Hydration and Heat-Related Illness in Children: A Maryland Summer Guide

Pediatric Providers Team
Jun 22
3 min read

Maryland summers are hot and humid. By late June, Baltimore County routinely sees temperatures above 95 degrees Fahrenheit. For children, this combination of heat and humidity creates a real risk of dehydration and heat-related illness.

Children are more vulnerable to heat than adults:

They have a higher body surface area to mass ratio
They produce more heat during physical activity
They sweat less efficiently
They are less likely to recognize the signs of overheating on their own

That is why it is up to caregivers to stay informed and proactive.

The Spectrum of Heat-Related Illness

Heat-related illness exists on a spectrum. Understanding the difference between heat cramps, heat exhaustion, and heatstroke helps you respond correctly.

Heat cramps: Painful muscle cramps or spasms, usually in the legs or abdomen, during or after physical activity. The child is still sweating and alert. Treatment: rest in a cool place, give fluids with electrolytes, and gently stretch the muscles with cramps.
Heat exhaustion: Heavy sweating, cool and pale or flushed skin, weakness, dizziness, headache, nausea, and a fast and weak pulse. Core temperature may be elevated but usually below 104°F (40°C). The child may feel faint. Treatment: move to a cool place, remove excess clothing, apply cool wet cloths, give fluids, and call our office.
Heatstroke: A medical emergency. Core temperature above 104°F (40°C). The skin is hot and may be dry or sweaty. The child may be confused, slurring words, having seizures, or losing consciousness. This requires immediate attention, call 911 follow the same steps for heat exhaustion while waiting for help.

How Much Should Children Drink?

Hydration needs are much higher in hot weather and during physical activity. Here are some general age-specific guidelines from the American Academy of Pediatrics:

Ages 1 to 3: About 4 cups (32 oz) of water per day from all sources.
Ages 4 to 8: About 5 cups (40 oz) per day.
Ages 9 to 13: About 7 to 8 cups (56 to 64 oz) per day.
Ages 14 and older: 8 to 11 cups per day for girls and 11 to 14 cups per day for boys.

On hot days or during active play, these amounts should increase. Encourage children to drink before they feel thirsty — thirst is a late sign of dehydration. During outdoor sports or intense activity, children should drink about 5 to 9 ounces of fluid every 20 minutes.

Best Fluids for Children in the Heat

Water: The best choice for everyday hydration and for activities lasting less than one hour.
Oral electrolyte solutions: Recommended for younger children or when significant sweating has occurred. These replace both fluids and electrolytes lost through sweat. Low sugar options are available.
Sports drinks (like Gatorade): Acceptable for older children and teens during vigorous activity lasting longer than one hour. Watch for high sugar content.
Avoid: Soda, juice, and caffeinated drinks. These do not hydrate effectively and can worsen dehydration.

Signs of Dehydration in Children

Catch dehydration early. Signs to watch for include:

Fewer wet diapers or trips to the bathroom than usual
Dark yellow or strong-smelling urine
Dry mouth, lips, or tongue
Sunken eyes or, in infants, a sunken fontanelle (soft spot)
No tears when crying
Lethargy, irritability, or unusual sleepiness

In infants and toddlers, these signs can escalate quickly. Contact our office or go to urgent care if you are concerned.

Preventing Heat-Related Illness

Timing matters: Avoid outdoor activity from 11 a.m. to 3 p.m. when temperatures and UV levels are highest. Plan outdoor play for early morning or evening.
Dress for the heat: Lightweight, light-colored, loose-fitting clothing. Wide-brimmed hats for sun protection.
Take shade breaks: Make shade a regular part of outdoor play. Even 10 minutes in a cool, shaded area helps.
Cool down actively: Sprinklers, cool baths, and air conditioning are all effective. A cool, wet towel on the neck and wrists works quickly.
Never leave a child in a parked car: The temperature inside a vehicle can increase by 20 degrees in just 10 minutes, even on a mild day. This is a leading cause of heat-related death in young children.
Know your child's risk factors: Children with chronic illness, those taking certain medications, and infants are at higher risk. Talk to our team if you have concerns.

Maryland Heat Resources

During heat emergencies, Baltimore County opens cooling centers across the county. Check the Baltimore County Government website or call 311 to locate the nearest cooling center. The Maryland Department of Health also issues heat alerts through the emergency notification system — make sure your family is signed up.

If your child shows signs of heat exhaustion or heatstroke, do not wait to see if they improve. Call us or head to the nearest emergency room. When in doubt, err on the side of caution.