Climate change lag time and pediatric health: Why we should care about this urgent need

The hidden timeline of climate health impacts

Climate lag time, occurring as a 10- to 20-year delay due to greenhouse gas emissions and climate-related illnesses, is a public health crisis and a challenge to traditional pediatric health care approaches. These delayed impacts manifest through severe weather events. A deeper scientific understanding of temporal delays is crucial for effective pediatric health interventions. Children are a vulnerable population due to their physiological immaturity, longer life expectancies, and behaviors that increase their environmental exposure. Extreme weather events, such as heatwaves (immediate respiratory and heat-related illnesses), air pollution (asthma exacerbations), wildfires (respiratory symptoms), flooding (injuries and displacement of families), and vector-borne illnesses, have immediate and long-standing ill effects on children.

Understanding the effect of climate lag times on children helps prepare pediatricians for endeavors such as anticipatory approaches, climate resilience, policy advocacy, and prevention strategies specifically designed for Children in the current changing climate.

We live in the shadow of climatic debt, not anticipating the health trajectory for decades to come. While we witness climate change manifesting through increasingly frequent and severe weather events, the scientific understanding of lag times between greenhouse gas (GHG) emissions and their full health impacts is burdensome. The climate-related health challenges children (and patients) will face in the coming decades are a manifestation of the past and current emissions.

The concept of climate lag time (the delay between GHG emissions and their full climate-related effects) has profound implications for pediatric health care planning. Abundant research demonstrates that the full warming effect will manifest over the next 10 to 20 years, even persisting for centuries.¹ It is purported that this overall lag is due to the thermal inertia of oceans and the gradual response of the climate system. For pediatric health care providers, this timeline means that infants born today will experience the peak effects of current climate disruption during their childhood and adolescence. Some of them will face unprecedented environmental health challenges throughout their adult lives.²

Children’s unique vulnerability to climate-related weather events

Children are more susceptible to climate-related health impacts due to their physiological, developmental, and social characteristics.³ Some of their reasons for heightened susceptibility are higher respiratory rates, immature organ systems, and behavioral patterns. Early intervention and prevention strategies are crucial as children have longer remaining lifespans to experience the cumulative effects of climate change.⁴

The relationship between specific weather events and pediatric health outcomes varies significantly in timing and mechanism. For example, heat waves pose immediate threats to children through heat exhaustion, dehydration, and exacerbation of chronic conditions like asthma. Children have limited thermoregulatory capacity, and they often play outdoors for longer periods and engage in vigorous activity. Hence, heat-related illness often occurs within hours of exposure to extreme temperatures.⁵ On the contrary, air pollution event effects are immediate and delayed health impacts in children.⁶ Ground-level ozone formation due to heat waves is associated with rapid increases in respiratory symptoms, emergency department visits, and hospitalizations among pediatric patients with asthma and other respiratory conditions.⁷ The lag time is shorter, often the same day or the subsequent day. However, the long-term consequences of repeated exposures may not become apparent until adulthood.⁸

Wildfire events are a complex interplay of immediate and delayed health impacts. The smoke and fine particulate matter affect local areas and can travel thousands of miles, persisting in the atmosphere for weeks and creating prolonged exposure periods. Immediate effects (hours to days), when they breathe wildfire smoke directly, manifest as coughing, wheezing, throat irritation, and difficulty breathing.⁹ Weeks of extended exposure from fine particulate matter (PM_2.5) occurred from California wildfires reaching the East Coast¹⁰, while Canadian wildfires affected air quality across the United States. Moreover, the seasonal and cumulative effects of wildfires are concerning, as each fire season can last for months, with multiple fires occurring. Hence, it causes repeated insults to developing lungs from infancy through adolescence.⁸

Flooding, similar to wildfire, creates immediate injury risks and long-term health consequences through waterborne diseases, mold exposure, and displacement of families. The lag time for flood-related health impacts varies considerably: drowning and injuries during the event, gastrointestinal illnesses develop within days, respiratory problems from mold exposure can emerge weeks to months later, and mental health¹⁰ impacts may persist for years.

