Every summer, when the heat index in Northern Virginia climbs into the triple digits, we see a predictable shift in what walks through our doors. Heat-related illness is not dramatic the way a broken bone is. It creeps up quietly. And by the time most families come in, they have already been dealing with symptoms for hours.

This is what we actually see during heat waves — and more importantly, what you can do to avoid becoming one of those visits.

Dehydration

This is by far the most common thing we treat during heat waves. And almost every family that comes in says the same thing: they thought their child was drinking enough.

Here is the problem. Thirst is one of the last signs of dehydration. By the time a child asks for water, their body has already been running low for a while. And in summer heat, especially during outdoor sports or play, kids lose fluids faster than they are replacing them without even realizing it.

What we see in the clinic: children who are tired beyond what the day explains, have a headache that will not go away, are unusually irritable, have not urinated in several hours, or have dry lips and sunken eyes. In more significant cases we see rapid heart rate and dizziness that gets worse when standing.

What we do: for mild dehydration we guide families through oral rehydration. For moderate cases, we offer IV hydration therapy on site, which replenishes fluids and electrolytes directly and gets kids feeling better significantly faster than drinking alone.

How to avoid it: hydrate before you go outside, not when your child is already thirsty. Offer fluids every 20 minutes during outdoor activity. Water is best. Avoid juice, sports drinks with high sugar content, and energy drinks entirely for children.

Heat Exhaustion

Heat exhaustion is what happens when dehydration and heat exposure combine and the body starts to struggle with temperature regulation. It is a step beyond simple dehydration and a step before heat stroke, which is the emergency.

What we see in the clinic: children who look pale and feel clammy, are sweating heavily, feel weak or nauseated, have a headache, and sometimes feel faint or dizzy. Parents often describe a child who came inside from playing and just collapsed on the couch and could not get up.

What we do: we assess vital signs, check for signs of heat stroke, support cooling, and rehydrate. Most cases of heat exhaustion resolve well with prompt care. The ones that do not get better quickly are the ones we monitor more carefully for progression to heat stroke.

How to avoid it: shade breaks matter more than most parents realize. Even if a child seems fine, bring them indoors or into shade every 30 to 45 minutes during intense outdoor activity in heat. Dress kids in light, loose, breathable fabrics. Limit vigorous outdoor activity to early morning or after 5pm when the heat index has dropped.

Heat Stroke

Heat stroke is a medical emergency and the one condition on this list where we will always tell you to call 911 first. We include it here because families need to recognize it before it gets to that point.

What distinguishes heat stroke from heat exhaustion is that the body has lost the ability to cool itself. The child stops sweating despite being overheated. The skin becomes hot, red, and dry. They may become confused, disoriented, or difficult to rouse. Temperature is very high.

If you see these signs, do not drive to urgent care. Call 911. Apply cool wet cloths to the neck, armpits, and groin while you wait for emergency services. Do not give fluids to a child who is confused or unresponsive.

How to avoid it: never leave a child in a parked car under any circumstances. Recognize heat exhaustion early and treat it promptly before it progresses. Know that children, elderly people, and those with certain medical conditions are at the highest risk.

Sunburn and Sun Poisoning

Minor sunburn is something families handle at home. What comes to urgent care is the kind of sunburn that crosses into sun poisoning, and the difference is more significant than most people realize.

What we see in the clinic: children with significant blistering, chills, fever, nausea, headache, and dizziness alongside the burn. Sun poisoning is the body’s systemic inflammatory response to severe UV exposure and it needs medical evaluation.

What we do: we assess the extent of the burn, manage dehydration which almost always accompanies sun poisoning, treat pain, and guide wound care for significant blistering.

How to avoid it: apply SPF 30 or higher mineral-based sunscreen 20 minutes before going outside and reapply every two hours and immediately after swimming or sweating. Do not rely on a single morning application for an all-day outdoor event. Reapplication is where most families fall short.

Swimmer’s Ear

Pool season and heat waves overlap, which means swimmer’s ear spikes every time temperatures climb and kids spend more time in the water.

What we see in the clinic: children with ear pain that is worse when you pull on the outer ear, sometimes with discharge, and often with a history of multiple days in the pool or lake. Swimmer’s ear is an infection of the outer ear canal caused by water that stays trapped and creates a warm moist environment for bacterial growth.

What we do: we diagnose it on site and prescribe antibiotic ear drops. Most cases resolve well with prompt treatment. The ones that wait too long are the ones that become significantly more painful and take longer to heal.

How to avoid it: tip each ear down and gently pull the earlobe after swimming to help water drain. Dry ears gently with a towel but do not insert cotton swabs into the ear canal. Swim plugs can help for children who are in the pool daily.

Heat Rash

Heat rash is not dangerous but it is extremely common during heat waves and we see it constantly this time of year.

What it looks like: small red or pink bumps, usually in areas where skin touches skin or where clothing sits tight. Common spots include the neck, chest, groin, and under the arms. It appears when sweat glands become blocked and sweat cannot escape properly.

What we do: for most cases we confirm the diagnosis, rule out other causes, and guide families on management at home. For cases where heat rash has become infected or is not improving, we treat accordingly.

How to avoid it: dress children in loose lightweight breathable fabrics. Keep them cool. Rinse off sweat after outdoor activity and pat skin dry. Avoid heavy creams or ointments that block the skin during hot weather.

When to Come In vs When to Manage at Home

Come in to Night Watch if your child:

👉 Cannot keep fluids down and shows signs of dehydration

👉 Has a headache, dizziness, or weakness after being in the heat

👉 Has a sunburn with blistering, fever, chills, or nausea

👉 Has ear pain after pool time

👉 Has a rash that is spreading, painful, or not improving

Call 911 if your child:

👉 Stops sweating despite being overheated

👉 Has skin that is hot, red, and dry

👉 Is confused, disoriented, or difficult to wake

👉 Has a very high body temperature

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We Are Here When Heat Waves Hit

Night Watch Urgent Care is open late every weekday and every weekend across all three Northern Virginia locations. During heat waves we see a significant increase in visits and we are prepared for it.

Walk in anytime. No appointment needed.