April 22nd is Earth Day and April 29th is Arbor Day so, it seems a good time to talk about climate change and its effect on child health. Discussing climate change and its inherent health effects seems to be another divisive topic in an election year. The far right tends to deny that global warming exists and the far left seems to abhor the potential solutions such as nuclear energy and genetic modifications in foods and insects. Perhaps a more rational scientific discourse can occur after the elections. As pediatricians we are concerned about the effects of climate change on our children and their children to come. Thinking long-range is natural for pediatricians; we advise vaccines that prevent cancer decade’s forward and propose many other preventative health measures that will take years deliver any positive outcome.
Regardless of your political view, the evidence of climate change is convincing, it’s the future extent of the warming is that is open to honest debate. The EPA warming estimates range from 2°C to 12°C over the next 85 years. Let’s all pray it turns out to be the lower estimate as the higher range projections would have catastrophic impacts on all life as we know it. Global warming changes have already shown effects on the health of children. Higher global temperatures cause higher levels of microscopic particulate matter in the air, increased ozone, Sulfur dioxide, Nitrogen dioxide and Carbon Monoxide. Warmer average summer temperatures have already increased ground-level ozone, a known respiratory irritant which can cause significant inflammation in the bronchial tubes of children with asthma and in those who exercise outdoors, even children without asthma. Warmer temperatures also contribute to more allergies, an earlier pollen season as well as the longer pollen season.
We see evidence in our own clinical practice of the negative health effects of global warming and have observed an increasing frequency and severity of allergies, asthma, sunburn and heat exhaustion. Even our irritant plant poison ivy seems to have flourished in warmer seasons. We are also more watchful of insect and arthropod vector infections such as a Lyme disease, West Nile virus and now the new threat of Zika virus as the range and frequency of mosquitoes move northward. We have seen local outbreaks of cryptosporidium, a parasite found in water parks that cause diarrhea in children. Global warming also increases the frequency of well water related illnesses, especially following more frequent heavy rains and stagnate heat contributes to the observed occurrences of the toxic algae bloom in Sodus Bay and the Finger Lakes.
Poor air quality has been shown to have negative health effects on children and can begin during pregnancy and affect placental development. Increases in airborne particulate matter, especially in urban areas, may expose children to mercury and lead and adversely affect the nervous system of young children. There is even evidence for an increased risk of sudden infant death syndrome from exposure to polluted air.
We are not helpless in this situation; we can and should take steps to protect children from the effects of global warming. The first step for parents is to watch for poor air quality which can occur in any season. An air quality index is reported in the newspaper and online at www.airnow.gov and reports the air quality index (AQI) which can tell us how clean the air is on any given day. The monitoring station for Wayne County is located in Williamson and others are located nearby in Fulton and another measuring the air quality near the expressways of Monroe County.
At this writing, the quality index in Williamson is good at 24 but in Cleveland Ohio, it is not so good at 55. Activities outdoors should be guided, just as you would any other weather information by this AQI. A quality index of 1-50 is good and children of all ages should enjoy all outdoor activities. An AQI of 51-100 is a moderate concern we would advise limiting outdoor time, particularly for children with asthma. An Air quality index of 101-150 is unhealthy for sensitive groups such as very young and asthma patients and air quality of 151 or more is unhealthy for all. During these higher level index days young children should actually play indoors and healthy adults in older children may wish to limit their time outdoors to the early morning hours when air quality is better. In patients with asthma and allergies the use of inhaled steroids, which have low bioavailability are very effective in mitigating the inflammatory effects of particulate pollution and high ozone levels.
Another caution as warmer temps increase is insect vector illnesses borne by Tick and Mosquitoes. It is therefore important to examine children closely for the presence of ticks after a day outside since early removal of the Deer Tick can prevent Lyme disease. Mosquito control includes keeping yards and nearby vacant lots free of standing water and using DEET or Picaridin insect repellant. DEET is safe for children and infants older than 2 months of age. For newborn infants less than 2 months of the age mosquito netting should be used when outdoors in the evening. To avoid getting DEET in the eyes don’t let children apply it themselves. The concentration of DEET should be interpreted than same way as an SPF rating on sunscreen, higher concentrations are not necessarily stronger but rather higher DEET percentages last longer and therefore the lower concentration brands should be reapplied depending on the children’s time outside.
Climate change will means more days with outside temps above 90 degrees. Heat exhaustion is a risk especially in mid-August when school sports teams begin intensive practices. Holding practices early in the morning or late in the afternoon and keeping good hydration before, during and after practice is the best way to prevent heat exhaustion. An additional risk of those 90° days is food poisoning from rapid bacterial growth, particularly on foods like macaroni salad, potato salad and undercooked chicken.
With global warming will come an increased frequency and intensity of winter and summer storms. The risk of water related illnesses appear to increase following those heavy rains and runoff. Occasionally there is contamination of the well water supply with increased likelihood of gastrointestinal infections. Keeping a supply of bottled water in storage for such events is a good plan.
Is never too early to engage children in ways that they can help reduce the family’s carbon footprint. Careful planning on running errands to minimize unnecessary driving, learning ways of conserving water, gardening to grow their own food, recycling and using compost pile for organic plant leftovers are all great teaching moments in environmental conservation for children. I sure don’t expect or depend on our political leaders to solve the potential crisis in global warming. Those solutions are more likely to come from the innovation of our children.
Michael Jordan, MD, MS-HQSM, CPE, FAAP, Chief of Pediatrics at Newark-Wayne Community Hospital is board-certified in Pediatric Medicine. He attended the College of Human Medicine at Michigan State University and completed his residency training at the University of Rochester. In addition to his leadership role as chief of Pediatrics at Newark-Wayne, he is the medical director of Rochester Regional Medical Group and is also chair of Rochester General Medical Group’s Quality Committee. He works in the Sodus Rochester General Medical Group Pediatric office. To send questions on children’s health, please email Wendy Fisher, Pediatric Practice Manager at wendy.fisher@rochestergeneral.org and write “Ask a Doc” in the subject line. To schedule an appointment, call 315- 483-3214.
