The climate challenged child: extreme heat, air pollution, and emerging infections in contemporary pediatric practice

Abstract

Climate change is altering the conditions in which children grow and receive healthcare. Children are disproportionately vulnerable because of immature thermoregulation, higher ventilation and fluid requirements relative to body size, developing organs, dependence on caregivers and greater lifetime exposure. This narrative review synthesises evidence on three interacting hazards of immediate relevance to paediatric and community practice: extreme heat, air pollution and climate-sensitive infections. It also proposes an author-derived four-question clinical lens linking exposure, individual susceptibility, protective-resource failure and immediate versus seasonal action. A structured search of PubMed/MEDLINE, Google Scholar and authoritative reports was undertaken, prioritising systematic reviews, meta-analyses, burden estimates and guidance published from 2019 to August 2026. Extreme heat is associated with heat illness, dehydration, renal stress, asthma exacerbations, adverse perinatal outcomes, impaired learning and mental-health morbidity. Climate change also worsens exposure to particulate matter, ozone, wildfire smoke and aeroallergens, contributing to pneumonia, asthma, impaired lung growth and possible neurodevelopmental harm. Temperature, rainfall, humidity, flooding and ecological disruption are changing transmission of dengue, malaria, diarrhoeal disease and other infections. Risks cluster among children affected by poverty, malnutrition, unsafe housing, chronic disease or weak health systems. Climate-resilient paediatrics requires climate-informed assessment, anticipatory guidance, child responsive heat plans, clean-air policies, integrated surveillance, resilient facilities and child centred disaster planning. Adaptation and mitigation should be treated as core child-health interventions.