As pediatric experts, Cook Children’s Health Care System know that protecting a child's health is about preventing emergency room visits just as much as treating illness. Ahead of the major soccer tournament, the system launched "World Cup Wednesday," a weekly healthcare series providing local and international visitors with essential resources on injury prevention, heat safety, water safety and guidance on when to utilize urgent care versus the emergency department.

The hottest time of the year in Texas is here, with temperatures regularly ranging from 80-100 degrees between June and August. Medical experts from Cook Children’s Health Care System advise caregivers and parents on what to know before attending outdoor activities or fan watch parties.

“Children can't cool off the body as well as adults,” said Monica Herrera, M.D., a pediatrician at Cook Children’s Pediatrics Windhaven, “it's important that we keep them hydrated.”

Dr. Herrera emphasizes that hydration is key during these months, as well as protecting children's skin from the sun and mosquitoes.

Learn the signs of heat-related illnesses

Spending too much time in the heat without proper hydration can lead to heat exhaustion and heatstroke. Dr. Herrera said learning the signs for heat-related illness is important, so caregivers know when to seek medical attention.

Symptoms include:

• Feeling faint or confused: A child may begin acting disoriented.
• Walking unsteadily and losing coordination.
• Headache
• Abnormally warm skin: Feels hot to the touch.
• Lack of urination: No wet diapers or bathroom use in eight hours.
• Nauseous and vomiting
• Shallow breathes: The body uses shallow breathing to try to shed excess heat.
• Muscle cramps: A child may complain that their legs hurt.
• Numbness

If a child exhibits these symptoms, seek immediate medical attention.

Preparedness is the number one way to avoid heat-related illness and Dr. Herrera says it starts with hydration.

Hydration Tips

Babies under 6 months old should generally be kept indoors. However, if an infant is outside, Dr. Herrera recommends they stay hydrated with formula or breastmilk. Babies under 6 months should not be given water.

“The breast milk has everything that the baby needs as does formula,” said Dr. Herrera. “If you're outside for a prolonged period they really need to be drinking every 20 minutes.”

As children get older water becomes the priority for hydration, but there are other tricks if your little one isn’t fond of H20. While water is best, other caffeine-free fluids and water-rich foods can help count toward hydration.

“Fluids don’t always come in the form of liquid,” said Dr. Herrera.

Alternative hydration sources:

• Ice cream
• Popsicles
• Snow cones
• Crushed Ice
• Fruits (Watermelon, grapes and cantaloupe) are an excellent source of hydration
• Soft liquids (such as yogurt, applesauce)

How do you know if your child is hydrated?

Check their urine. Urine is the best indicator of hydration status for both children and adults. A well-hydrated child's or adult’s urine should be clear to a light yellow, similar to a light lemonade color. If the urine is dark yellow or tea-colored, dark orange, more fluids are needed.

Sun protection

While hydration is critical, protecting a child’s skin is a close second. Dr. Herrera explained that children’s skin is sensitive and can burn when exposed to the sun for a prolonged period. While sunblock Sun Protection Factor (SPF) ratings range in coverage from SPF 10 to 80, Dr. Herrera recommends choosing products with two active ingredients: zinc oxide or titanium dioxide and use a sunblock of SPF 30.

Babies under 6 months of age should not have sunblock applied. Instead, keep them in the shade and dress them in a wide-brimmed hat.

Sunblock recommendations for 6 months and older:

• Choose a mineral-based sunscreen.
• Use SPF 30
• Apply 15 to 30 minutes prior to going outside.
• Reapply every two hours.
• Avoid sunscreens containing oxybenzone.
• Choose lotions over aerosol sprays to ensure total skin coverage.

Staying Cool in the Sun

• Dress children in light-colored, loose-fitting clothing.
• Choose breathable, absorbent materials.
• Avoid sitting directly in the sun. Seek shade when possible.
• Use cool mist sprays for quick relief.

Mosquitos

Summer heat in Texas also brings mosquitoes, which thrive around stagnant water and in hot, humid climates.

“Mosquitoes, as we know, can carry viruses which can cause severe infections and serious complications,” said Dr. Herrera. “We want to avoid mosquito bites if at all possible.”

The most effective line of defense is insect repellent.

Finding the best repellent:

• DEET is the most effective option.
• For infants up to 2 years of age, use a maximum of 10% DEET.
• For children older than 2, a maximum of 30% DEET.
• Apply repellent only to exposed skin or on top of clothing. Do not apply it underneath clothing.
• If concerned about applying directly on the skin, apply repellent on clothing instead.

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Texas surpassed its number of hot car deaths from 2024 on July 14, according to the Texas Department of Health Services (DSHS). A sixth and seventh fatality was reported in August in North Texas.

