Summer brings memories of mangoes and merriment in playing in the sun-baked fields of our state. Summer being the vacation time after annual exams belongs to the very young, but in today’s extreme hot climate, amidst all the fun, there are many hidden dangers too.
The thermoregulatory mechanisms and the immune systems of the tiny one are not fully developed and these make them vulnerable to diseases. Rising temperatures in addition to causing fatigue, tiredness, heat cramps, heat stroke bring raging infections like chickenpox,acute gastroenteritis, acute diarrhoeal diseases, typhoid and jaundice. Parents and caregivers to the young ones should give extra importance to food habits, lifestyle and clothing choices to prevent health complications in summer.
The common problems faced in summer are fatigue and tiredness. Summer is the time when children play in the open for the whole day, under scorching sun without drinking water or resting. Profuse sweating will result in loss of both water and salts, especially sodium, from body. It may lead to fatigue, myalgia, muscle cramps and even loss of consciousness (heat exhaustion). Running back from the playground and drinking bottles of water without salt replacement will result in severe muscle cramps (heat cramps). Swelling of the limbs will occur as the body tries to combat the rise in temperatures by dilating the blood vessels and try to dissipate the heat (heat oedema).
Skin diseases
Summer brings skin diseases due to the prickly heat. This occurs more commonly among children and is because of blockage of sweat glands due to retention of sweat. Prickly heat occurs in arm pits, inner thighs, back of neck and body. Excessive itching and burning sensation are the most common symptoms. Other skin changes are increased pigmentation, occasional burns and defoliation. Prostaglandin and prostacyclin are produced excessively by the skin cells due to ultraviolet radiation of the sunlight, which in turn causes odema, redness, pain, burning sensation and boils. Extensive defoliation of skin will also occur. These changes are seen most prominently in fair skinned children with less melanin pigment. Fungal infections like tinea are also common among children who wear tight uniforms, socks and tie during the summer season.
Sunstroke
The most dreaded complication of the summer is sunstroke. It is an emergency which requires urgent care without which 30-50% of the affected children may die. Body core temperature which is strictly maintained in a narrow range by the thermoregulatory mechanisms of the body is completely deranged and may rise up to dangerous levels due to this. Temperatures above 40? will cause a shutdown of internal organs like brain, liver, kidneys, lungs, leading to coma state. Sudden loss of consciousness seen among children playing in open spaces should raise an alarm and immediate suspicion of sunstroke. Altered behaviour, delirium, confusion and then seizure like condition and finally coma will occur. Child will be wet and cold. There may be burns with blisters on the skin.
Sunstroke is a dire emergency and the treatment should be instituted promptly, in an intensive care setting on a war footing. If not treated optimally, 20%of the affected children will have residual memory loss, neuropathy with resultant weakness and kidney failure.
So to conclude, let the little ones fly high and play as they wish but do have an eye on them and shelter them from the rays of the sun. As the Mahabharata story goes even Sanjana, the wife of Surya, could not handle the power of her husband in summer and so she created her shadow (chayya) to handle his power.The story is powerful and the message is clear: protect our little ones and let them play in the shadows.
(The author is Professor of Medicine, Govt. Medical College, Alappuzha)
