Photo Credit: Maryna

As climate change increases in certain pediatric illnesses like asthma, pediatricians have a role in caring for children, especially in vulnerable communities.

As the climate crisis intensifies air pollution, mold, allergens, extreme heat, and flooding, more children worldwide are getting sicker and dying.

“Pediatric clinicians and healthcare systems have an urgent responsibility to advocate for evidence-based solutions to address the climate crisis,” Shalini H. Shah, DO, and Maya I. Ragavan, MD, MPH, MS, wrote in a commentary for Pediatrics. “Globally, flooding is the most common type of extreme weather event (EWE) and >500 million children reside in flood zones worldwide. Climate change increases the frequency and severity of floods, with compounding effects on child health.”

The commentary that accompanied a retrospective cohort study of increased post-EWE asthma among children.

In that study, researchers analyzed data from over one million participants from 0 to 19 years of age after torrential rains, floods, and landslides occurred in 2018. Survival analysis showed that, one year later, victims were more prone than non-victims to receiving inhaler prescriptions (adjusted hazard ratio, 1.30; 95% confidence interval, 1.16-1.46).

“Asthma is the most common chronic disease of childhood, affecting millions of people worldwide and nearly 4.7 million children in the United States,” Dr. Shah and Dr. Ragavan noted.” It is inextricably linked to the climate crisis, defined as human-driven planetary warming because of increased carbon emissions from burning fossil fuels.”

Impact of Climate Change on Children’s Health

Physician’s Weekly (PW) spoke with coauthor Maya I. Ragavan, MD, MPH, about the effects of climate change on children’s health and pediatricians’ role in protecting children from its harms.

PW: How is climate change impacting children’s health globally?

Dr. Ragavan: Climate change has a wide range of devastating impacts on children. Among the many effects of extreme weather events are heat waves triggering heat-related nephropathy, illnesses such as Lyme disease spreading more infectious diseases, worse air pollution increasing asthma, and heavier pollen counts exacerbating allergies. Heat-related illnesses impact all children, particularly young infants, who have poorer thermoregulation, and adolescents, including athletes and military recruits who are active outside.

How can events linked to climate change affect children’s mental health?

Higher rates of depression, anxiety, and post-traumatic stress disorder after disasters are well documented. Exposure to EWEs profoundly affects children’s mental health due to both the trauma and to their anxiety and sadness about their future.

How are children in vulnerable communities at greater risk?

Climate-related illnesses disproportionally affect children in the global south and those who experience structural marginalization due to racism and poverty. For example, studies have shown that formerly redlined neighborhoods in the US have more heat-related morbidities. Studies have also shown that climate change is deeply related to other child health issues, including violence, with associations between heat and intimate partner violence.

How can pediatricians address these new health challenges?

Addressing the climate crisis needs to be multipronged. Pediatricians can guide families on, for example, ensuring adequate rest and hydration during games, as well as on identifying and acting on signs of heat illness. Families also need physical resources such as places to go for shade or to cool down during extreme heat days.

How can all clinicians influence climate-related health policies?

 Policymakers need to prioritize this vital pediatric health issue. In the US, EWEs cause 60% of power outages. Without timely fossil fuel phase-out, an estimated 1 in 12 hospitals worldwide are projected to be at risk for shutdown.

Policy and structural solutions focused on carbon emission reduction and adaptation are needed to ensure that healthcare systems and other vital infrastructures are available during climate-related emergencies. Disaster preparedness plans need to include child and family health and ways to preserve access to needed services. Mental health services need to be part of disaster preparedness to ensure that children have access to behavioral health.