Under Fire: A Brazilian Perspective on Climate Change and Child Health

Abstract

Climate change significantly impacts child health, with Brazilian children facing unique vulnerabilities due to the country’s environmental and socioeconomic landscape. This article explores how rising temperatures, pollution, and extreme weather amplify respiratory, neurological, and psychological issues, spread vector-borne diseases, and reduce food security, disproportionately impacting children and adolescents. We also discuss mitigation strategies and recommendations for climate adaptation, including initiatives for sustainable land-use, expanded educational and health programs, and enhanced support for biodiversity conservation. These actions are essential to safeguarding child health and addressing the growing climate crisis nationally and internationally.

1. Introduction

Climate variations affect everyone, but children are disproportionately affected due to both physiological and lifestyle factors [1]. Their developing bodies, with faster breathing rates and higher water and food intake relative to body weight, increase their exposure to environmental contaminants [1,2]. Additionally, children’s frequent outdoor activities amplify their exposure to extreme weather, allergens, pollutants, and insect-borne diseases [1]. As their brains are still developing, they are also susceptible to mental health impacts from severe climate events like storms, floods, and fires, which can lead to trauma or displacement [3,4].

Importantly, the effects of climate change on child health are not limited to direct environmental exposures; disruptions in food systems also mediate them. Climate-related stressors such as droughts, heatwaves, and flooding reduce agricultural productivity, drive up food prices, and decrease access to diverse, nutritious foods. These conditions may compromise healthy growth and development, especially among children from low-income households. As food systems contribute to and are affected by climate change, they represent a crucial intervention point in efforts to protect child health.

This article offers an overview of key discussions from the Symposium on Climate Change and Child Health, held as part of the 7th International Sabará-PENSI Congress on Child Health on 5 October 2024, in São Paulo, Brazil. Drawing on insights from the symposium sessions, we present evidence on the impacts of climate change on child health and emphasize the need for climate-sensitive health policies. The discussion includes various dimensions of child health—physical, mental, and nutritional—to highlight climate change’s interconnected and far-reaching effects on younger populations.

This work contributes to the growing body of literature on climate-related health impacts by offering a perspective grounded in the Brazilian context. Brazil presents a unique case due to its acute exposure to climate extremes, regional inequalities, and central role in global environmental sustainability. As one of the world’s most biodiverse countries and a leading agricultural producer, Brazil’s land-use patterns, food system transitions, and public health vulnerabilities provide insights into the challenges and opportunities of climate action in low- and middle-income settings. By integrating scientific evidence and real-world experiences, this article advances the understanding of how local realities can inform national and global policies.

2. Environmental History in Pediatric Care

Despite growing awareness of the connections between the environment and health, environmental history-taking is often overlooked in clinical practice, especially in developing countries [5]. Consequently, routine demographic and social anamnesis rarely includes questions about potential environmental hazards.

By asking targeted questions about the environments where children spend their time, such as home, school, playground, and even work, in some circumstances, healthcare providers can gather information that may reveal hidden risks. The obtained data should include details on air quality and water sources. It should also cover exposure to household materials prone to mold in humid conditions (such as untreated wood or drywall) or that cause intense heat (such as fiber cement tiles). In addition, it should consider neighborhood factors like limited green spaces [6] (Figure 1). Such information enables pediatricians to identify early patterns or symptoms that may suggest environment-related conditions, such as respiratory problems due to poor air quality [7] or prolonged allergy symptoms from extended pollen seasons [8]. Questions about the environment are also appropriate when symptoms are unusual and persistent, or when multiple people in the home, at a childcare facility, or at school exhibit similar symptoms [9].

After identifying these environmental triggers, pediatricians can provide specific, actionable advice that may prevent or mitigate health issues. For example, if a child lives in an area experiencing increased pollen seasons due to warmer temperatures, pediatricians can advise families on managing allergy symptoms. They may recommend scheduling outdoor activities in the late afternoon or evening, when pollen counts are typically lower. Similarly, pediatricians may suggest strategies to limit smoke exposure for families living in areas prone to wildfires. These strategies include using indoor air purifiers and minimizing outdoor activities during poor air quality days.

