Letters to the Editor
In Reply
We agree that the current wording, “Children, for example, have a less favorable ratio of body surface area to body mass, which hampers heat dissipation” (1) is misleading, especially when looking at the sentence in the original study by Tsuzuki-Hayakawa et al. (2), which we cited: “They [the children] had a greater body surface area-to-mass ratio than the mothers by 64%, which indicated that they had advantages for thermal regulation.”
As Dr Nocke correctly comments, the ratio of body surface area to body mass does not hamper heat dissipation, but might actually facilitate it. In spite of this, the children in the cited study had—when experimentally exposed to heat—a significantly higher core body temperature than their mothers (2). The study authors assumed/suspected that the greater ratio of body surface area to body mass facilitates heat absorption and that simultaneously the potential for heat dissipation is not fully realized, which may possibly be due to the small body mass or the immature thermoregulation mechanisms in small children (2). We therefore agree with Dr Nocke and thank him for this clarification regarding the complex question of thermoregulation in children.
DOI: 10.3238/arztebl.m2026.0027
On behalf of the authors
Dr. Hedi Katre Kriit
Universitätsklinikum Heidelberg
hedi.kriit@uni-heidelberg.de
Conflict of interest statement
The authors of both letters to the editor declare that no conflict of interest exists.
| 1. | Kriit HK, Herrmann A, Norris R, Rocklöv J, De Allegri M: Heat exposure and the risk of emergency hospitalization in Germany: Stratified analyses by age, sex, and diagnostic group. Dtsch Arztebl Int 2025; 122: 709–14. CrossRef MEDLINE PubMed Central |
| 2. | Tsuzuki-Hayakawa K, Tochihara Y, Ohnaka T: Thermoregulation during heat exposure of young children compared to their mothers. Eur J Appl Physiol Occup Physiol 1995; 72: 12–7. CrossRef MEDLINE |