The increase contributes to the more than 20 hot car deaths reported nationwide this year as of August 26. Vehicular heatstroke is the second-leading cause of vehicle-related deaths in children under 15, trailing only car crashes.

Experts from Cook Children's Health Care System, Viviana Esparza, program coordinator at the Center for Community Health, and Sharon Evans, trauma injury prevention manager, emphasize the preventable nature of these tragedies.

“It can happen to anyone but it is 100% preventable,” Esparza said.

She notes that 52% of hot car child deaths occur when a child is forgotten. According to kidsandcars.org, parents can suffer from exhaustion due to lack of sleep, stress, and changes in their normal routine. Any one of these can cause a parent or caregiver's memory to fail at a time when you least expect it.

“Parents need to realize this can happen to anyone,” Evans said. “They aren’t bad parents but they get distracted or there’s a change in their routine. Make it a habit to put something you need in the back seat with the child.”

Twenty-five percent of hot car child deaths are due to a child gaining access to an unlocked vehicle or a child getting the keys. Evans recommends teaching toddlers and preschool-aged children to honk the horn if they become trapped, enabling them to draw attention to the vehicle.

Esparza says the third most common is knowingly leaving a child in a vehicle for a quick errand. DSHS emphasizes that a cracked window does not protect a child or pet from heatstroke.

“A car heats up about 20 degrees in 10 minutes and the temperature just keeps growing after that, often reaching 130-140 degrees in 30 minutes to an hour,” Evans said.

Esparza encourages families to remember the acronym A.C.T. to prevent heatstroke:

• A: AVOID heatstroke and other heat-related injuries by never leaving your child alone in a car, not even for a minute. When the vehicle is at home, keep the doors locked and keys or key fobs out of a child's reach.
• C: CREATE reminders. Place an item you need, such as a bag, wallet, or cellphone, in the back of your car or next to your child. This is especially important if you're not following your normal routine. If your child is with a care provider, ensure vehicle-related procedures are in place, such as vehicle searches or locking vehicles when not in use. Use technology to your advantage and use apps or other communication methods to stay connected with your childcare provider.
• T: TAKE action. If you see a child alone in a car, call 9-1-1. Emergency personnel want you to call, and they are trained to respond swiftly to these situations. One call could save a life.

Summer has begun, which means more outdoor activities and finding ways to cool down. Cook Children's Health Care System experts share tips for parents on how to keep children safe and prepared for the heat, from cooling down at the pool to summer travel safety.

As the 4^th of July approaches, we are sharing the latest drowning data from Cook Children’s Health Care System. As of January 1 to June 18, there were 20 drownings treated at Cook Children’s, two of which were fatal. Most of these patients have been in the 5-year-old and under age group.

So far in 2025, there has been a decrease with 18 drownings and two fatalities. Most drownings in 2025 have occurred in a swimming pool or spa, second highest were bathtub-related.

While most drowning encounters were not fatal, drowning injuries can result in severe effects, especially on a child’s brain development. Drownings can happen silently and quickly. A submerged person might not attract attention or appear to be in danger.

Cool Down: Water safety and drowning prevention

Drowning is the leading cause of unintentional injury and death for children ages 1 to 4 and the second leading cause for kids 5-14 in Texas.  Eighty-eight percent of drownings occur with at least one adult present. 

• Wear swimsuits with bright colors that are easily detectable in water.
• Designate an adult Water Watcher to ensure constant visual supervision of children in and around water.
• Implement 15-minute shifts for Water Watchers.
• No Distractions: The Water Watcher must have no distractions, including conversations, phones, reading, or consuming alcohol.
• Communication is key: Talk with all caregivers (family and friends) about your child’s swim ability or water competency skills.
• Never assume that adults will be watching, but rather verbally confirm it before leaving your child in their care.
• Barriers: Locks, alarms, and pool fences can help keep unsupervised young children from entering swimming pools.

Fun in the Sun: Boating Safety

The risk of drowning in open water triples at age 15. Setting safety expectations with the whole family ahead of time is paramount. Most drowning fatalities in natural water are not related to boating. Texas law requires that all children 13 and under wear a life jacket while on a boat. Cook Children's Health Care System supports over 60 Loaner Life Jacket Stations in North Texas lakes, rivers, and reservoirs. The goal is to make sure no child or adult drowns at a public lake because they did not have access to a life jacket.

• Make sure life jacket usage is mandatory, along with adult supervision.
• Toe In/Vest On Policy: If a toe is in the water, a life jacket goes on.
• Life Jackets: Must be U.S. Coast Guard-approved.
• When your life jacket is on, ensure that it is buckled on your child as directed.  Always. 
• Know water conditions before getting into open water. Water conditions in lakes and oceans can vary daily.  