Although environmental health is not yet widely integrated into medical training, environmental anamnesis offers an immediate, practical tool that clinicians can implement without waiting for curriculum changes. The recently published document, “Environmental Anamnesis in Pediatrics (Anamnese ambiental em Pediatria, in Portuguese)” by the Scientific Department of Toxicology and Environmental Health of the Brazilian Society of Pediatrics, aligns closely with this approach. It provides pediatricians with guidance to identify environmental risks through clinical history. This proactive approach empowers healthcare providers to address community concerns about environmental health and to incorporate basic environmental principles into their practice [10]. As climate change escalates environmental risks, embedding environmental history-taking practice in pediatric care is essential for fostering resilience and safeguarding child health [11].

3. The Impact of Pollution and Climate Extremes on the Pediatric Population

Figure 2 provides an overview of how pollution and climate extremes impact children’s health. It highlights four critical areas: fetal and perinatal health, respiratory health, neurological and mental health, and vector-borne diseases. We discuss each of these areas in the sections that follow.

3.1. Fetal and Perinatal Health

Maternal exposure to air pollution— driven partly by climate-related factors such as increased wildfire frequency and urban heat islands resulting from climate change—is associated with complications like reduced fetal growth, preterm births (gestation < 37 weeks), and low birth weights (birth weight < 2500 g) [12,13]. These adverse birth outcomes increase the risk of mortality and predispose affected children to health and developmental challenges, including respiratory, immune, neurological, and growth-related issues [14,15,16,17].

The presence of microplastics and chemical pollutants in water and soil, exacerbated by climate-related changes in rainfall patterns and flooding, introduces additional risks [18]. Recent studies have reported microplastic particles in the human placenta, suggesting that these contaminants can enter the maternal body through ingestion, skin contact, and inhalation, ultimately crossing the placenta and reaching the amniotic fluid and fetus [19,20]. Although high-quality observational studies are needed to fully understand the effects of prenatal microplastic exposure, research indicates that such exposure during pregnancy and early life may lead to lasting changes in the reproductive and central nervous systems across species [21,22,23]. Similarly, infants born to mothers exposed to toxicants, including pesticides or industrial chemicals mobilized by extreme weather events, may face risks of altered immune responses and developmental issues, particularly in the respiratory, reproductive, and nervous systems [24].

Extreme weather events, such as prolonged heatwaves, hurricanes, and floods, also create hazardous conditions for pregnant women. Exposure to extreme heat can lead to maternal dehydration, reduced placental blood flow, intrauterine growth restriction, and an inflammatory response that may increase the risk of preterm birth [25]. In addition to these physical challenges, adverse life situations experienced by the pregnant mother, such as displacement, property loss, or lack of social support, can alter the fetal environment, potentially impacting the child’s developmental rate, as well as their mental and physical health [26,27,28].

In this context, two global child health frameworks are particularly relevant: the Developmental Origins of Health and Disease (DOHaD) hypothesis and the concept of the First 1000 Days. The DOHaD framework emphasizes how exposures during critical periods of development, especially in utero and early childhood, can program long-term health outcomes [29]. Exposure to environmental hazards during these sensitive windows can alter fetal and infant physiology, increasing the risk of noncommunicable diseases later in life [30]. Complementing this, the First 1000 Days approach highlights the period from conception to a child’s second birthday as a unique window of opportunity for shaping a child’s lifelong health, growth, and cognitive development [31]. Climate-related stressors, such as extreme heat, air pollution, and disrupted access to nutritious food, threaten this sensitive phase, especially in settings marked by social and environmental vulnerability.

To mitigate climate-related health risks, it is essential to incorporate climate resilience measures into prenatal care programs, particularly in regions vulnerable to extreme weather events and environmental pollution. Health systems can play a critical role in this scenario by providing cooling zones for pregnant women during heat waves. They can also support mental well-being and offer guidance on minimizing exposure to pollutants and toxicants. The impact of these adaptive measures on maternal and fetal health would be even more significant if systematically incorporated within Brazil’s Public Health System (Sistema Único de Saúde [SUS]). Incorporating these strategies into SUS would enable consistent, widespread access to climate-sensitive prenatal care, ensuring that pregnant women across the country receive the support needed to protect their health and the health of their babies.

