Warmer temperatures in late spring and summer were associated with higher rates of emergency room visits for children across the United States, researchers said Wednesday.
The research adds to a growing body of evidence for the dangers that heat poses to vulnerable populations, including children and adolescents. Although children dissipate heat in the same way as adults, they suffer differently from the effects, in part due to different body surface areas, body fat composition, and hydration.
"We have previously run into problems by assuming that children are small adults," said Dr. Aaron Bernstein, a pediatrician at Boston Children's Hospital, who was one of the newspaper's writers. But the results show that their bodies suffer from some unique effects of heat.
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The research, published Wednesday in Environmental Health Perspectives, is the first to offer a comprehensive study of the effects of rising temperatures on people 18 and younger across the country. The authors analyzed data from nearly 4 million emergency room visits at 47 children’s hospitals nationwide in the late spring and summer between 2016 and 2018.
They found that almost 12% of these visits to the emergency department could be attributed to elevated temperatures. But these rates were much higher under certain conditions. Nearly a third of the emergency room visits for heat-related illness, such as heat stroke and heat exhaustion, and a quarter of the visits for bacterial intestinal infections were attributed to heat.
Bernstein said some of the infections that peaked in the summer could be linked to changes in behavior caused by the hot weather. For example, higher incidences of ear infections may be the result of more time spent in swimming pools, and bacterial gut infections may be the result of picnicking or eating foods that had been removed from the refrigerator.
But a number of the results surprised the researchers. For example, the increased risk of children suffering from blood, immune and nervous system diseases during periods of higher heat cannot be easily explained by changes in behavior and has not been seen in adult studies.
With climate change, heat waves and rising temperatures become more frequent. And it has implications for human health.
It is well established that days of extreme heat are dangerous for adults and can lead to many deaths, especially in vulnerable populations such as the elderly. When temperatures rise, people can become seriously ill or die if they are not able to effectively sweat and cool down. This can lead to an increase in internal body temperature.
In addition to temperature-related illnesses such as heat stroke or heat exhaustion, adults can also suffer from cardiovascular and respiratory disorders. Last summer, a New York Times analysis found that the deadly heat wave in the Pacific Northwest resulted in 600 more deaths than would have been typical.
"We know that days of extreme heat due to climate change will be more frequent and intense," said Francesca Dominici, a biostatistician at Harvard's TH Chan School of Public Health who has studied the effects of extreme heat on human health and was not involved. in the new research. "The extent to which children are susceptible to the risk of climate change should be a high priority for researchers to investigate."
One reason why it is important to study children is because of the possibility of lifelong effects. "The question of which of these diseases manifests on a hot day that can be completely cured with proper intervention and which can create chronic disease later in life is a very open research question," Dominici said.
Dominici added that this research could make clinicians and parents more aware of the range of disorders that affect children during warmer temperatures. "If we know what types of diseases can get worse these days in children, we can either prevent these diseases, or when children get into the emergency room, clinicians are aware of what's happening."
Bernstein said the research highlighted the inequalities in pediatric health care. For example, although a quarter of all bacterial intestinal infections were attributed to heat, these rates were significantly higher for non-white children and those who rely on a public health insurance such as Medicaid. The data, which did not include pediatric visits to local hospitals or primary care appointments, reiterated that "children without good access to care are more likely to use an emergency department," he said.
"It's one thing when we see these inequalities exposed in people at the end of life," Bernstein said. But for a child, "we put them on a substantially different course for the rest of their lives."
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