SITUATION: 

This QuickHit was informed by recent Connected Care Live consults regarding dehydration, as well as the opening of more activities for recreation and play this summer for children across the province. 

BACKGROUND: 

Children with medical complexity enjoy diverse recreation activities and are at risk of heat-related illnesses when the temperature and humidity rise in the summer. 

Dehydration is the most common heat-related illness and it can happen quickly or slowly, depending on the child’s age and health condition. 

Those most at risk for heat stress and dehydration include:

• Babies and young children – as they absorb more heat and expend more energy, relative to their body surface area 
• Children with developmental disabilities – as they may not change position nor alert others for help if needed 
• Children who depend on others to administer their fluids- as some may not be able to communicate thirst 
• Children with neurological conditions- as they may not recognize thirst, produce sweat and/or regulate body temperature 
• Children with chronic illnesses- as those with chronic lung, cardiac and/or GI conditions may experience excessive fluid losses 
• Children with acute illness- as fever, sunburns, or gastrointestinal infections may cause or potentiate dehydration 
• Children who exercise heavily- as they may suddenly experience onset of heat stress when not used to the heat or level of activity 
• Children taking select medications- as some may interfere with fluid/electrolyte balance and/or photosensitivity (e.g. antihistamines, diuretics, or medications for mental health conditions) 
• Any child that has had a heat-related illness- as this is a risk for another similar event

ASSESSMENT: 

In starting a shift, preparing for and during an outing with a child with medical complexity, assessing for symptoms of dehydration include being extra vigilant when it’s hot and humid, and looking for: 

Increased thirst

• Elevated heart rate and breathing rate 
• Dry mouth, and dry, cracked lips 
• Low to no urine output or dark yellow urine 
• Low energy levels 
• Fatigue, drowsiness or irritability 
• Headache 
• Chills, cold or dry skin 
• No production of tears when crying 

Severe cases of dehydration include: 

• Sunken eyes, or dark circles under the eyes 
• Sunken fontanelle (soft spot) on a baby’s head 
• Nausea or vomiting 
• Lethargy or coma 

RECOMMENDATION: 

To Prevent Heat Related Illness: 

• Consult with the child’s health care provider and have an individualized plan for managing the child’s risk of heat stress (e.g. how much and types of extra fluids) 
• Carry extra fluids and administer per the care plan, and consider adding salty food, or those that replace electrolytes as tolerated (e.g. bananas, oranges) 
• Avoid the use of ‘sport drinks’ unless they are advised by the child’s health care team 
• Employ heightened monitoring of the child’s ins and outs and compare vitals to their baseline and repeat often 
• Anticipate where and when to take breaks from the heat and use comforting strategies like bathing in cool water, fans or air conditioning 
• Always apply sunscreen for children > 6mos of age, and use sunglasses, hat and light coloured/loose clothing for comfort 

If a child is suspected to be dehydrated, err on the side of caution and take precautions ASAP 
 
If they do not feel better soon after moving from heat, seek immediate medical attention