Stating that with the arrival of summer months, applications to physicians increased due to health problems related to temperature increase in children, Yeditepe University Hospitals  Pediatrics Specialist Dr. Fatma Tülin Şimşek warned the families.

Stating that the simplest are heat-related skin lesions called rash among the people, Specialist Dr. Fatma Tülin Şimşek stated that after the rash according to the severity of the heat disease (from mildest to lightest), it can be subdivided into hot edema, hot cramps, heat-related exhaustion, heat-related fainting, and heat stroke (Hyperthermia).

Heat stroke is one of the most severe types of injury due to heat. In some studies, the rate of loss of life is up to 70%. An average of 38 children under the age of 15 die every year in the United States due to being confined in a car (heat stroke without effort). According to TURKSTAT death and cause of death statistics in Türkiye, the highest number of child deaths in the 1-17 age group in 2019 was due to external injuries and poisonings. The percentage of loss of life in children due to being confined in the vehicle has not been fully expressed. Death rates from heat-related illnesses are very high in children younger than 5 years of age and the adult group over 65 years of age with chronic illnesses. The biggest reason for the loss of a child's life due to heat is that babies and children are forgotten in a parked vehicle. Because in a vehicle parked under the sun, the temperature rises at least 6-7 degrees in 10 minutes, and the average body temperature rises to 40-44 degrees in 10 minutes.

Causes of prolonged exposure to high temperatures in the vehicle; 

• The babysitter is absent-minded, preoccupied with another theme,
• As a result of placing the baby car seat facing backward, the child leaves the caregiver's field of vision,
• Since the children who get off with the child falling asleep in the car are not counted individually, the missing one is not noticed (especially in school buses),
• If there is more than one child in the car (especially on school buses), it is necessary to take care of one of them more and think that the other will get off by themselves,
• Failure of the child to unfasten the safety belt as a result of the child being tightly fastened to the car seat with the safety belt,
• Only the parent can unlock the car, the child is trapped inside because of the lock.

If children are forgotten in the vehicle for a long time, the region in the brain called the Hypothalamus, which provides the body's temperature balance (thermoregulation) after the sudden temperature increase in the first 10 minutes, because the cooling capacity is exceeded, it is no longer sufficient to reduce the heat, it cannot function. This is because this heat-regulating center in children is not fully developed compared to adults; it is more vulnerable and inadequate to temperature increase.

Critical maximum thermal heat is the high body temperature and duration of heat exposure that can be tolerated before cell damage occurs. When the critical maximum thermal time and degree are exceeded, heat-related permanent damage occurs, which is more than 45 minutes of exposure to heat above 42 degrees in children. In adults, this time is 45 minutes-8 hours on top of 42 degrees.
 

What are the Physiological Events that Occur on the Road Leading to Death in a Child Locked in a Car In Hot Weather?  

If treatment is delayed or not treated, it may result in multiple organ damage and loss of life,  primarily the neurological system. Apart from the neurological system, organs such as skeletal muscles, liver, kidneys, lungs, and heart may be damaged.

• The body, which is exposed to heat, first tries to cool itself with sweating, and with excessive sweating, it loses electrolytes such as water (liquid), salt, and potassium. Weakness and prostration begin. There are cramp-like pains and cramp-like contractions in the legs and abdominal muscles.
• Stomach cramps, nausea, vomiting. They may also die from aspirating their vomit.
• Edema in the legs and redness in the body occurs in the arms due to the expansion of the veins and the decrease in tension. 
• Although the child feels thirsty due to fluid loss in the first 15 minutes, fluid loss increases more because they are locked in the car and cannot get fluid. Dizziness and hot syncope due to hypotension may occur in the first 30 minutes-1 hour, i.e., fainting.
• Since the kidneys do not bleed enough, the urine output decreases, and the urine color begins to darken. If this period is prolonged, the patient may first return to acute renal failure, and if treatment is delayed and the patient survives, the patient may return to chronic pastry failure with permanent kidney injury.
• As the fluid decreases, the sweating stops. Increased heart rate (tachycardia) due to increased heart rate and increased metabolic rate due to heat in order to bloodify vital organs 
• Neurological symptoms appear to vary in degrees. There may be hot exhaustion, sleepiness, or vice versa as a result of decreased blood circulation and lack of oxygen. A series of events takes place, leading respectively to daydreaming, drowsiness, visual impairment, convulsions, and coma. Permanent neurological damage often occurs in children who are exposed to more than 42 degrees for more than 45 minutes. These are spasticity, ataxia, speech disorder, coordination retardation, and memory problems. Although these symptoms may appear in children who have been exposed to this temperature for a shorter period, there may be a complete recovery in children who have been intervened early.
• Above 42 degrees, various enzymes lose their function, and proteins become denatured.
• Destruction of body muscles can begin and muscle destruction products may cause low calcium. The destruction products we call myoglobin can cause kidney dysfunction.
• The functioning of the liver enzymes called hepatocytes and the auxiliary proteins are disrupted so that liver failure develops.
• Common intravascular coagulation occurs when the vascular endothelium cells are damaged and highly fatal. Poor effect (prognosis); depends on the high temperature and duration of exposure. Loss of 

Early and effective intervention is life-saving and prevents the development of permanent damage.

What to Do in a Child Exposed to a Heat Shock; 

1. It is necessary to cool the body as soon as possible to normal body temperature in order to prevent damage to the brain and vital organs of the child or to reduce the damage as much as possible. Because long-lasting hyperthermia causes permanent damage and loss of life.
2. In order to get emergency professional help, 112 should be called and briefly informed about the age, weight, estimated duration of exposure to heat, pulse, respiration, and consciousness of the child.
3. The cooling process should continue AS QUICKLY AS possible until the paramedics arrive:

• The child should be attracted as quickly as possible to the cool-cold-shade area (there may be air-conditioned shopping malls and an air-conditioned commercial center in the vicinity).
• The clothes on the patient should be removed.
• The arms and legs should be raised to raise the blood pressure by lying on the back.
• If he is conscious and does not have vomiting and nausea, he should be given 1 teaspoon salt in 1 liter of cold water and 1 teaspoon baking soda, if any, to drink in a controlled way.
• If the air conditioner is in the environment, it should be turned on to the coldest setting and the environment should be cooled.
• The child can also be cooled by providing airflow to the wet body with a ventilator.
• The child's body may be rinsed with cold water.
• The body can be wiped with cold clothes. It can be wrapped in a sheet and washed in cold water.
• Ice bags can be placed on the armpits, groin, neck, and back.

4. The number of minutes and which intervention is performed should be explained to the healthcare professionals when the patient is delivered.
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