Climate Change arid Children's Health and Well-Being in the United States

For more details, please see
the report, appendices, and
data linked below.

svEPA

Summary for Clinicians

Climate change is already affecting the health and well-being of
Americans. Children are uniquely vulnerable in part because of
the natural physiology of growing bodies. Children - particularly
those in the earliest lifestages - also have less control over their
environment, less knowledge about health effects from climate
change, and are less able to remove themselves from harm.

Climate impacts can have lifelong consequences stemming from
effects on cognition, physical development, chronic disease, or
other complications.

This factsheet summarizes findings from EPA's report Climate Change and Children's Health and
Weil-Being in the United States which quantifies future health risks to children for a sub-set of key
impacts, in addition to reviewing a broader set of pathways in which children are affected by climate
stressors. The analyses presented in this report are part of the EPA's Climate Change Impacts and
Risk Analysis (CIRA) project, a framework for quantifying and monetizing the impacts of climate
change in the U.S. Some of the findings from the report most relevant to clinicians are summarized in
the pages that follow by climate stressor. The pages also identify the ways clinicians can reduce risks
to children.

April 2023	EPA 430-R-23-001


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Climate Change arid Children's Health and Well-Being in the United States

f| Extreme Heat

lOI Extreme heat, including sustained high temperatures and heat waves, can have a
variety of effects on children's physical and psychosocial health and cognitive
capabilities. Effects may include hyperthermia, dehydration, and death, as well as premature birth or
low birth weight, clinical psychological impacts, and an inability to concentrate.

WHAT EMERGING ISSUES
SHOULD CLINICIANS BE
AWARE OF?

The number of emergency
department visits among
children is expected to increase
between May and September
each year as summer
temperatures continue to rise,
up to tens of thousands of
additional visits annually.

HOW CAN CLINICIANS HELP REDUCE RISKS TO CHILDREN?

•	Talk with patients and their caregivers about limiting time
outdoors in hot weather.

•	Educate them on proper hydration in all temperatures, how to
recognize the early warning signs of dehydration and
overheating, and the risks associated with excessive exposure
to high heat. Emphasize that dehydration can occur easily even
in what seem like lower temperatures.

•	Empower patients to know how to advocate for safe practices
in outdoor activities, and destigmatize safety, especially in
sports.

April 2023	EPA 430-R-23-001

WHAT DID THIS
REPORT FIND?

Heat experienced
during the school year
affects learning in
children. This report
projects a reduction in
annual academic
achievement per child
of 4% under a moderate
level of warming (2°C).

These losses can affect

f U t U fG income with David L. Ryan / The Boston Globe via Getty Images

potential losses across cohorts of graduating students
reaching billions of dollars annually, even under more
moderate warming scenarios. Installing air conditioning
(A/C) in schools is generally less costly, although this
action only partially mitigates these effects. Black,
Hispanic or Latino, and low-income students report the
lowest rates of current A/C in schools, and therefore are
likely to experience these impacts disproportionately.


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Climate Change arid Children's Health and Well-Being in the United States

Air Quality

Most health effects associated with poor air quality stem from climate-induced
changes in weather conditions that impact concentrations of particulate matter (PM)
and ozone, including wildfires and ground-level dust in the arid Southwest. Exposure to poor air
quality can result in the development and exacerbation of asthma, poor cognition, and other
pulmonary health outcomes, including upper respiratory tract infections, cancers, and chronic
obstructive pulmonary disease (COPD) in adulthood. Preterm birth, low birth weight, and birth
defects are associated with in utero exposures.

WHAT EMERGING ISSUES SHOULD
CLINICIANS BE AWARE OF?

WHAT DID THIS REPORT FIND?

Rates of pediatric pulmonary conditions have been
steadily increasing over the past decades, in part due to
changes in air quality and more children being exposed
to higher levels of air pollutants. New asthma diagnoses
across the U.S. are projected to increase 4% due to
climate change-induced effects on air quality at 2°C of
global warming. This rate rises to 11% under a higher
level of warming. Low-income and Black, Indigenous,
people of color (BIPOC) children are more likely to
experience new asthma diagnoses associated with
climate-related exposure to PM2.5.

Emergency department (ED) visits and
hospital admissions from respiratory
conditions also are expected to
increase because of these effects, as
are school days lost. Further, the
analysis projects an increase in
premature deaths among newborns
due to poor air quality impacts on
maternal health.

Wildfire smoke is comprised of
numerous other air pollutants that
pose significant human health impacts,
including adverse birth outcomes. New
research documents the association
between wildfire smoke exposure and
risk of preterm birth, suggesting a
dramatic potential increase in these
outcomes as wildfire activity continues
to increase.

HOW CAN CLINICIANS HELP REDUCE RISKS TO CHILDREN?

•	Advise patients and their caregivers to avoid being outside on days with the
poorest air quality. Patients can check the Air Quality Index forecast for their
area.

•	Advise patients to reduce exposure to wildfire smoke and ambient dust by
closing windows and vents in homes and vehicles. Encourage patients to
consider purchasing a high-efficiency furnace or HVAC filter arid/or a portable
air cleaner to use during smoke emergencies.

•	Learn more on patient health related to ozone, particle pollution, and wildfire
smoke, and safeguarding indoor air qua lit during wildfires.

