Effects of thermal stress during rest and exercise in the paediatric population

Thermoregulation during exposure to hot or cold environments differs between children and adults. Many physical and physiological changes occur during growth and maturation that can affect thermoregulation during rest as well as during exercise. Thus, physical as well as physiological differences between children and adults may explain the different response to thermal stress. The main physical difference between children and adults affecting thermoregulation is the much higher surface-area-to-mass ratio of children. In a warm environment this allows them to rely more on dry heat loss and less on evaporative cooling. However, in extreme conditions, hot or cold, the greater surface-area-to-mass ratio results in a higher rate of heat absorption or heat loss, respectively. The lower body fat in girls compared with women provides lower insulation and presents a disadvantage in a cold environment. The smaller blood volume in children compared with adults, even relative to body size, may limit the potential for heat transfer during heat exposure and may compromise exercise performance in the heat. The main physiological difference between children and adults is in the sweating mechanism, affecting their thermoregulation in the heat, but not in the cold. The lower sweating rate characteristic of children is due to a lower sweating rate per gland and not to a lower number of sweat glands. In fact, children are characterised by a higher density of heat-activated sweat glands. The lower sweating rate per gland may be explained by the smaller sweat gland size, a lower sensitivity of the sweating mechanism to thermal stimuli and, possibly, a lower sweat gland metabolic capacity. Other physiological differences between children and adults that may affect thermoregulation include metabolic, circulatory and hormonal disparities. The higher metabolic cost of locomotion in children provides an added strain on the thermoregulatory system during exercise in the heat. On the other hand, during acute exposure to cold it may prove advantageous by increasing heat production. Circulatory differences, such as a lower cardiac output at any given exercise intensity and the lower haemoglobin concentration in boys compared with men, are likely to increase the cardiovascular strain during exercise in the heat, although their effects in a cold environment are unknown. Finally, testosterone and prolactin are 2 hormones that differ in baseline levels between children and adults and may affect sweat gland function and sweat composition. These possible effects need to be further investigated. The effectiveness of thermoregulation is reflected by the stability of core temperature. In a thermoneutral environment, children are characterised by a similar rectal temperature and a higher skin temperature when compared with adults. The latter may reflect the higher reliance on dry heat loss compared with evaporative cooling in children. In a hot environment, children's body temperatures are higher compared with adults while walking and running but not necessarily while cycling. This may be related to the higher metabolic cost, and therefore higher heat production, in children while walking or running but not while cycling. In a cold environment, children are characterised by lower skin temperatures, reflecting greater vasoconstriction. Their metabolic heat is increased in the cold to a greater extent than that of adults, although this appears to be sufficient to maintain their body temperature during exercise but not during prolonged rest. Neither children nor adults sufficiently replace fluid loss during exercise in the heat. Nevertheless, recent studies suggest that in children, when the available beverage is flavoured and enriched with NaCl and carbohydrates, dehydration can be prevented. (ABSTRACT TRUNCATED)