3.2. Respiratory Health

In August and September 2024, air quality across Brazil deteriorated significantly, primarily due to widespread wildfires, particularly in the Amazon region. Data from Brazil’s National Institute for Space Research (INPE) indicated a 63% increase in fires in Brazil from 1 January 2024 to 28 October 2024 compared to the same period in 2023 [32]. Smoke from these fires spread over 60% of Brazil, impacting major cities like São Paulo and Rio de Janeiro and affecting neighboring countries [32]. In São Paulo, air quality reached levels almost 14 times higher than the World Health Organization’s (WHO) recommended limits, placing it temporarily among the most polluted cities globally. The drought, intensified by climate change and reduced rainfall due to El Niño, enabled fires to spread rapidly and produce widespread smoke, harming the respiratory health of people living in the affected regions.

These pollution levels are particularly harmful to children, who are more vulnerable to respiratory problems [33]. Early exposure to pollutants can impair lung development, increasing susceptibility to chronic respiratory conditions in adulthood [34]. Additionally, particulate matter pollution (PM2.5), a complex mixture of solid and liquid particles suspended in the air, exacerbates pre-existing respiratory conditions like asthma and allergies, which raises the risk of acute respiratory infections [35,36,37,38].

Extreme temperatures further aggravate asthma, increasing the frequency of asthma exacerbations and emergency department visits. A meta-analysis found a 7% relative risk increase for asthma exacerbations during extreme heat and a 20% increase during extreme cold [39]. Studies in China and Australia support these findings, noting that temperatures above 30 °C and below 14 °C significantly raise emergency visits for asthma [40,41]. Beyond asthma, extreme temperatures also impact lung development in infants. A French study on mother–child pairs found that exposure to heat and cold waves from 35 gestational weeks until the first four weeks after birth was linked to reduced lung capacity and higher respiratory rates in female infants at two months old, indicating potential long-term respiratory effects [42].

Given the impact of climate change on air quality and children’s respiratory health, it is crucial to equip pediatricians with the tools and knowledge necessary to respond effectively. This requires educational initiatives that enable pediatricians to manage climate-related respiratory challenges. Moreover, they must be able to advocate for health policies that protect children and educate families on the adverse health effects of climate change.

Implementing effective coping and adaptation strategies is also important for safeguarding children’s health and preparing healthcare services’ responses. A promising initiative in Brazil is the development of PENSI Analytics, a predictive platform that integrates pediatric respiratory health data with atmospheric pollution and urban environmental information using artificial intelligence and big data. The platform automatically geocodes patient data, incorporates external information on air pollution, temperature, and humidity, and generates exposure maps. These features enable more accurate prediction and management of respiratory cases in children, including assessing the likelihood that a patient will require immediate treatment or hospitalization.

3.3. Neurological Development and Mental Health

Worldwide, one in seven adolescents experiences mental health disorders, with suicide ranking as the third leading cause of death in older adolescents and young adults (15–29 years) [43,44]. Climate change now adds to this burden, with escalating environmental crises contributing to what experts call “climate anxiety”, a pervasive fear and uncertainty about the future that can lead to chronic stress, depression, and other mental health challenges [45,46].

Young people face multifaceted threats due to climate change, including direct exposure to traumatic events like droughts, floods, and wildfires. These events threaten their physical safety, displace families, and disrupt communities, leading to social isolation, economic insecurity, and disruptions to educational and social support systems—all factors that aggravate mental health risks [47,48]. The mental health of young people is being impacted not just by climate-related disasters and disruptions, but also by their increasing understanding of the scale and urgency of the climate crisis. Children and adolescents are more informed than ever about environmental threats and, in many cases, feel overwhelmed by the scale of the crisis and the perceived lack of meaningful action to address it [49]. A study surveying 10,000 individuals aged 16 to 25 from 10 countries, including Brazil, revealed that 59% were very or extremely worried about climate change, and 84% expressed at least moderate concern [45]. More than half of the respondents reported feeling sad, anxious, angry, powerless, helpless, and guilty about the state of the planet [45]. Notably, 75% of participants described the future as frightening, whereas 83% felt that society has failed to care for the environment [45]. This study emphasizes the need for both mental health support and meaningful climate action to address youth concerns about climate change.