Climate change impacts geographic regions and the seasonal transmission of vector-borne infectious diseases in children. Young children are often closer to the ground during activities, making them more prone to tick bites. The tick’s survival and activity period increase with rising temperatures. The prevalences of malaria, dengue, Lyme disease, and West Nile virus infection are expected to increase as warming temperatures extend vector habitats into previously unaffected regions. These vector-borne diseases are concerning as they affect immunologically naive pediatric populations, where they can manifest as severe diseases and challenge clinical diagnosis and treatment.¹¹

The implications of climate lag time for pediatric practice

Pediatric care, including planning and prevention, needs an understanding of climate lag times. Therefore, the traditional model of reactive health care is inadequate when facing climate-related health impacts. We must adopt an advocacy and proactive anticipatory approach to challenges that are already predetermined by past emissions and ongoing issues. This fundamental proactive approach considers climate resilience as a core component of preventive care. This approach is akin to providing anticipatory guidance about car seat safety and vaccine schedules. Examples of incorporating climate-related health risks into routine pediatric counseling include educating families about air quality monitoring, heat safety practices, and emergency preparedness for extreme weather events. The lag time concept also highlights the intergenerational nature of climate health impacts. Today’s children will become tomorrow's parents, and hence building resilience is not just for current health challenges, but for the capacity to adapt to future environmental conditions.

Recommendations for pediatric health care and policy

1. Clinical practice recommendations: Pediatric practices should integrate climate-informed care into their routine services, including risk assessment for climate-sensitive health conditions, providing anticipatory guidance on extreme weather preparation, and enhancing the monitoring of children with chronic conditions during high-risk weather periods. providers should also advocate for improved air quality monitoring and early warning systems in their communities.
2. Health care system adaptation: Health care systems must develop climate-resilient infrastructure and emergency response protocols specifically designed for pediatric populations. This adaptation includes ensuring backup power for pediatric units during extreme weather events, maintaining adequate supplies for surge capacity during air pollution episodes, and developing evacuation and transfer protocols for climate-related emergencies.
3. Policy and public health integration: Pediatric health care organizations should actively engage in climate policy discussions, bringing the unique perspective of children's vulnerability to inform decision-making processes. Examples include supporting policies that reduce greenhouse gas emissions, improve air quality standards, and enhance community resilience to extreme weather events.
4. Education and training: Medical education and continuing professional development programs should incorporate climate health competencies specific to pediatric care. Such efforts include training in recognizing climate-related health impacts, understanding local climate risks, and implementing prevention strategies tailored to different developmental stages.

Conclusion

The science of climate lag times underscores the urgent need for individual and collective action. By understanding and acting on the implications of climate lag times, pediatric health care providers can help ensure that today's children have the healthiest probable future in our changing climate.

References

1. The Time Lag of Climate Change. Earth.org. August 27, 2020. Accessed September 24, 2025. https://earth.org/data_visualization/the-time-lag-of-climate-change/
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8. Gauderman WJ, Avol E, Gilliland F, et al. The effect of air pollution on lung development from 10 to 18 years of age. N Engl J Med. 2004;351(11):1057-1067. doi:10.1056/NEJMoa040610
9. Kiser D, Metcalf WJ, Elhanan G, et al. Particulate matter and emergency visits for asthma: a time-series study of their association in the presence and absence of wildfire smoke in Reno, Nevada, 2013-2018. Environ Health. 2020;19(1):92. Published 2020 Aug 27. doi:10.1186/s12940-020-00646-2
10. Aguilera R, Corringham T, Gershunov A, Benmarhnia T. Wildfire smoke impacts respiratory health more than fine particles from other sources: observational evidence from Southern California. Nature Communications 2021; 12(1): 1493
11. Chitre SD, Crews CM, Tessema MT, Plėštytė-Būtienė I, Coffee M, Richardson ET. The impact of anthropogenic climate change on pediatric viral diseases. Pediatr Res. 2024;95(2):496-507. doi:10.1038/s41390-023-02929-z