 60 minutes then water is adequate for hydration or re-hydration. If exercise is particularly intense or lasting longer than 60 minutes a sports drink should be considered since it has important electrolytes.

Salt is probably the most important electrolyte that needs to be replenished so if you are rehydrating with water make sure to include some salt in your diet. Most sports drinks will contain adequate amounts of salt, glucose and potassium. 

Please remember that sports drinks are good for people who are exercising or suffering from a stomach virus; otherwise they contain significant “empty” calories that can lead to obesity in children who are not active. The same is true for fruit juices. 

What about sodas or other soft drinks? 

Many sodas contain caffeine. Caffeine is a mild diuretic meaning that it will make you urinate. These are not helpful for keeping hydrated as you will urinate out as much as you are taking in.

Sodas without caffeine are better but are full of sugar. In addition, the carbonation in most sodas will fill you up; limiting the amount of fluid, you are able to take in. When combating dehydration, it is best to stick with water or sports drinks. Sodas should be saved for an occasional treat, as they have no nutritional value. 

How does a person know if they are well hydrated and what is the “pee test”? 

The pee test refers to the color of your pee.  A person who is well hydrated should have urine that is light in color similar to lemonade. If you are dehydrated, you urine will be dark, sometimes even orange typically with a strong smell. Kids, especially older ones, should be taught to look for this and encouraged to drink more liquids until their “pee” is light yellow. 

Despite taking all the precautions, what are the signs of heat illness in children? 

Heat illness can be considered a spectrum of severity. Very mild might be just some overheating indicated by flushing of the skin and can be treated by hydration and a cool environment. This can proceed to heat exhaustion. Heat exhaustion typically consists of muscle cramps, nausea or vomiting, headache, lightheadedness. This can be treated with aggressive sports drink rehydration and a cool environment. If undetected, heat exhaustion can proceed to heat stroke, which is a medical emergency. It involves a significantly elevated body temperature along with alteration of patient’s level of consciousness. This needs to be treated in an Emergency Center immediately. 

On Call for All Kids is a weekly series featuring Johns Hopkins All Children’s Hospital experts. Visit each Monday for the latest report. Check out more advice from Joe Perno, M.D. 

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