Heat Safety

Spending too much time in the heat can lead to heat-related illnesses, including heat exhaustion and heatstroke.

• Stay hydrated: Water is best, but other fluids count if they do not include caffeine.
• Hot car danger: Make a habit of double-checking your backseat each time you get out of the car.
• Watch out for hot buckles on car seats, as these can cause burns on your child’s skin.
• Be aware of heat illness. Know the difference between heat exhaustion and heat stroke.

Sun’s Out, Fun’s On

When it comes to sunburn, prevention is key. 

• Use a zinc oxide-based sunscreen with a minimum SPF of 30.
• Cover skin with SPF clothing.
• Apply sunscreen generously and frequently, 15 minutes prior to sun exposure.
• Reapply sunscreen every two hours and after swimming.
• For infants: Keep them out of direct sunlight, especially during peak hours of 10 a.m. and 4 p.m. Keep their skin covered with lightweight pants, a lightweight, long-sleeved shirt, and a wide-brimmed hat. 
• Wear sunglasses: Look for sunglasses that protect your child’s eyes from at least 97% of the UV rays. 
• If you are worried about any burn, even if it seems minor, consult your child’s pediatrician.

Fireworks
Fireworks can cause severe injuries that are both harmful and painful to children. Children should never handle fireworks. Even seemingly harmless sparklers can heat up to more than 1,200 degrees, making them dangerous for young children.

• The safest way to enjoy fireworks is at a professional display.
• If setting off fireworks at home, adults should only set them off in a “kid-free” zone.
• Adults should not hold fireworks in their hands or keep any part of their body over them while lighting.
• Avoid accidental burns: keep children away from bonfires and grills.

Heat illness during sports practice or competition is among the leading causes of death in the U.S. for high school athletes, according to the Centers for Disease Control and Prevention (CDC). Scorching summer sun and high temperatures put athletes at increased risk for heat illness, no matter their fitness level. 

Coaches and directors of marching bands are currently conducting practices, rehearsals and scrimmages ahead of football season. This summer, North Texas experienced lengthy stretches of triple-digit temperatures and drought. Rainy days have tampered down the heat, but the humidity is still high.

Students’ primary preparation begins with hydration – not just during and after practice. Drinking water and clear liquids must begin hours, even a day, before the exercise and exertion, said Jason Terk, M.D. of Cook Children’s Pediatrics Keller Parkway.

“If you're not dealing with a full tank, you are not going to be able to catch up or keep up,” Dr. Terk said. “Those leading the practices must also build in enough breaks for rest, shade and hydration.”

Keeping pace with science and research, the University Interscholastic League (UIL) sets guidelines around heat stress and athletic participation for high schools. Their recommendations follow research from the American Academy of Pediatrics Committee on Sports Medicine. UIL now recommends water availability for athletes in unlimited quantities. Cold water is best. Additionally, practice schedules should include 10-minute water breaks for every 20-30 minutes of exercise in the heat.

Dr. Terk is a self-proclaimed marching band nerd and is an unofficial chaperone for Keller High School’s marching band.

Guidelines Make Sense

“In 15 years of doing this, the last nine of them at Keller High School, I have no reported heat-related emergencies,” said Ryan Heath, director of the marching band.

There are two parts to Heath’s preparation for marching season, the music-only rehearsals indoors and the music-plus-marching outside.

“Our district has great guidelines related to temperatures and that dictates what our hours are,” Heath said. “We work to schedule the outdoor part in early morning or in the evening before sundown.”  

Keller Independent School District bases decisions on the National Weather Service’s Wet Bulb Globe Temperature Forecast. Its measurements can help manage workload in direct sunlight and capture temperature, humidity, wind speed, sun angle, and cloud cover (solar radiation). Many of us are more familiar with the “heat index” that only measures temperature and humidity, and does so in the shade.  

Heath starts the discussion with his students in the spring, about summer training for the fall marching band season. When rehearsals get underway, he expects students to have done enough summer activity so they can complete a one-mile run in 10 minutes. Heath says the measurement ensures band students have the cardiovascular endurance required, to play an instrument successfully and march simultaneously. He came up with it after consulting medical professionals and other  experts.

“We don’t have a certain training regimen,” Heath said. “But this is an athletic activity as much as sports and my expectation of participants is they maintain good physical health and stay hydrated.”

For safety precautions, he requires students to have a hat, sunglasses, a gallon of water, and sunscreen when they report for outdoor marching rehearsals. Without those, they cannot participate. He also says, during the first weeks of marching practice many parents show up with extra pop-up tents, ice packs and more water to help monitor students’ response to the heat. Many of the parents are doctors, nurses, nurse practitioners and others with professional expertise.   

