The reality of climate change one summer day in 2011 for dr. Samantha Ahdoot came home when her son was 9 years old.
She and her family lived in Charlottesville, where Ahdoot is an assistant professor at the University of Virginia School of Medicine. There was a heat wave. Morning temperatures hovered in the high 80s, and her son had to walk up a steep hill to get to his day camp.
About an hour after he left for camp, she received a call from a nearby emergency room. Her son collapsed from the heat and needed IV fluids to recover.
“It was after that event that I realized that I had to do something,” she said. “That, as a pediatrician and a mother, it was something I had to learn about and get involved with.”
Dr Ahdoot fulfilled that vow. She is the lead author of the American Academy of Pediatrics’ newly updated policy statement on climate change, which appeared earlier this year. The statement urges pediatricians to talk about climate change with their patients. But research suggests that this is not happening much yet, and there are practical obstacles in the way.
Back in 2007, the AAP was the first national physician group to establish a public statement about climate change. The updated statement covers the growing research about the many ways climate disproportionately affects children in particular. Heat increases the risk of prematurity birth; babies are among the most probably to die in heat waves. Because their bodies cool themselves less efficiently than adults, children remain more susceptible heat related diseases as they grow. Children breathe in more air per pound of body weight, making them up to 10 times more affected by toxins in wildfire smoke. Excessive heat harms children’s performance in school, especially low-income children with less access to air conditioning. And research suggests that teens and young adults feel more climate anxiety than older adults.
The new policy statement’s number one recommendation is that its members “incorporate climate change counseling into clinical practice.” This may seem like a tall order, considering the average pediatrician visit is 15 minutes. A 2021 study found that 80 percent of parents agreed that the impact of global warming on their child’s health should be discussed during their routine visits. But only 4 percent said it had actually happened in the past year.
“How do you talk about climate change in a visit where you have to talk about x,y, z, do all the vaccines, answer every concern?” says Dr. Charles Moon, chief resident at Children’s Hospital at Montefiore in New York. A member of the AAP Council on Environmental Health and Climate Change, he worked to build a curriculum at his hospital to begin teaching pediatricians and other doctors about this.
“I don’t think we have all the answers to that yet,” he said. “I do a lot of work teaching other pediatricians, and it takes a bit of a mindset shift.”
Dr. Moon sees patients in the South Bronx, nicknamed “Asthma Alley” for its air pollution. Part of his challenge is to put environmental threats into perspective for families who face many different obstacles in their lives, in a way that does not lead to despair or disempowerment.
Or, as he put it: “If you can’t put food on the table, who wants to hear about climate change?”
In Oakland, California, Dr. Cierra Gromoff has a lot of experience with families on Medicaid, and she says the pressure on them and their health care providers is real. “There are these already incredibly marginalized groups of kids who are facing other insurmountable things,” she said. “These providers have so little time, they have to focus on the biggest burning fire — whatever systemic problem is going on.”
Gromoff, a clinical child psychologist, has been concerned with the environment since her childhood as an Alaskan in the remote Aleutian Islands. She thinks that to overcome these obstacles, state and federal insurance providers should require or reward doctors for taking the time to include environmental health in their assessments.
She is the co-founder of a telehealth startup, Kismet Health, which is building a tool that can show local environmental threats indexed to a patient’s home or school address.
The tool can help doctors recognize climate risks by showing whether a patient lives near a green space, an urban heat island or a polluting chemical plant.
Gromoff said she would like to see free resources that pediatricians can give families about everything from the signs of heatstroke in an infant to eco-anxiety.
“We have to have a screening question,” she said. “‘Are you concerned about what’s happening to our earth?’ And if they say yes, we need to be able to provide some kind of handout: What you feel is real. These are small steps you can take.”
The good news, Moon and Ahdoot say, is that interest in the topic is growing in the medical community. past half of medical schools Cover climate change in the curriculum, a number that has more than doubled since 2019. And there are state research consortia on climate and health in 24 states, Ahdoot said. The American Academy of Pediatrics created continuing education material also on the subject.
Incorporating climate change into clinical practice is not about adding another item to an already long checklist, Ahdoot said. Nor is it about turning pediatricians into activists, or talking about factors that families can’t do anything about.
“Pediatricians never want to be proselytizing,” she added. “It always has to be valuable to the individual patient.”
The goal of the new climate policy for pediatricians is to help doctors translate their climate knowledge into solutions and useful advice for their patients. A few examples of Ahdoot include: a test for Lyme disease for patients in Maine, which used to be too cold for ticks; start allergy medication in February because pollen arrives earlier in the year; or teach athletes the warning signs of heat exhaustion.
For Ahdoot, it is also important to be aware of how climate affects a child’s mental health. Part of the answer, she said, is talking about actions families can take that benefit both people’s health and the planet, such as eating more plant-based diets, and walking or biking instead of driving.
“What’s good for the climate,” she said, “is generally good for children.”