Supporting the mental health of children and youth in the context of climate change involves strengthening support networks within families, schools, and public health services and promoting healthy coping strategies. Community-based programs encouraging youth participation in environmental actions can be particularly effective in fostering a sense of purpose, hope, and optimism. Young people are increasingly involved in climate activism [50]. Strategies such as incorporating environmental education into school curricula, promoting realistic and proactive climate involvement, and creating collaborative partnerships between youth and adults are valuable to support their engagement in climate change discussions. These initiatives validate the concerns of children and adolescents and give them a platform to voice their ideas and advocate for meaningful change.

Fostering mental health resilience in young people goes beyond providing immediate support; addressing the complex stressors related to climate change and investing in sustainable mental health strategies is also necessary. By building these foundations, we can empower young individuals to better manage climate change and contribute to creating resilient, adaptive communities prepared for the environmental challenges ahead.

3.4. Increase in Vector-Borne Diseases

Climate change has increased the geographic spread and incidence of arboviral diseases, particularly those transmitted by the Aedes aegypti mosquito, such as dengue, chikungunya, Zika, and yellow fever. The interplay of climatic elements (air temperature, humidity, and precipitation) strongly influences the transmission of arboviral diseases. For example, rainfall directly impacts mosquito breeding sites, while higher temperatures accelerate mosquito development and reproductive rates, increasing vector density [51,52]. Thus, extreme climate events, such as El Niño, which disrupt normal precipitation and temperature patterns, can shift the seasonal patterns of arboviral diseases and increase their incidence [53].

Dengue is the most important arboviral infection worldwide. From January to September 2024, over 13 million cases and 8500 dengue-related deaths were reported worldwide—an eightfold increase in cases since 2000 [54]. Most cases have occurred in the Americas, which have reported over 11 million cases this year (53% laboratory confirmed). Dengue-related fatalities in the region exceed 6000, with a case fatality rate of 0.057%. Brazil alone accounted for more than 9.5 million cases in 2024, approximately 73% of global cases, followed by Argentina, Mexico, Paraguay, and Colombia [54]. Besides climatic changes, Brazil’s historical patterns of urbanization, with unequal territorial organization and insufficient sanitation services, have fostered conditions that facilitate mosquito breeding, creating a cyclical environment of outbreaks, epidemics, and endemicity [55].

Children are particularly vulnerable to dengue, Zika, chikungunya, and yellow fever [56]. In severe cases, dengue can cause life-threatening complications, including dengue hemorrhagic fever and dengue shock syndrome, which require intensive medical care and may lead to long-term health issues [56]. In children under 2 years old, the disease may begin unnoticed, with severe symptoms emerging subtly and sometimes representing the first clinical manifestation of the disease [57].

Children are also at increased risk of neurological complications from the Zika virus, as seen in the 2015–2016 epidemic in Brazil, when congenital Zika syndrome led to cases of microcephaly and other severe developmental conditions [58]. Neurological complications of chikungunya, including meningoencephalitis, seizures, and acute encephalopathy, also occur more often in children than adults [59,60].

Prevention and treatment options for arboviral diseases are limited. Brazil was the first country to incorporate the dengue vaccine Qdenga^® into its public health system. The vaccine is now available through SUS in regions with high dengue incidence and transmission, specifically targeting children and adolescents aged 10 to 14, a group identified by the Ministry of Health as having one of the highest hospitalization rates for dengue in recent years [61]. However, vaccine coverage remains low. Of the 4,792,411 doses distributed by the federal government to states and the Federal District since the vaccination campaign began in February 2024, only 2,341,449 doses (48.88%) had been administered through SUS by 15 September 2024. These data were presented by the director of the Brazilian Immunization Program at the 26th National Immunization Conference in Recife, Brazil.