Ease Into Practice  

“I played high school football and we practiced for three hours with one water break,” said Daniel Guzman, M.D., pediatric emergency medicine physician with Cook Children’s Medical Center. “I’m happy to see that we have advanced from the archaic ‘it will toughen you up’ to water breaks are important for players’ safety.”

Dr. Guzman’s youth sports career included summer practices in South Texas. He knows now just how dangerous it was and how preventable heat emergencies are.

“Exertional heat illness is one of the leading causes of death each year. Parents need to be aware and informed about their children’s practice schedules and the team’s policy on modifications of practice depending on the level of heat that day,” Dr. Guzman said. “At what temperatures do we modify our practice schedule?  It is within a parents’ right to know what these policies are and what are children being taught about rest and hydration to keep them safe.”

Dr. Guzman says coaches and band directors can help student athletes by acclimatizing to heat during the first seven to 14 days of practice. He says athletes can become more heat tolerant, but are never out of danger. Coaches should be careful and watch closely, while athletes need to self-restrict activity if they begin feeling badly – the sooner the better – to avoid emergencies.

“It’s important to be careful when pushing these young athletes to their limit and be mindful that most kids won’t say they feel bad or need to stop,” Dr. Guzman said.

Early Warnings

What are the earliest signs of heat illness? Dr. Guzman says it usually begins with muscle cramps, lightheadedness, headache, abdominal cramps and nausea. If you ignore these early signs, your condition could become emergent quickly. If you are too sweaty and looking pale, Dr. Guzman says that means it is time to get in the shade and drink something with electrolytes, like a chilled sports drink, to replace salts. It’s really important to treat the symptoms quickly, especially if the athlete is confused.

The color of urine is a good monitor for sufficient hydration. Dr. Guzman says it should be clear and not dark. If urine begins to look brown, red or tea-colored, there could be serious issues underway, like the medical condition called rhabdomyolysis (rhabdo). Rhabdo occurs when injured muscle tissue breaks down rapidly and releases proteins and electrolytes into the bloodstream. In large amounts, the substances can damage kidneys and other organs, cause rapid heart rate and even death.  

“The process makes the blood sluggish. Everything just aches and patients often say it’s too painful to move, they have achiness everywhere, flu-like discomfort,” Dr. Guzman said. “Kids can complain of feeling sluggish and weak. They should skip practice if this occurs and seek medical attention.”

Athletes that have dark-colored urine with or without any other symptoms should consider it a significant cause for concern. Blood tests can measure the level of substances released into the blood stream to diagnose rhabdo. One measurement important to Dr. Guzman is creatine kinase (CK). Normal ranges can vary among patient populations. Generally, he wants to see it under 300-350 micrograms per liter (mg/L). In the emergency department, he has seen patients whose CK is 1,000-2,000 mg/L range and he recalls one athlete with over 10,000 mg/L.

“The treatment is to continue IV hydration two times the normal amount until the patient feels better and the creatine kinase begins to decrease to normal levels,” Dr. Guzman said “Big muscular kids are the ones that concern us the most. Working out vigorously can break down all that muscle and create a dangerous situation.”

Avoiding heat illness among sport and marching-band athletes is a group effort among coaches, band directors, parents and kids. Respecting any outdoor activity for the possibilities and concerns related to heat stress is vital to the safety of student participants. Be cool this summer – literally!

Early Signs of Heat Stress

• Muscle cramps
• Lightheadedness
• Headache
• Abdominal cramps
• Nausea

Reminders for Athletes and Parents

• Monitor your body’s need for water or cooling breaks.
• Avoid worrying about being the ‘weak link.’
• It is okay to say, “I can't go anymore.”

RELATED: The Facts About Fainting in Children (checkupnewsroom.com)

The family of Michael Stuyvesant knows he beat the odds on a hot June day six years ago when he survived being accidentally left in the mini-van parked outside their Garland home.

Michael, 3 years old at the time, experienced brain swelling, seizures and other trauma caused when his body overheated. He was hospitalized for 10 days – three of them in intensive care – and then spent almost a month in a rehabilitation facility. Michael had to relearn skills such as walking, eating and playing.

His father says Michael still deals with short-term memory loss. But the Stuyvesants count themselves lucky that he didn’t die in the accident. On average, 39 children in the United States suffer fatal injuries every year from what’s known as pediatric vehicular heatstroke, a tragic and preventable danger. Four children have died so far in 2021 as of mid-June.

Eric Stuyvesant wishes his vehicle had been equipped with a device to remind him that Michael was asleep in the car seat that day in 2015. Some type of alarm “would have saved a lot of anguish, tears and heartache,” he said.

