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Climate change puts children in jeopardy.

WHEN PEDIATRICIAN AARON Bernstein, MD, sees young patients with Lyme disease at Children’s Hospital Boston, in Massachusetts, his advice to parents often goes beyond the obvious of protecting their children against infectious ticks with insect repellant, long pants, and long sleeves on trips to the woods. “I explain to them that really, Lyme disease is a disease of ecology,” says Bernstein. “We tend to think that we get infectious diseases from other people, but it turns out that the majority of infectious diseases are diseases that we share with other species.” And many of those species today are on the move. They are propelled not only by natural migratory patterns but also by human pursuits that drive climate change, especially the burning of fossil fuels, which can push birds, insects, and other disease vectors into new habitats. Experts several years ago sounded the alarm on climate change’s potential harm to human health in the years to come. But the impact on a particularly vulnerable group—children—has not received a great deal of attention. Only a handful of studies and reports have described the undue burden that climate change may place on children worldwide. But children’s health advocates are coming forward with a message of caution and encouragement: for pediatricians and other clinicians who care for children, climate change may not be on their clinical radar screen just yet, but they can play a lead role in mitigating its effects to create a healthier environment for their young patients and children everywhere. NOT JUST “LITTLE ADULTS” Average temperatures in the Northern Hemisphere in the second half of the 20th century were likely to have been the highest in at least the past 1300 years, the Intergovernmental Panel on Climate Change (IPCC) reported in its fourth assessment report, Climate Change 2007 (http://www.ipcc.ch /ipccreports/ar4-syr.htm). But several years before that IPCC report was released, when climate change was the subject of greater scientific controversy, Supinda Bunyavanich, MD, now a clinical fellow at Harvard Medical School in Boston, noticed that studies examining the potential consequences of warming temperatures on human health looked primarily at adults or entire populations. She found none focused specifically on children. “Children aren’t just little adults,” she says. “They have a different physiology and different exposures.” So Bunyavanich and several colleagues, including Paul R. Epstein, MD, MPH, Associate Director of the Center for Health and the Global Environment at Harvard Medical School, reviewed the existing data on climate change and analyzed the impact it might have on children’s health (Bunyavanich S et al. Ambul Pediatr. 2003;3[1]: 44-52). Their review notes that, compared with adults, children breathe more rapidly and usually spend more time outdoors, exercising and playing. Children also have narrower airways. During vigorous outdoor activities they would be more likely to breathe through the mouth instead of the nose. All of these factors translate into higher exposures in children than adults to increased air pollution levels that generally result from warmer temperatures, putting children at greater risk of respiratory diseases. Climate change also is linked with more extreme weather patterns, including heavy rains, floods, drought, and cyclones. Bunyavanich and her colleagues note that these patterns not only increase children’s risk of drowning, they also disrupt sanitation systems, increasing the risk of waterborne diseases. Children are more susceptible than adults to these diseases, for several reasons.