As the climate warms, infants, children and adolescents face increasing health risks and make more visits to the emergency room, according to new research.
The study underscores underlying health care access disparities that particularly affect Black and Latino communities.
Scientists found that emergency department visits for children at 47 US hospitals rose almost 12% during the warmest months of the years they studied.
The research was published in the journal Environmental Health Perspectives.
“Some of the things we saw were entirely unsurprising,” says pediatrician Dr. Aaron Bernstein, the study’s lead author and the interim director of the Center for Climate, Health and the Global Environment at Harvard University.
“Heat-related illnesses — what we call heat exhaustion [or] heatstroke — go up with heat, and the hotter it gets, the more likely those visits are,” Bernstein explains. “But a lot of the other things might not be immediately obvious.”
For example, the researchers found an increase in the number of pediatric ER visits for bacterial intestinal infections. These bacteria cause diarrhea and vomiting and are often found on spoiled food, which is more likely in the warmer months.
"One of the things that is important to note here is that we see stark differences in rates of visits based upon whether a child had private insurance or public insurance and whether they were a white child or a racial or ethnic minority child."
"One of the things that is important to note here is that we see stark differences in rates of visits based upon whether a child had private insurance or public insurance and whether they were a white child or a racial or ethnic minority child,” Bernstein notes. “Those differences reflect what we know, which is that many children who are either on public insurance or of a minority status are more likely to use an emergency department, in general, because they lack access to the primary care offices and other resources."
This held true for many of the other conditions for which doctors measured increased rates of ER visits, including things like ear and skin infections.
“Interestingly, we also find that injuries and poisonings are more likely with higher temperatures, as well,” Bernstein adds. “So we find a suite of effects, and often we see greater rates of visits for minority children.”
Bernstein says he was most surprised by increased rates of visits for blood and immune system disorders. These include a broad group of conditions, such as anemia and immunodeficiencies. Heat doesn’t cause immunodeficiencies, Bernstein explains, but children with immunodeficiencies are probably more at risk for illnesses like bacterial infections.
“This is a finding that I think really warrants some further investigation,” Bernstein says. “I have a pretty good mind as to how we would see more ear infections or more bacterial intestine infections, more skin infections, more accidents, greater visits for children with diabetes, but I'm not sure I really understand this [other] piece. And if it turns out that there is some way in which heat is affecting risk for those children, that would be something that I think is potentially new and concerning."
The researchers did not find that heat had a significant effect on mental and behavioral health on the whole population of children in the study, but when they divided the group into white children and children of minority status they found a substantial effect, Bernstein says.
“Children who are Latino, Black American, Asian American, etc., are much more likely to show up in emergency departments for those problems,” he notes. “Do I think that's because white children aren't getting those effects from the heat? No. I think it's because white children have better access to care. And this is what I mean when I talk about the effects of heat amplifying the inequities we see.”
The research findings should not discourage parents to send their kids outside to play when it’s hot, Bernstein says. The study shows that heat does matter to children, especially to children with certain chronic medical problems. But it also shows that parents can do things to ensure that their children can play outside safely, even in hot weather.
A good question for a parent to ask is, what is too hot, Bernstein notes. The answer depends on where you live because “80 degrees in Boston is not 80 degrees in San Antonio.”
“What really matters is the percentile of temperature,” Bernstein explains. “How hot is today as compared to the usual? And, fortunately, there are more resources that are coming on line to give parents and providers that information. We're starting to see heat forecasts that tell you 'this day is going to be in the 85th percentile of temperature,' which is a signal to those people who are at risk [to] be mindful of those heat concerns, maybe offset your activities, maybe make sure you're well hydrated, or whatever the reasonable action is.”
"[The study] underscores a whole body of work that says we absolutely need to provide better health care to the least fortunate children in our country.”
Bernstein says the study “underscores a whole body of work that says we absolutely need to provide better health care to the least fortunate children in our country.”
Children on public insurance uniformly have higher rates of ED visitation, which reflects a broader trend that these children do not have access to primary care, he points out. If all children had access to primary care, concerned parent parents can call that office and get some health guidance before a child kid ends up in an emergency department.
“I think that's one of the key messages that we see in this study, about what it means more broadly for the health care system,” Bernstein says.