To mitigate the spread and impact of arboviral diseases, it is essential to combine immediate responses with long-term planning. Immediate strategies include community education, vector control initiatives, and increasing awareness and accessibility of dengue vaccination. Enhanced forecasting capabilities can also help by enabling more efficient allocation of resources, focused vector control efforts, and targeted community awareness campaigns. Chen et al. (2024) [62] identified the Indian Ocean Basin-Wide index as a climate indicator for predicting the timing and scale of dengue outbreaks. This index, which measures sea surface temperature anomalies in the tropical Indian Ocean, impacts local temperature patterns, influencing mosquito breeding conditions and dengue transmission dynamics across both hemispheres. Such forecasting tools can extend the lead time for outbreak predictions, enabling public health authorities to respond to potential outbreaks with greater precision and effectiveness.

4. Food Systems, Climate Change, Food Security and Child Nutrition

Food systems include individual components, environmental factors, inputs, processes, infrastructure, and activities involved in the production, processing, distribution, preparation, and consumption of food. They encompass the socioeconomic and environmental outcomes of these activities and are shaped by natural conditions, as well as by historical, cultural, economic, and trade policies and practices. [63].

Central to sustainable food systems is the principle of food security, which goes beyond merely having access to sufficient food. It involves the right of all individuals to regular and reliable access to nutritious, culturally appropriate food, supported by practices that promote environmental, cultural, economic, and social sustainability [64].

As shown in Figure 3, food systems play a dual role in climate change: they are a contributor to its causes and a victim of its impacts. The dominant agricultural model, characterized by large-scale production, intensive use of fertilizers and pesticides, and monoculture focused on commodity crops, substantially contributes to greenhouse gas emissions. This model also drives deforestation, soil degradation, reduced pollination services, and land-use changes [65,66,67,68], all exacerbating global warming. On the other hand, rising temperatures, altered precipitation patterns, and an increased frequency of extreme events reduce the productivity of crops, livestock, fisheries, and aquaculture by impacting water availability and quality, causing heat stress, and altering pest and disease dynamics [69].

The consequences of this dynamic are becoming increasingly evident in Brazil, where climate change-related droughts have caused severe agricultural losses. In Pernambuco, bean and corn crops suffered losses of 99.4% and 99%, respectively, in 2012. Similarly, in Rio Grande do Norte, grain yields declined by up to 92.9% between 2012 and 2016. These challenges extend beyond rural areas, impacting urban centers like Belo Horizonte, Rio de Janeiro, and São Paulo, where agricultural prices rose by as much as 30% between 2014 and 2016, and crop yields dropped by up to 40% [65,70,71].

Kotz et al. (2024) [72] found that global warming and heat extremes lead to sustained food inflation over several months. Seasonal and regional variations in inflationary pressures revealed that areas with higher baseline temperatures are particularly vulnerable and that this effect is amplified during hot seasons [72]. Projections suggest that, by 2035, rising global temperatures could increase food inflation by approximately 1–3% annually, placing additional pressure on low-latitude regions with already warm climates [72].

With the price of nutritious foods rising, families are often forced to rely on cheaper, unhealthy options, which contributes to obesity, malnutrition, and related health issues among children. This shift is deeply connected with the rapid expansion of ultra-processed foods [73]. While convenient and widely accessible, the production and consumption of ultra-processed products come with significant costs. High in sugars, trans fats, and salt, and lacking essential nutrients, ultra-processed foods intensify childhood nutrition challenges [74,75]. Moreover, their production relies on resource-intensive ingredients such as palm oil, soy, and meat, which drive deforestation, biodiversity loss, and greenhouse gas emissions [76]. The environmental impact of ultra-processed foods is intensified by their packaging and distribution processes, which significantly contribute to plastic pollution and increase their ecological footprint [76,77].

Notably, the burden of poor nutrition disproportionately affects children and adolescents in Brazil. Data from the National Food Insecurity Survey in the Context of the COVID-19 Pandemic in Brazil (2021–2022) revealed an inverse relationship between the number of children in a household and its level of food security. Households with adults only showed the highest levels of food security (47.4%), whereas those with three or more residents under 18 years old exhibited the lowest rate (17.5%). Even families with only one child under 18 showed reduced food security (41.1%) compared to adult-only households. Importantly, food insecurity was more pronounced in the North and Northeast regions, rural areas, and Black and Brown households [78].