Legislation introduced last month in the U.S. Congress would require automakers to install technology that detects a backseat occupant, and then alerts the driver. The Hot Cars Act would make the technology a standard safety feature in every new passenger vehicle. The legislation calls for sensors and warning systems in an effort to protect unattended children and pets.

Here’s an example, a rear-seat reminder: If someone opens and closes a car’s back door within 10 minutes of starting the ignition, an alert will activate later whenever the vehicle shuts off. The alert chimes and a message on the instrument panel tell the driver to check for backseat riders. Supporters of the Hot Cars Act draw comparisons to other technology mandated over the years for auto safety, such as seatbelt reminders and levers for emergency release in trunks.

Chad Hamner, M.D., pediatric surgeon and trauma medical director at Cook Children’s, believes in the potential benefit of such devices whenever parents and caregivers unintentionally leave their little passengers behind.

 “It’s not a sign that you’re an unintelligent person or forgetful. It just happens,” Dr. Hamner said. “We get in a routine or we’re thinking about other things. It’s natural human behavior.”

When it comes to excessive heat, infants and young children are particularly at risk. Their bodies heat up five times faster than an adult in the same environment as a result of a larger surface area relative to body mass for heat exchange with their surroundings. Infants are at exceptional risk as they also have an immature temperature regulatory system.

What happens during heatstroke? Dr. Hamner said profuse sweating leads to loss of water and electrolytes, which can rapidly produce dehydration. A severely dehydrated child can’t maintain adequate blood pressure to support the delivery of oxygen and nutrients to their vital organs. According to Dr. Hamner, eventually heat stroke results in cardiovascular collapse and damage to muscles, the kidneys, the intestines and the brain. In the emergency department, the staff works fast to bring down the body temperature and replace lost fluids and lost electrolytes.

 Symptoms of hyperthermia include rapid pulse, shallow breathing, flushed skin, high fever, vomiting, dizziness, confusion and loss of consciousness. Organs start shutting down when the body core temperature reaches 104 degrees, said Sharon Evans, trauma injury prevention coordinator at Cook Children’s.

“Usually by the time the child is found (in a hot car), they‘re dead. They rarely even make it to the hospital,” she said.

Texas leads the nation in the most fatalities, with 132 since 1998, including five last year. Evans said public awareness campaigns in the state have made a difference. But she also favors the implementation of more technology, such as devices that detect motion or breathing in the back seat. She supports the Hot Cars Act.

Experts want caregivers and bystanders to know: 

1. Never leave a child unattended in a vehicle, not even for a second, even with the windows cracked and the air conditioning on.
2. Create a habit of checking the back and front seats before you walk away from the vehicle.
3. As a reminder, place something essential -- your purse, briefcase, shoe or other personal items -- next to the child during the drive.
4. Teach your children that a vehicle is not a play area. Keep the doors locked, even if the car is in the garage. Keep the keys out of reach.
5. If you see a child alone in a car, try to get him out. Call 911.

State law in Texas gives liability protection to anyone who forcibly enters a locked vehicle (by breaking a window, for instance) to reach a vulnerable person inside who faces imminent harm. State law also protects the confidentiality of anyone who calls to report suspected child abuse or neglect.

Statistics kept by the advocacy groups KidsandCars.org show July as the deadliest month for pediatric heatstroke. Even in milder weather, the temperatures inside a vehicle can quickly climb to a hazardous level. Studies found that in just 10 minutes a car’s internal temperature rises 19 degrees. To put it another way … 80 degrees outside, but a sweltering 99 degrees for anyone inside the vehicle.

KidsandCars.org keeps track of pediatric vehicular heatstroke in three main categories: A caregiver forgets the child (55% of cases), the child gets into the car on his or her own (26%), and someone leaves the child in the car deliberately (14%). A common thread in many instances is a deviation in the family’s routine on the day of the accident.

That’s what happened to the Stuyvesants on June 10, 2015. Eric Stuyvesant normally dropped off Michael at daycare and then drove his wife Michelle to work. But this particular day, to get Michelle to work earlier, he drove her to the office first with the intention of stopping off at daycare on the way back. But the phone rang, autopilot kicked in, and he forgot about Michael.

“I drove down to my regular exit, drove home, finished my phone call, went in the house and cooked my breakfast,” Stuyvesant said. “About 45 minutes later I remembered we hadn’t been to the babysitter.” He found his son “barely hanging on.”

He rushed Michael into a cold shower, gave him mouth-to-mouth resuscitation and put an ice pack on his carotid artery while waiting on paramedics to arrive. At the hospital, doctors put the boy into a coma to reduce swelling in his brain. Recovery wasn’t easy.

Stuyvesant and others emphasize that heatstroke accidents can happen to anyone. Because of what his family went through, Stuyvesant now makes the case for all new cars to come equipped with the features that the Hot Cars Act endorses.

