The public health consequences of cold and heat 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 occurs during 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:
- Provide anticipatory guidance to families on home disaster preparedness while considering the unique problems of children with special health care needs.
- Encourage families to prepare an emergency kit and develop a family emergency plan. See Family Readiness Kit. (Spanish version)
Advocate for local, state, child care facility, and school-related disaster plans to address children’s needs. - With all audiences, discuss emergency or disaster situations where children might be affected by extreme temperatures.
- 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.
Extreme Temperatures
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 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 indoor environments, such as automobiles.
Extreme Cold
Because they are
less able to regulate their body temperature than adults, children can
quickly develop a dangerously low body temperature (ie, 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.
- Carefully select timed periods of cold exposure.
- 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 and Winter Weather: Indoor Safety for more tips on safe indoor heating.
Resources
Extreme Heat
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 there may be fever and intense thirst. Other signs 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.
Take the following steps to prevent heat extremes and their consequences:
- Make plans for home cooling or alternate shelters in the event of a heat wave.
- Never leave children in unattended vehicles.
- Ensure adequate access to water and periods of rest.
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. They may worry that they, too, will die. Adults should promote adjustment and help children cope. They 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.
Resources
For more information about the AAP Disaster Preparedness Initiatives, please e-mail DisasterReady@aap.org.