Editor’s Note: Dr. Eli Cahan (he/him) is the editor emeritus of the Section on Pediatric Trainees (SOPT) feature in Pediatrics and an investigative journalist who covers child welfare. He is also a resident at The Boston Combined Residency Program. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
At 4:40 pm on an August Wednesday in Kansas, the high schoolers started sprinting. Ten-yard dashes became 40, and 40 became 120.
Everyone knew it was hot. But that day was particularly hot. It was so searing—a peak heat index of 112 degrees Fahrenheit, well above the historic average of 88 degrees—that the National Weather Service had posted a heat advisory that morning.
At some point during the sprints, Ovet Gomez Regalado—a 15-year-old with a toothy smile—collapsed. His core temperature hit 104.6 degrees as the football team’s staff hustled to immerse him into an ice bath. Two days later, the aspiring varsity lineman died.
In recent decades, as temperatures across the US have hit historic highs amid climate change, the number of heat deaths have skyrocketed. Heat-related illnesses now kill more Americans annually than every other natural disaster combined: in 2023, over 2,300 Americans died from extreme heat, a rate about 6 times higher than in the mid-1990s. The rate of heat-related illnesses requiring hospitalization was also about 60-fold higher in 2023, with almost 120,000 people requiring emergency care.
The burden of heat-related illness is not spread equally. People of color are more likely to die from extreme heat than are Whites. Those with low-income also face higher risks, due to jobs that put them at greater threat of prolonged extreme heat exposure, neighborhoods known as “heat islands,” and lack of access to air conditioning, among other factors.
While the impacts of extreme heat on children are not fully known, theoretically, the impact in certain subgroups may be more severe. For example, infants and children with medical complexity may lack the ability to maintain temperature homeostasis when faced with extreme conditions.
And while most school-aged youth likely have an equivalent ability to thermoregulate in optimal environments as do adults, they also face disproportionate risk of extreme heat exposure in non-optimal environments, the AAP’s Council On Sports Medicine and Fitness and Council on School Health jointly wrote in 2019.
To better understand the impact of heat on children, Dr. Wen-Qiang He and colleagues studied how extreme conditions related to emergency visits and hospitalizations in Australia between 2001 and 2020, in an article being early released in Pediatrics this week (10.1542/peds.2024-068183). They found that emergency visits due to infectious diseases rose up to 17% and those due to heat-related illness increased up to 104% during extreme weather. Notably, the authors found that infants younger than 1 year of age, children with medical complexity, and those from the most disadvantaged socioeconomic groups comprised a disproportionate share of hospitalizations.
In sum, these findings suggest—as written in the 2019 AAP report—that “known contributing risk factors are modifiable . . . and exertional heat illness is usually preventable.”
“Hotter days are the new normal,” Dr. Sandra Jee from the University of Rochester and Dr. Lisa Patel from Stanford University wrote in an accompanying commentary (10.1542/peds.2024-068812). Reading the article by He and the accompanying commentary by Drs. Jee and Patel can “infor[m] our clinical practice and ensur[e] there are appropriate resources in place to keep children safe.”
