Children and heat: Extreme temperatures mean everyone from public health pros to primary care needs to pay more attention

As Ontario, Quebec and the Atlantic provinces experience an intense heat wave, conversations are heating up on the risks of these rising temperatures. Advocates are expressing serious concerns about scorching hot weather, especially its effects on vulnerable populations like school-age children in classrooms. Environment Canada issued a heat warning earlier this week for several regions of Ontario, including the Toronto area, and politicians like Ontario Green Party Deputy Leader Aislinn Clancy and the Ontario School Safety have been speaking to the media on elevated classrooms temperatures.While hundreds of schools in the province have air conditioning, hundreds of others do not. School boards have indicated that, aside from providing fans and establishing designated cooling centres, their options for mitigating the situation are limited.“My understanding is that we have cold day plans for school, but we don't have hot day plans, and there are no established recommendations,” said pediatrician Dr. Anna Gunz, president of the Environmental Health Section of the Canadian Paediatric Society in an interview with the Medical Post. “I know that public health is doing a lot of work with this, and school boards are working with public health, but we really need hot day plans and recommendations, as well as air conditioning.” Seasons of heatThe situation is urgent, she said, as global temperatures are rising with climate change.“It’s not that it’s hot just in the summer now. We have really hot weather in March, and every year, in April, May, June, we get periods where it’s above 30 degrees. In the fall as well,” she said, noting that her own kids’ school has been retrofitted with air conditioning, but previously its classrooms could be “intolerable” for kids. Dr. Gunz said heat can lead to more infections like Kawasaki disease, other viruses, pneumonia and breathing issues. Kids, who are already biologically more susceptible to dehydration than adults, often don’t drink enough water and can become dehydrated and develop electrolyte imbalance as well and other gastrointestinal illnesses. “And then there’s the susceptibility to other things like heatstroke and heat stress.”A January 2024 paper from Harvard Graduate School of Education highlighted the dangers of rising temperatures on children’s health. Pointing out that 2023 was the warmest year ever recorded globally, the researchers noted that excessive heat can cause major health complications for babies, toddlers and young children, whose bodies react differently to excessive heat than adults. Children are not able to regulate their body temperatures like adults and severe heat can lead to “muscle breakdown, kidney failure, seizure, coma or even death in extreme cases.”The paper highlights how rising temperatures can impact the long-term development of all children, especially those from low-income communities. But the impact goes beyond the physical.Learning, mental healthChildren’s cognitive functions slow down in the heat and their ability to concentrate diminishes, said Dr. Gunz. Overheated classrooms can cause students to become unmotivated, distracted, irritable or even aggressive. And as the Harvard paper pointed out, hot and humid temperatures, especially for those who lack air conditioning, can reduce the likelihood of a good night’s sleep, something children need plenty of for learning, emotional well-being and healthy growth and development.“Heat affects our whole health, so our mental, emotional and physical health. So, from a physical health perspective, there are more admissions to the emergency room as well as admissions to hospitals with heat with children, the same as with adults,” said Dr. Gunz. “There is evidence that you can't concentrate the same way when you're hot. The other thing to remember is that the temperature outside obviously isn't always the temperature inside. So, some of these classrooms can be even hotter. So, everybody feels worse when it's hot in terms of mood, aggression and even violence. With psychiatric illnesses, patients are much more susceptible to heat and there is a risk of it worsening.” Cautions on medicationsPhysicians and patients also need to be aware that some medications interact with heat, notably antidepressants that young people might be on. “There are many antidepressants that might interfere with our perception of heat or our ability to respond with our physiological mechanisms to help (like sweating). There are other also psychiatric medications, like antipsychotics, that can impair mechanisms of sweating.” Dr. Gunz noted as well that some antidepressants can make patients more susceptible to electrolyte imbalances. Cardiac medications and diuretics, more often prescribed to adults, can create problems as well.Dr. Gunz highly recommends the free WHO-affiliated Pan American Health Organization’s Climate Change for Health Professionals, which offers recommendations on treating patients during extreme heat and includes detailed information on medications that interact with heat and how to safely prescribe them.Solutions, short- and long-termIn the meantime, Dr. Anna Gunz reminds patients young and old about sun protection, eye protection with sunglasses, keeping hydrated, recognizing children’s unique vulnerability, and taking heat seriously as a potential threat.Dr. Gunz says that in addition to air conditioning in schools, governments need to ensure there are trees and shade in playgrounds and that schools have not makeup days for activities that were scheduled for extreme heat days, the same as if an activity were to get rained out. “We need to do whatever we can do to make schools safe places. Schools should be havens of safety. They could be cooling shelters in the summer. We need to start changing our ideas about what child health is, include the educational system and pour in resources. We need to start reinvesting in child and child healthcare. But that starts in schools. As a pediatrician, I can’t see a better place to start.”

Children and heat: Extreme temperatures mean everyone from public health pros to primary care needs to pay more attention

Register for free access or login.

Related Topics