What to do (and avoid) in extreme heat

The Earth has never been so hot. The year 2023 was the globe’s warmest year on record. Millions of people in the mid-Atlantic, Midwest, and South are currently under heat alerts. It’s not just the US: More than 1,300 people died in Saudi Arabia during this year’s Hajj pilgrimage. Over 1,000 temperature records were broken worldwide in June.

Extreme heat is extremely dangerous, and can even be deadly. Heat is the leading weather-related cause of death in the United States. Prolonged exposure to hot temperatures can result in heat exhaustion, heat stroke, heat cramps, sunburn, and heat rash. Infants and young children, adults over the age of 65, people who are overweight, and people who are on certain medications — like amphetamines and antidepressants — are most at risk for heat-related illness. People who work outside and are exposed to the sun and heat also are at greater risk.

Children produce more body heat and sweat less than adults, and tend to not stay as hydrated, making them more sensitive to the heat. “Their skin is also vulnerable,” says Joanna Cohen, a pediatric emergency medicine physician at Johns Hopkins Children’s Center. “They can get sunburned more easily and sunburns actually increase your body temperature and can contribute to overheating and dehydration as well.”

Like children, older adults don’t have as rapid or efficient a thermoregulatory response as other adults, explains Raleigh Todman, an emergency medicine physician at Columbia University Medical Center. The body doesn’t cool down as quickly as the rest of the population, she says.

However, everyone should take precautions to stay cool and hydrated during extreme heat. When humidity exceeds 75 percent, the body’s ability to cool off by sweating is not as effective, Todman says, making heat safety all the more important. Here’s what to keep in mind.

One of the most effective ways to fend off heat-related illness is to stay in an air-conditioned building (even though air conditioning is a contributor to climate change). According to the 2020 Residential Energy Consumption Survey, 88 percent of US households use air conditioning. The survey also found that half of households in the Northeast use individual AC units, like window and wall units, mini-splits, and portable units.

You can lower the temperature in your home by closing your shades to prevent the sunlight from heating up the house and avoiding the use of your stove and oven. Electric fans may feel nice, but will not prevent heat-related illness. If you have individual air-conditioning units, try to contain the cold air to one area by keeping the doors closed to one room.

Other at-home ways of cooling down include avoiding exercise or strenuous activities, taking a cool bath or shower, placing wet cloths or ice on your wrists, neck, and temples, and wearing light-colored, loose-fitting fabrics like cotton and linen — and dressing your children in loose, light clothes as well.

If your home does not have air conditioning or if you still feel hot, find a cooling center — an air-conditioned indoor location where the public can stay safe from the heat — in your area by calling 211 and asking for information about local cooling centers. Some states have lists of cooling centers online. Museums, libraries, movie theaters, cafes, malls, and stores can offer respites from the heat as well. Parents should remember to never leave children and pets unattended in the car. Cohen suggests placing your purse or phone next to your child or pet in the backseat as a double reminder to take them all with you.

Children may want to take advantage of sunny days outdoors with trips to the park, beach, or pool. Outdoor activities can be safe for children so long as there’s shade and water available, Cohen says, like a pool, beach, or backyard or park with sprinklers. “If they’re going to be doing exercise, like playing soccer outside, they should take frequent breaks and go into the shade,” Cohen says. “If they do start to get overheated, get inside in air conditioning, if you can.”

Everyone, regardless of age, should take plenty of rest breaks in the shade and wear sunscreen and a hat if you’re spending time outdoors, though Todman suggests avoiding going outside between noon and 4 pm. “If you need to do something and you have your elderly parents and your baby and you need to go get groceries,” Todman says, “if you can possibly do it in the morning before noon, or in the afternoon after 4, that’s your best bet for avoiding the most direct sun and the hottest part of the day.”

Aside from avoiding the heat in a cool location, staying hydrated is another crucial aspect of hot weather safety because it helps regulate your body temperature. On hot days, you need to increase your water intake, even if you don’t feel thirsty or aren’t physically exerting yourself. Avoid alcoholic or caffeinated beverages, which can contribute to dehydration. Try to consistently sip water all day and encourage kids to always have a water bottle with them, Cohen says. If your kids are resistant to drinking water, Todman suggests giving them sports drinks or drinks with electrolytes, like Pedialyte, coconut water, and Gatorade, and even milk, which will help replenish the electrolytes lost in sweat. You’ll know if you’re properly hydrated if you use the bathroom every two to three hours and your urine is light yellow; if it’s dark yellow or gold, drink more water. One way to determine if children are dehydrated is by gently pinching their skin. If they’re hydrated, the skin should bounce back, Todman says, if they’re dehydrated, the skin will stay pinched.

Ideally, everyone should drink 32 ounces of water a day, Todman says, although “I know it’s not easy to convince elderly people or small children to drink that much water.” People who work outside should drink one cup of water every 15 to 20 minutes (and ensure you’re wearing sunscreen). Cold treats and foods with a high water content, like ice cream and watermelon, can keep you hydrated and cool, Todman says.

Treat your pets the same way you would a baby, Todman says: Don’t leave them outdoors, keep them in the air conditioning, and always keep their water bowl filled.

If you, a family member, or a neighbor start to exhibit signs of heat exhaustion or heat stroke, it’s important to recognize the symptoms and react swiftly.

According to the CDC, symptoms of heat exhaustion include:

Here’s what to do if you or someone else is experiencing heat exhaustion:

According to the CDC, symptoms of heat stroke include:

Here’s what to do if you or someone else is experiencing heat stroke:

The signs of heat exhaustion and heat stroke are the same for both adults and children, Cohen says, but a baby or younger kid may not be able to vocalize how they’re feeling. Ensure children are consistently drinking, urinating frequently, and that they look alert.

Best practices for dealing with extreme heat are to stay hydrated, avoid strenuous or prolonged activities outdoors, keep your environment as cool as possible, and ensure members of the community are doing the same. Keep in touch with elderly neighbors or folks with young children or pets who may not have access to an air-conditioned location.

“This sort of neighborly mindfulness,” Todman says, “is something, if possible, to keep in mind.”

Update, June 24, 4 pm ET: This story was originally published in June 2023 and has been updated with information about 2024’s spate of extreme heat.