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Climate Change arid Children's Health and Well-Being in the United States

Changing Seasons

Increasing temperatures and changing rainfall patterns are extending the growing
season, resulting in longer and more intense pollen and allergy seasons. Seasonal
allergic rhinitis is a major contributor in the U.S. to the development of poor pulmonary health
outcomes, including asthma.

WHAT DID THIS REPORT FIND?

Due to climate-driven increases in some aeroallergens,
rates of annual asthma-related ED visits are projected to
increase by 17- 30%, under more moderate to higher
levels of warming, 2°C to 4°C, respectively. Less severe
outcomes, like visits to healthcare facilities for allergic
rhinitis and prescriptions filled for allergy medications for
children, may increase by the tens to hundreds of
thousands annually at higher levels of warming (4°C or
greater). Limited English-speaking or BIPOC children, and
children without health insurance are more likely to
experience these impacts stemming from oak pollen
exposure specifically.

WHAT EMERGING ISSUES
SHOULD CLINICIANS BE AWARE

OF?

Overall, new evidence suggests that
lengthening warm seasons are
expected to result in more time
spent on outdoor recreation,
especially boating and water sports.
On the other hand,
the number of
trips associated
with some
recreation
types, like
winter

recreation and
cold-water
fishing, are
projected to decrease under climate
change. These changes are likely to
have both positive and negative
effects, in terms of physical health,
mental well-being, and injury risks.

HOW CAN CLINICIANS HELP REDUCE RISKS TO CHILDREN?

•	Talk with patients and caregivers about risk factors associated with
developing worse health outcomes following aeroallergen exposure.

•	Identify patients with comorbidities that may make them particularly
at risk of health effects. Counsel them on relevant treatment
regimens, including personally appropriate drug protocols,
maintaining awareness of their area's air quality status, and limiting
time outdoors on days with poor air quality, including high pollen
concentrations (check their local Air Quality Index forecast).

April 2023

EPA 430-R-23-001


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Climate Change arid Children's Health and Well-Being in the United States

Flooding

Coastal and inland flooding can result in exposures to waterborne diseases, housing
uncertainty, and psychological trauma. The frequency of flooding events due to
storm surge and sea level rise will continue to worsen as the climate changes, affecting homes of
children living in coastal zones.



WHAT DID THiS REPORT FiND?

If no additional adaptation actions are taken, more than
1 million children are estimated to experience
temporary home displacement or complete home loss
from coastal flooding, at even moderate levels of global
mean sea level rise. Under greater levels of sea level
rise, the report anticipates that more than 2 million
children will be affected due to increases in coastal
flooding. Children in overburdened households will
experience these impacts disproportionately. Well-
timed adaptation measures, including building sea
walls, could avoid or delay many of these impacts, but
are themselves costly to implement and maintain.

WHAT EMERGING ISSUES
SHOULD CLINICIANS BE AWARE
OF?

Inland flooding, also known as
riverine flooding, could increase in
the future due to climate change,
leading to home damage and loss.

HOW CAN CLINICIANS HELP REDUCE RISKS TO CHILDREN?

•	Encourage families who have experienced home damage or loss to
seek psychological treatment for children.

•	Work with patients and their caregivers to identify evacuation
routes and strategies, including support networks outside of their
town or city, to employ at times of flooding and severe weather.

•	Children and pregnant people should not take part in flood work
clean up. Encourage families to safely clean up flooded homes, be
aware of the risks of mold, and find information on mold cleanup.

April 2023

EPA 430-R-23-001


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Climate Change arid Children's Health and Well-Being in the United States

Infectious Diseases

The range of vector-borne diseases from mosquitoes and ticks, and the duration of
favorable weather conditions for the vectors, are expected to increase in a changing
climate, Lyme disease is one of the most common and best-known vector-borne diseases in the U.S.
If left untreated, or if treatment is delayed, pediatric patients may develop a gamut of severe
sequelae, including juvenile arthritis and Lyme carditis.

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WHAT DID THIS REPORT FIND?

This report projects a
significant increase in
new cases of Lyme
disease (Lyme
borreliosis) among
children in the
Eastern U.S. even at
lower levels of global
warming (2°C), with
an expected 31%
increase in cases. At
higher levels of global

warming (4°C), the overall number of new cases
increase 272% above baseline levels. States in the
northernmost areas of the Northeast and Midwest
regions are expected to see most of new cases among
children. Some research demonstrates that Lyme
disease may be underdiagnosed, misdiagnosed, and
undertreated among some overburdened populations,
particularly BIPOC children, increasing the likelihood of
more severe outcomes in these communities.

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L

WHAT EMERGING ISSUES
SHOULD CLINICIANS BE AWARE

OF?

West Nile Virus (WNV), an arbovirus,
is also likely to see a rise in new cases
as temperatures increase, including
among children. While existing
evidence suggests the estimated
increase in new cases of West Nile
Neuroinvasive Disease, a severe
outcome associated with WNV, is
anticipated to be small in magnitude,
changes in case counts could be
indicative of greater rates of other
types of mosquito-borne illnesses.

HOW CAN CLINICIANS HELP REDUCE RISKS TO CHILDREN?

•	Educate patients and caregivers about appropriate measures for
avoiding exposures to ticks and mosquitos, including wearing
long-sleeves and long pants, or proper application of insect
repellants.

•	Teach them about how to identify early symptoms of illness,
including erythema migrans rash and other characteristics.

•	Remain current on tick bite treatment protocols and localized
disease rates.

April 2023

EPA 430-R-23-001


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