“If we have technology in our vehicles that remind us that our cell phone is plugged in, our headlights are on, our turn signal has been blinking for awhile, we ought to have technology that remind us we forgot where we are and we need to turn around and go to the babysitter.”

Surgery teams from the two hospitals joined together in Lubbock on Monday to perform two cardiothoracic procedures on pediatric patients. The partnership is part of an initiative to make treatment more convenient for patients and families in Lubbock and surrounding areas.

“Cook Children’s and Covenant Children’s developed a partnership, which allowed Cook Children’s to come to Covenant and perform procedures on a recurring basis,” said David Gray, D.O., chief medical officer of Covenant Children’s.

Vincent Tam, M.D., medical director of cardiothoracic surgery at Cook Children’s, performed both surgeries at Covenant Children’s. He traveled to Lubbock this week, along with seven other members of the Cook Children’s team. With the help of the surgical team from Covenant Children’s, Dr. Tam repaired the hearts of two children, including that of four-year-old Adrian Rosalez. Adrian was born with a vascular ring, a malformation of the aortic arch in the main blood vessel leading from the heart that partly or completely encircle the trachea or esophagus. Thanks to the collaboration between Cook Children’s and Covenant Children’s, Adrian is now recovering at home in Lubbock.

“Heart surgery is not a simple thing, I can’t take my suitcase of instruments, come to West Texas and do surgery," Dr. Tam said at a press conference at Covenant Children’s on Tuesday. "Heart surgery requires a large team of people, it requires a significant collaborative effort.”

Without this partnership, Adrian and his family would have had to travel to Dallas/Fort Worth, or another major medical hub to receive his surgery.

Covenant Children’s and Cook Children’s formed the joint partnership between the two hospitals in 2018. The plan allows Cook Children’s surgery team to perform cardiothoracic procedures on pediatric patients at Covenant Children’s once every quarter.

The highs this week will be above 100, with temperatures expected to reach 105 degrees. As we head into the scorching heat, it’s important to remember that infants and young children rely on adults to keep them cool, hydrated and safe while outside.

Stay Cool

Too much time out in high temperatures can cause heat-related illnesses such as heat exhaustion and heatstroke.

"As the outside temperature rises, your family's risk of heat stroke rises right along with it," said Corwin Warmink, M.D., medical director of Emergency Service at Cook Children’s. “On 100-degree days, it's best to stay inside. If temperatures exceed 90 degrees, stay in the shade and keep a close eye on the kids."

Take these steps during the summer to prevent heatstroke and heat exhaustion:

• Wear appropriate clothing: Choose lightweight, light-colored, loose-fitting clothes. Wear a hat to shield yourself from the sun, until you feel yourself getting warm. Then remove any items covering your head which can trap heat close to the body.
• Schedule outdoor activities carefully: Heatstroke can occur in less than an hour when you are participating in strenuous activity during a hot day. Try to limit outdoor activity to when it’s coolest, like morning and evening hours. Rest often in shady areas so your child’s body has a chance to recover.
• Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Be sure to drink water or a sports drink before, during and after any strenuous activity.
• Ventilate: Stay where there’s plenty of air circulating to keep the body cool. If you are without air conditioning, visit a shopping mall or public library. Remember, electric fans may provide comfort, but when the temperatures reach the 90s, they will probably not prevent heat-related illness. A bath or cool shower is a much better way to stay cool.
• Wear Sunscreen: If you got outside, use sunscreen, wear a wide-brimmed hat, sunglasses and put on sunscreen of SPF 15 or higher 30 minutes before going outside. Continue to reapply according to the package directions.

Don’t Leave Your Child Alone In A Car

Over the weekend, a 6-month-old girl in Ohio and 17-month old boy in Florida died after being left inside vehicles. Twenty-four children have died in hot cars in the United States this year, according to noheastroke.org.

Since 1998, 767 children have died nationally as a result of being left in a car. Texas leads the nation in children dying from pediatric vehicular heatstroke with 16 deaths since 1998.

For the Trauma department at Cook Children’s, statistics are much more than numbers. They represent very real, too often tragic consequences.

“Every time we hear of a child dying in a hot car, it’s heartbreaking for all of us,” said Sharon Evans, Trauma Injury Prevention coordinator at Cook Children’s. “It’s especially devastating because these deaths are preventable."

For More Information On This Topic:

• Tips for Preventing Heat-Related Illness - CDC
• Heat Exhaustion and Heat Stroke
• Child Safety Center
• Vehicle/Car Safety
• Drowning Prevention

But are they ready for the hottest part of the year?

Locally, the National Weather Service has issued a heat advisory that remains in effect until 8 p.m. Saturday. Daily temperatures will range between 94 to 102 degrees, with a heat index between 105 to 109 degrees.