Food insecurity is frequently addressed in terms of its direct physical outcomes, such as malnutrition, stunted growth, and other health issues. An equally concerning but less visible impact is its effect on the psychological health of children. Studies show that children in food-insecure households experience behavioral issues [79,80,81,82], reduced social and emotional functioning [83,84], depression, and suicidal thoughts [82,85,86]. While the exact mechanisms behind these associations remain uncertain, these effects likely result from more than just nutritional deficiencies. Leung et al. (2021) [87] examined the psychological distress associated with food insecurity from children’s perspectives through in-depth qualitative interviews. Children reported six primary themes related to their psychological distress: concerns about food scarcity, worry over their parents’ well-being, anger and frustration about insufficient food, embarrassment about their family’s food situation, strain on family dynamics, and sadness due to lack of food.

These findings emphasize that food security is not only a matter of physical health but also of mental and emotional stability. Addressing the complex interplay of climate change, food security, and child health requires prioritizing sustainable farming practices, enhancing support for small farmers, and ensuring food systems are resilient and adaptable to a changing climate. Encouraging a diet rich in fresh or minimally processed foods is equally essential [88]. Moreover, taxing ultra-processed foods and implementing tax reforms to support basic food baskets can improve the accessibility of healthy food options for vulnerable populations. Together, these measures can protect children’s physical health, support their mental well-being, and foster long-term resilience to climate challenges.

5. Solutions and Intervention Models

Limiting greenhouse gas emissions remains a critical global target, with the Paris Agreement setting a limit of 1.5 °C on global temperature rise to prevent the most severe consequences [89]. Current projections indicate that temperatures may increase by up to 3.5 °C by 2100 without urgent interventions, leading to widespread ecological and social disruptions [89]. Brazilian policy, especially regarding land-use and forest management, plays a substantial role in this context. As one of the leading global emitters due to deforestation and land-use changes, Brazil’s commitment to reversing deforestation and restoring native vegetation could significantly impact emissions [90].

Soterroni et al. (2023) [91] showed that nature-based solutions, particularly stopping deforestation and promoting large-scale vegetation restoration, are Brazil’s most effective strategies for achieving its climate goals. These solutions alone could fulfill nearly 80% of Brazil’s net-zero commitments during the next 30 years, mitigating approximately 781 million tons of CO₂ annually without relying on expensive, less mature technologies like bioenergy with carbon capture and storage. This approach could lead Brazil toward net-zero emissions as early as 2040, highlighting the critical need for policies that go beyond the Forest Code, which, while important, covers only 38% of the necessary emissions gap to reach net zero by 2050. Strengthening legal frameworks to protect primary and secondary forests and overcoming political challenges are other essential initiatives to support forest conservation efforts [90,92].

Locally, educational programs can support children and their families by providing age-appropriate information on how to protect their health and well-being in a changing climate [93]. Health programs aimed at adaptation, such as those that provide resources for telehealth, can ensure healthcare access in remote areas while minimizing environmental costs [94]. Another important strategy involves investing in sustainable agricultural practices, including biodiversity preservation, soil quality improvement, and support for small farmers. This can reduce the pressure on food systems exacerbated by climate change [95,96].

Finally, addressing the climate crisis and its impact on child health requires confronting its structural root causes. Industrial systems driven by extractive models of capitalism, a relentless pursuit of economic growth, and concentrated global wealth (often within industries that disproportionately contribute to greenhouse gas emissions) are central to this crisis. Holding these actors accountable is essential for shifting policies and resources toward equitable, climate-resilient systems that protect the health and development of current and future generations. This requires implementing structural reforms that reorient economic incentives, regulatory frameworks, and investment priorities. For example, governments can begin by reducing fossil fuel subsidies and redirecting these resources toward the development of clean, renewable energy infrastructure, particularly in underserved and climate-vulnerable regions. Simultaneously, tax and regulatory mechanisms can be strategically leveraged to influence private sector behavior. By offering incentives for the adoption of low-carbon technologies, environmentally responsible sourcing, and sustainable production methods, governments can help shift corporate practices away from extractive and polluting models. Encouraging circular economy principles, such as reducing waste, reusing materials, and designing for sustainability, can further reduce the environmental footprint of industries.

