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Heat stroke in children

Paul Ishimine, MD
Section Editor
Daniel F Danzl, MD
Deputy Editor
James F Wiley, II, MD, MPH


The manifestations, evaluation, and management of heat stroke in children will be reviewed here. Other forms of heat illness in children and hyperthermia in the adult patient are discussed separately. (See "Heat illness (other than heat stroke) in children" and "Severe nonexertional hyperthermia (classic heat stroke) in adults" and "Malignant hyperthermia: Clinical diagnosis and management of acute crisis".)


Hyperthermia is defined as elevation of core body temperature above the normal diurnal range of 36 to 37.5°C (96.8 to 99.5°F) due to failure of thermoregulation. Hyperthermia is not synonymous with the more common sign of fever, which is induced by cytokine activation during inflammation and regulated at the level of the hypothalamus. Heat-related illnesses range from minor syndromes to life-threatening processes. While there are many manifestations of heat-related illnesses, all heat-related illnesses result from excessive heat stress caused by an increased environmental heat burden, an inability of the body to dissipate endogenous heat, or a combination of these two factors. Heat stroke is the most severe heat-related illness and can rapidly lead to death without prompt treatment.


Heat stroke is defined as a core temperature ≥40 to 41°C (104 to 105.8°F) accompanied by central nervous system dysfunction in patients with environmental heat exposure [1]. While anhidrosis (lack of sweating) is frequently present, especially with classic heat stroke, this is not an absolute diagnostic criterion [1,2]. This condition represents a failure of the body's ability to maintain thermoregulatory homeostasis. Heat stroke is further classified as follows:

Classic (nonexertional) heat stroke – Classic heat stroke arises from environmental exposure to heat and is more common in younger children who are unable to escape from hot environments and those with underlying chronic medical conditions that impair thermoregulation (table 1).

Exertional heat stroke – Exertional heat stroke generally occurs in young, otherwise healthy individuals who engage in heavy exercise during periods of high ambient temperature and humidity. Typical patients are athletes and military recruits in basic training [3,4].


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Literature review current through: Jul 2017. | This topic last updated: Oct 26, 2016.
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