So while you don't want your children to waste their summer vacation away playing video games inside, warm summer temperatures can lead to more than just a sunburn. Being outdoors in the heat for too long can pose a heat-safety risk.

Corwin Warmink, M.D., medical director of the Emergency Department at Cook Children's, says eight kids have been treated in the ED this summer with a chief complain of heat related illness.

"As the outside temperature rises, your family's risk of heat stroke rises right along with it," Dr. Warmink said. "On 100-degree days, it's best to stay inside when it gets that hot. If temperatures exceed 90 degrees, stay in the shade and keep an extra eye on the kids."

Children today are spending increasing amounts of time in air conditioned environments, lured indoors by the constant upkeep of social media accounts and online gaming. One study of nearly 9,000 U.S. children, ages 3 to 5 years old, found that only half were taken outside by their parents on a daily basis to walk or play.

"The more you're out in the heat, the more your body gets used to it, or 'acclimatizes,'" Dr. Warmink said. "Children who are always inside are more prone to heat exhaustion and heatstroke than those who are frequently outdoors and active."

Play it cool

But don't mistake what Dr. Warmink is saying. Too much time out in the heat can cause heat-related illnessess such as heat exhaustion and heatstroke.

Lack of acclimatization has led to an uptick in heat illness among children in recent years, according to Dr. Warmink. Most incidents occur during the first two weeks of school athletics training when kids begin cross country, football, cheerleading or band practice.

"More is being demanded of young athletes during the late summer months," Dr. Warmink said. "Kids who spend all summer indoors and then go out for training in August are setting themselves up for heat illness."

Staying safe

Symptoms of heat exhaustion include flu-like symptoms such as paleness, sweating, nausea and vomiting. Signs of heatstroke include hot, red and dry skin, as well as confusion, vomiting, rapid heart rate, decreased sweating, shortness of breath, decreased urination, increased body temperature (104 to 106 degress Farenheight), or convulsions.

MedStar reminds us that heatstroke and heat exhaustion are common this time of year, but they can be easily prevented:

• Hydrate: Drink plenty of water during the day, especially if you are engaged in any strenuous activity. Sports drinks are a good choice if you're exercising or working in hot conditions, but water is a good way to hydrate as well.
• Ventilate: Stay in a place where there is plenty of air circulating to keep your body cool. If you are indoors and don't have access to air conditioning, open windows and use a fan.
• Cover Up: Wear light-colored and loose-fitting clothing to avoid absorbing the sun's light and trapping heat. Wear a hat to shield yourself from the sun, but once you feel yourself getting warm, remove any items covering your head which can trap heat close to your body.
• Limit Activity: Heatstroke can occur in less than an hour when you are participating in strenuous activity during a hot day. If you feel yourself getting hot or light-headed, stop your activity and rest in a cool place out of the sun. Be sure to drink water or a sports drink before, during, and after any strenuous activity.
• Check on Loved One’s: MedStar reminds families to make sure that your child's grandparents are OK. The elderly are especially vulnerable to heat related emergencies. Many elderly residents are not aware of how hot it may get in their residence. Call on older friends and family members regularly to assure they are doing OK.

About the source

Corwin Warmink, M.D., is the medical director of Emergency Services at Cook Children's. Cook Children's Emergency services are available 24 hours a day, seven days a week. Cook Children's Emergency Department (ED) treats more than 105,000 patients every year. Our ED is the only EMS-designated pediatric trauma center in Tarrant County. 

According to noheatstroke.org, 32 children have died in the U.S. as a result of being left in a car. In all of 2015, 24 kids died. 

On Sept. 21, 2016, a 7-month-old baby died in a hot car in Huntsville, Ala. The temperature was 94 degrees. The following day, a 4-month-old child died in Geronimo, Okla. The temperature at the time was 96 degrees. 

As anyone who lives in a state like Texas can attest, summer-like temperatures can occur even in winter. But it doesn’t take a scorching hot day for a child to be in danger. Heatstroke deaths have been recorded in 11 months of the year in nearly all 50 states.

“It truly doesn’t have to be a ‘hot’ day in Texas for a death to occur,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County coordinator. “The temperature inside a vehicle can quickly climb over 20 degrees hotter than outdoor temperature. So even a cool day in Texas can become dangerous very quickly. Since children’s body heat rises three to five times faster than adults, it’s important to know that temperatures can become deadly any time of year.

Heatstroke, also known as hyperthermia, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

Because of this, and because cars heat up so quickly – 19 degrees in 10 minutes – tragedies can happen faster than you think. Symptoms can quickly progress from flushed, dry skin and vomiting to seizures, organ failure and death.

