Protecting kids from heatstroke and heat exhaustion

Children's Health

by Kayla Cehand, BSN, RN, CPN, CPST

Jul 1, 2016

If ever you’ve forgotten your cell phone, you may forget your child in the back seat.

Our minds are powerful. We can prioritize things of importance, multitask remarkably well and process thousands of daily tasks. But for some, a simple act of forgetting can turn deadly. An otherwise normal day can turn tragic, and the story is all too common.

Every heart-wrenching account differs a little, but there is always the terrible moment when a parent realizes what has happened, often through a phone call from a spouse or caregiver. This realization is followed by a frantic sprint to the car. What awaits is the worst thing in the world.

Otherwise wonderful parents find their child dead in the car, unresponsive due to heat stroke. Far too many children have been inadvertently left in vehicles or have gotten into a vehicle on their own.

Already in 2016, there have been 35 child vehicular heat stroke fatalities. This total fluctuates every year, but there are still far too many preventable deaths. Of these tragedies, 54 percent state the child was “forgotten by caregiver,” while 28 percent cited the child was playing in an unattended vehicle and 17 percent state the child was intentionally left in vehicle by an adult.

As an Injury Prevention Coordinator and part of Safe Kids Mid-Texas Coalition I help promote community education and injury prevention. Coming together to help promote awareness of heat stroke is the only thing that will decrease our rates of heatstroke related death. According to SafeKids Worldwide, more than 660 children across the United States have died from heat stroke while unattended in cars since 1998.

Increasing Awareness of How Tragedies Occur

How does this happen? A common first inclination is to assume negligent parenting, however, there is rarely previous reports of neglect or abuse. The cases seem to come out of nowhere. It can happen to a construction worker just as much as a lawyer, a mom just as much as a dad.

Many people may scoff and say, “How could you possibility forget your child?” This approach draws a line in the sand and paints these parents as monsters, completely different from ourselves. The truth is, we must all take precautions because it could happen to anyone.

In fact, if you’re capable of forgetting your cell phone, you may be capable of forgetting your child in the back seat of your car. Child advocacy group explains that our brains perform repetitive tasks automatically. This is why you may forget to stop for groceries on your way home from work. Your usual habits are competing with your memory. Our conscious mind prioritizes things by importance, but our memory does not.

This is a common thread through everyone’s story. Something out of the ordinary happened that was otherwise different from their normal routine. I have seen stories from parents forgetting to drop their children off at daycare or being left in the car while running into the store, to stories where children use the car as a place for hide-n-seek.

Unintentional childhood injury is the leading cause of death in children. With that being said, we must all remember that the key word is unintentional. There are injuries related to neglect, and there are injuries related to normal development of children and a tragic incident.

Increasing Awareness of Why it Turns Fatal

“Temperature elevation causes an increase in oxygen consumption and metabolic rate,” said Beth Kassanoff, MD, an internal medicine physician on the medical staff at Baylor University Medical Center at Dallas.

“Plus the body’s mechanisms for relieving excess heat are not effective when the environmental temperature exceeds the skin temperature (as would happen quickly in a hot car). Children in particular are at increased risk due to their higher metabolic rates at baseline, their higher body surface area to mass ratio, and their decreased sweat production.”

This can happen within minutes. Dr. Kassanoff explained when a child is left in a hot vehicle, the liver, blood vessels, and brain tissue are exquisitely sensitive to the effects of high temperature. This causes multi-organ system failure and death. Safe Kids performed a test in 2010 and it only took five minutes for the temperature inside the car to climb 30 degrees.

These incidents are laden with guilt, self-blame and unexplainable grief. Many parents have bravely opened up to share their stories, to educate and help prevent future fatalities. These stories tell of parents holding their child in their arms one last time, vowing to be an advocate so it won’t happen to another child.

Possible Risk Factors

Although it is difficult to ever see why this may happen, possible explanations include:

  • A change in normal routine
  • Added stress or distraction
  • Rear facing car seats can make it difficult to see if your child is in there
  • A child falls asleep or is quiet in the back seat
  • Lack of communication between caregivers
  • Misremembering, operating on auto-pilot
  • A mix-up with responsibilities, or who should be watching or driving the child
  • Moving the car seat within the vehicle or between vehicles

Possible Means of Prevention

Parents and caregivers must come together to discuss means of prevention, especially in Texas. Our state leads the country in heat stroke deaths of children in vehicles, whether they are unintentionally left there or found later in a parked car.

Unintentionally left in a car

  • Never leave a child alone in a car, not even for a few minutes.
  • Cut down on multitasking, specifically when driving.
  • Make sure you are getting adequate rest and managing your stress.
  • Communicate childcare responsibilities clearly between spouses and caregivers.
  • Work out a call system with your childcare provider or family to assure that you have made it safely after dropping the children off at school or daycare.
  • Put your cellphone, briefcase or employee badge by the car seat so you have to open the back door.
  • Have a stuffed animal in the passenger seat of your car as a visual reminder to remove the child from the back when getting out of the car.
  • Purchase a car seat mirror to see the child facing in the rear.
  • Create reminders on your cell phone.
  • When getting out of your car, leave a door open until you have removed your children from the vehicle; this will help to assure you or your children do not accidentally lock yourself out of the car.
  • Hospitals have implemented a “Backseat Buddy” program to help educate new parents about the dangers of hot cars, using a teddy bear key chain as a visual reminder of the child in the car’s back seat.
  • Be aware of new vehicle features like GM’s rear seat reminder technology.
  • 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.

Accessing a parked car

  • Lock all doors when the car is not in use to avoid a child getting into the parked car.
  • Remove all toys, pictures, shoes from the car before going inside to avoid a child returning for these items later.
  • Install high latches or bells on doors so you are aware if young children are leaving the house.
  • Keep keys and remote entry keys out of children’s reach.
  • Lock all vehicles at all times.
  • Check cars and trunks first if a child goes missing.
  • Talk and educate your young children about the dangers of parked cars and trunks.

About the Author

Kayla Cehand, BSN, RN, CPN, CPST, is a trauma and injury prevention coordinator at Baylor Scott & White McLane Children's Medical Center – Temple. Cehand studied at Temple College and University of Texas at Arlington, and she strives to make an impact on decreasing preventable injuries and death in children.

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