To facilitate the translation of evidence into action,

Table 1. Strategies to mitigate the health impacts of climate change on children. High-priority actions (★★★) are those likely to produce broad and equitable improvements in child health outcomes. Intermediate-priority actions (★★) contribute meaning-fully to child health, but may require complementary policies or behavior change to achieve full impact.

Actor	Proposed Action	Pathways to Improve Child Health	Priority
Government	Enforce deforestation control and promote large-scale native vegetation restoration.	Reduce emissions; protect ecosystems essential for nutrition and air quality.	★★★
Government	Redirect policies and subsidies away from extractive economic models toward sustainable, equity-based development.	Address structural drivers of the climate crisis; promote equitable health and development.	★★★
Government	Tax ultra-processed foods and subsidize healthy, minimally processed options.	Improve nutrition and reduce the risk of diet-related diseases.	★★★
Government/Education system/Health professionals	Provide climate adaptation education.	Increase knowledge; support adaptive behaviors to reduce climate-related health risks.	★★
Government/Health sector	Expand access to climate-sensitive prenatal and pediatric care.	Address early vulnerabilities and reduce inequalities.	★★
Government	Strengthen community-based mental health support networks and emergency preparedness programs for children.	Reduce trauma-related effects from climate disasters; support emotional resilience.	★★
Public health authorities	Implement integrated strategies to prevent arboviral diseases, including community education, vector control initiatives, increased access to dengue vaccination, and the use of climate-based forecasting tools to guide interventions.	Reduces incidence and severity of dengue and other mosquito-borne diseases	★★★
Health sector	Train pediatricians to recognize and respond to climate-related health symptoms.	Ensure earlier detection and preventive care.	★★★
Family/caregiver	Promote dietary shifts toward fresh/minimally processed foods and reduce ultra-processed intake.	Support healthy growth and prevent malnutrition.	★★
Family/caregiver	Implement protective behaviors: hydration, reduced smoke exposure, indoor cooling.	Reduce the risk of heat illness and air pollution-related symptoms.	★★
Academia	Advance research on how climate policies influence child health outcomes and identify child-specific vulnerabilities	Inform more effective, evidence-based climate policies.	★★

summarizes key strategies to mitigate the health impacts of climate change on children. These recommendations outline who should act (e.g., government, health sector, family), the impact of the proposed action, and their relative priority. Priority levels were determined based on two criteria: (1) the action’s expected impact on child health; and (2) its capacity to address structural or systemic risk drivers.

6. Conclusions

From respiratory and neurological health to food security and mental well-being, children are particularly vulnerable to the adverse effects of climate change. Brazilian youth face unique risks due to the country’s geographic and socioeconomic conditions and the devastating effects of climate change on the region. Notably, much of Brazil, including the most populated areas, shows high socio-climatic vulnerability [97]. Addressing this crisis requires global commitments to limit greenhouse gas emissions and dedicated local efforts to build community resilience, especially through education, health programs, and sustainable practices.

Beyond the health implications, climate-related disruptions to child development carry substantial long-term economic and social costs. Malnutrition alone is estimated to cost the global economy US$3.5 trillion annually, or US$500 per person [98]. An additional $2 trillion per year is lost due to overweight and obesity [99]. Moreover, chronic health and developmental conditions arising in childhood can reduce educational attainment, increase the risk of social assistance dependence, and lower income in adulthood by as much as 15% [100]. These findings reinforce the urgency of early, integrated interventions that protect child health—not only as a moral imperative but also as a cost-effective strategy for sustainable development.

With around 1 billion children worldwide at extremely high risk of being affected by the climate crisis [101], decision-makers must balance immediate actions with a long-term vision. This approach will help protect all children, especially the most vulnerable, enabling them to thrive and lead meaningful lives today and in the future.