“We still have to get the word out that there’s never a safe time to leave your child in the car,” said Sharon Evans,Trauma/Injury Prevention coordinator at Cook Children’s, said. “We’ve seen children die in February. We hope people will take extra precaution in never leaving a child in the car.”

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle related deaths for children and that young children are particularly at risk as their bodies heat up three to five times faster than an adults’.

It’s hard to imagine someone forgetting a child is in the car, but human error, and people make these mistakes during their busy day-to-day lifestyle. Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

Last year, 24 kids died in the U.S. and from 1998 to present, 676 children have died.

“What’s heartbreaking is that this is a serious public health issue that is totally preventable,” said Dana Walraven, Community Health Outreach manager at Cook Children’s and Safe Kids Tarrant County Coordinator. “Every mom and dad out there must realize it can happen to you. Texas leads the nation in child heat-related car deaths.”

Parents may mistakenly think they can safely leave a child in a vehicle for a “quick” errand, but that’s simply not true. Temperatures inside the car can be 20 or more degrees hotter than the temperature outside, rising to dangerous levels in minutes. Unfortunately, it only takes a few minutes for tragedy to occur.

Safe Kids Worldwide says that heatstroke is the leading cause of non-crash, vehicle-related deaths for children.

“Heat is much more dangerous to children than it is to adults,” Walraven said. “When left in a hot vehicle, a young child’s core body temperature may increase 3 to 5 times faster than that of an adult. This could cause permanent injury or death.”

Heatstroke, or hyperthermia, occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Safe Kids recommend the “ACT” method to prevent tragedy to your child or to a child you see left in a car:

• A: Avoid heatstroke-related injury and death by never leaving your child alone in a car, not even for a minute. And make sure to keep your car locked when you’re not in it so kids don’t get in on their own.
• C: Create reminders by putting something in the back of your car next to your child such as a briefcase, a purse or a cell phone that is needed at your final destination. This is especially important if you’re not following your normal routine.
• T: Take action. If you see a child alone in a car, call 911. Emergency personnel want you to call. They are trained to respond to these situations. One call could save a life.

It’s difficult to think that as parents, we could “forget” our children, but it happens each year with no exception to socioeconomic or education level. Often times, a change in routine, a distraction along the way, or the event a child falls quietly asleep, unseen, in the back seat, allows for a parent/caregiver to “forget” and leave a child in the car.

Here are some important tips to help prevent unintentional injury to your child:

1. Dial 911 if you see an unattended child in a car. Sometimes, people don’t want to get involved or just assume the parents are on the way out. But as you read earlier, it doesn’t take long for a child to die in a hot car. If you see a child or children alone in a car without an adult, call 911 immediately.
2. Never leave your child alone in a vehicle, even for 1 minute. Windows left slightly open will not affect rising temperatures in the car.
3. Set safe habits: leave a cell phone, purse, briefcase, etc. in the back seat before driving, forcing you to always check the back seat and see a child is/is not back there.
4. Program your cell phone and/or computer to remind you to drop off your child each day.
5. Have a plan with your daycare provider to contact you within a few minutes of being late or absent. Let your daycare know that you want them to call you if you are late or you have not called in saying your child will not be in that day.
6. Teach children not to play in any vehicle.
7. Lock all car doors, even at home.
8. If a child goes missing, always check the cars and trunks.

Learn more by clicking here. Also, visit noheatstroke.org for the latest on heatstroke deaths of children in vehicles.

For more information

Every year children are rushed to the emergency room to be treated for car related injuries, many don't even involve traffic or another car. Some injuries occur without the car ever leaving the driveway. Click here for some of the top dangers to be aware of and the key things you can do to help make your car safer for your kids.

"This case just goes to show that you should never leave a child alone in a car," said Sharon Evans, Trauma/Injury Prevention coordinator at Cook Children’s. “We’ve seen children die in the winter months before. We hope people will take extra precaution and know that there's never a safe way or time to leave a child in the car.”

An autopsy shows the child's cause of death was hyperthermia, or being exposed to heat for a long period of time. According to deputies, the temperature inside the car swelled past 100 degrees.

Hyperthermia, also known as heatstroke, is the leading cause of non-crash, vehicle-related deaths for children. It occurs when the body isn’t able to cool itself quickly enough and the body temperature rises to dangerous levels.

Young children are particularly at risk as their bodies heat up three to five times faster than an adult’s. When a child’s internal temperature gets to 104 degrees, major organs begin to shut down. And when that child’s temperature reaches 107 degrees, the child can die.

"In 2015, 24 children died in hot cars across the country, which is the lowest number since records started being kept in 1998," said Evans. "It doesn't matter what the temperature is outside, if you see a child alone in a car, call 911 or break a window. Do whatever you can to help that child."