The public health consequences of cold and heat temperature extremes are substantial. Although adults can actively seek help, children cannot; they depend on the adults in their lives to get them the assistance they need. If a disaster or emergency occurs during at a time when there are already extreme temperatures, children will be much more severely affected. The first step in supporting children in a disaster is to ensure that their basic needs are met (the most basic of which is physical safety [supervision and shelter] along with safe food and drinking water). Pediatricians can:
Help families plan ahead to address day-to-day or emergencies or disaster situations where children might be affected by extreme temperatures.
Provide anticipatory guidance to families on home disaster preparedness while considering the unique problems of children and youth with special health care needs.
Encourage families to prepare an emergency kit and develop a family emergency plan. See the American Academy of Pediatrics (AAP) Family Readiness Kit.
Advocate for local, state, child care facility, and school-related disaster plans to address children's needs.
Train Emergency Medical Services (EMS) personnel and others to monitor children for signs and symptoms of developing heat illness and when indicated to implement effective heat illness risk-reduction strategies.
Collaborate with Head Start and other early education and child care programs, as well as schools on protocols and plans for when it is appropriate for children to play outdoors. See the AAP Standard on Playing Outdoors and a sample Child Care Weather Watch chart.
Heat and cold stress are environmental hazards. Because of their unique physiology, children are more susceptible to temperature extremes and their health effects. Children are less able to regulate their body temperature compared with adults. As a result, children are more likely to develop significant health effects when they are exposed to environmental temperature extremes. These temperature extremes result from natural or manmade causes. Natural causes include heat waves, unseasonably cold weather, and winter storms. Manmade events can result from inadequate home heating or cooling, extended exposure to temperature extremes without proper gear, and overheated environments, including automobiles.
Because they are less able to regulate their body temperature than adults, children exposed to extreme cold can quickly develop a dangerously low body temperature (i.e., become hypothermic). Newborn infants are prone to hypothermia because of their large body surface area, small amount of subcutaneous fat, and decreased ability to shiver. Children and adults respond to cold extremes by shivering, developing "goose bumps", and experiencing lethargy and a slow heart rate. Eventually the shivering ends, and disorientation and lack of responsiveness occur. Severe hypothermia can also result in arrhythmias, an abnormal beating of the heart.
The following steps can help to prevent cold extremes and their consequences:
Wear proper cold-weather gear.
Avoid severe cold.
Find alternate shelter if the home or residence has lost its heat.
Use safe indoor heating sources. Ensure that all stoves and fireplaces are adequately vented, do not use charcoal indoors, and do not use gasoline or diesel generators indoors or outside near an open window or vent that could bring in fumes. Access Prevent Carbon Monoxide (CO) Poisoning andWinter Weather: Indoor Safety for more tips on safe indoor heating.
Heat extremes can produce several health effects in children, the most common of which is dehydration. Heat extremes can also lead to heat exhaustion, heat cramps, and heat stroke. Children can develop faintness, extreme tiredness, and headache, and even fever and intense thirst. Other signs of heat exhaustion include nausea, vomiting, hyperventilation, and skin numbness or tingling. Children can die when left in a closed car or truck even when the outside temperature is not that high. According to the San Francisco State University Department of Geosciences, when the outside temperature is 80 degrees, the inside of a car will reach nearly 110 degrees (a potentially fatal temperature) in 20 minutes and be greater than 120 degrees in 60 minutes. A child left in a hot car can die of heat stroke very quickly. Encourage parents and caregivers to review the Prevent Child Deaths in Hot Cars HealthyChildren.org Web page for more information. The AAP also has a policy statement for clinicians titled "Climatic Heat Stress and Exercising Children and Adolescents".
Pediatricians can advise parents to take steps to prepare in advance; know what to do to reduce the effects of extreme heat:
Make plans for home cooling or alternate shelters in the event of a heat wave.
Never leave children in unattended vehicles not even for a minute.
Ensure adequate access to water and periods of rest.
When exposed to the consequences of extreme temperatures, children may become fearful, feel hopeless, or develop a range of stress-related symptoms. For example, it may be upsetting for them to see dead birds or other wildlife, if there is a drought or wildfire. Children may worry that they, too, will die. Clinicians can share strategies with adults to promote adjustment and help children cope. Parents can also reassure children that many people are working to resolve the situation. For information on protecting children during natural disasters and guidelines for shelters and other temporary care situations, see floods, hurricanes/tornadoes/storms, and wildfires.