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How Emergency Preparedness Can Better Protect Children’s Health

September 23, 2024 | Justin McClain, Adrianna Evans

Adult holding a child's hand outdoors.

Disasters and public health emergencies can be dangerous and scary for everyone, but particularly children. Children may not fully understand the events happening around them or how to protect themselves. Any emergency that impacts adults will also impact children, but children may have different or additional needs. Because of this, children can have a higher risk of negative health outcomes during public health emergencies

Protecting children during a public health emergency requires planning for their unique needs that may be underprioritized in current planning efforts. Recent public health emergencies have highlighted a need for greater attention to this group. The COVID-19 pandemic impacted children’s health in a variety of ways including learning loss from school closures and the change to virtual teaching, increases in childhood obesity from a decrease in physical activity, and increased reports of family violence. Beyond the pandemic, other emergencies highlight the challenges faced by students. For example, students with disabilities may need additional support to stay safe during an emergency, so it is especially important that schools are prepared to address their needs.

ASTHO, in collaboration with the Administration for Strategic Preparedness and Response, hosted a listening session to discuss how to better prepare for the needs of children in future public health emergencies, particularly those that will emerge as priority threats in the next five years. Over 100 people attended, representing 50+ organizations from sectors including public health preparedness, environmental health, maternal and child health, epidemiology, pediatrics, nursing, emergency management, and more. Federal, state, territorial, and local levels of government were all represented in this discussion

Attendees discussed several key questions, such as the following:

  • What are the highest priority threats to children’s health that should be a focus of preparedness over the next five years?
  • What important policies, programs, and activities are needed to adequately prepare for these emergencies?

Attendees were also encouraged to discuss ways to consider health equity, mental health, climate change, and strategies such as telehealth, surveillance, medical countermeasures (MCMs), and more to address the questions above.

This blog post shares key takeaways and themes from the listening session that health agencies can apply to their preparedness practice.

Key Themes

Listening session attendees identified mental health, climate change, and gun violence as the top three priority threats to children’s health that health agencies should consider when developing and updating their emergency plans.

Mental Health

Children’s mental health was the most frequently identified priority threat in this conversation. During disasters, children may face an overwhelming sense of anxiety, frustration, or fear due to uncertainty and lack of control. They may lack knowledge of how to effectively cope with those feelings. Media can also impact mental health during disasters. Depending on the framing of content, children may experience reinforced or worsened fear and anxiety. Children may also face stigma around seeking mental healthcare. Even in the midst of several states implementing scholarships and career pathway programs to bolster the behavioral health workforce, access to providers is another challenge as over 70% of U.S. counties lack child and adolescent psychiatrists. Displacement and migration take a toll on children’s mental health. During these scenarios, children may lack a place to call home and lose a sense of belonging due to shifting schools, social circles, and communities.

Climate Change

This listening session took place a week after Earth’s hottest day on record and in the middle of what is shaping up to be the hottest year on record, so extreme heat was a prominent piece of the discussion. Schools without air conditioning may close on particularly hot days causing disruptions to education. Stronger and more frequent extreme weather events and disasters can increase the risk of school closures and temporary or permanent displacement. Additionally, climate change can increase the risk of vector-borne diseases as the geographic range of vectors, such as mosquitos and ticks, expands into new areas. 

For example, on June 25, 2024, CDC released a Health Alert Network Health Advisory noting an increased risk of dengue in the United States, which is typically uncommon in the continental United States and health providers may be unaccostomed to recognizing and diagnosing VBDs they haven't see before. Dengue has historically seen the highest burden of disease in children ages 11-19 and infants younger than one year old are among groups that are at highest risk of severe dengue. These examples point to a need to continually re-evaluate risks to children as climate change continues to shift the disaster landscape.

Gun Violence

Firearms are the leading cause of death for children. On top of the immediate physical health threats, listening session attendees emphasized the long-term mental health and educational consequences children may face following an active shooter situation or building lockdown. Children may also experience notable increases in stress, anxiety, and depression following active shooter drills in schools.

Other Threats

Alongside the prominent threats listed above, participants also discussed other challenges including countering mis- and disinformation on childhood vaccines and medical treatments, societal instability stemming from growing politicalization and distrust in government institutions, terrorism and extreme violence, supply chain disruptions for child-specific products (i.e., personal protective equipment, MCMs, baby formula, diapers) and cyberattacks that can leave hospitals without access to health records and expose the personal data of patients.

What Do Health Departments Need To Know?

This rich, cross-sector discussion also identified several strategies to better prepare for these emergencies. Health agencies can take ideas from this discussion and look to apply them to their preparedness planning.

Consistent Funding

Current preparedness funding strategies create a challenging environment for long-term planning. Funding available for preparedness tends to wax and wane depending on current events. During emergencies, there may be an influx of available funding for specific activities and/or populations. However, once the emergency ends, funding often dries up and may place a burden on previously allocated funds to continue basic functions. This current funding landscape is not conducive to long term capacity building for preparedness for children. Sustained funding that is dedicated to supporting children during emergencies will better enable health agencies to build expertise and capacity to support this population. Health agencies can braid and layer resources and staff with subject matter expertise in children to maximize available funding.

Inclusive Exercising

Health agencies are required to complete annual emergency exercises. Often, these exercises include members of the public but may not include children. It can be difficult to recruit and gain permission to include children; but without their participation, health agencies cannot understand if they have adequate protocols and resources in place for the unique needs of children. Partnering with community organizations such as Boys and Girls Clubs, local scout troops, or schools can provide a recruiting pool for exercises.

Data and Evidence

Children are biologically and cognitively distinct from adults, so they have different health needs during emergencies. MCMs, personal protective equipment, mental health services, and other health interventions need to be tailored to the needs of children. Health agencies need stronger evidence and data to provide direction on how response actions can best meet the needs of children. Better data collection, data sharing across sectors/government agencies, and stronger surveillance will strengthen this evidence base. Health agencies can consider adapting existing tools to monitor children’s health and using data sharing agreements with other agencies to gather the necessary data in a cost-effective way.

Training

Emergency response often requires a wide range of staff from across health agencies, healthcare, and other sectors, including those who may not have experience working with children. Training on the unique health needs of children can help to inform everyone involved and better prepare them to interact with children while working in a response capacity. For example, talking to children about a disaster can help them cope, but training may be needed to ensure the conversation is age-appropriate and conducive to their healing process. Health agencies can leverage internal staff or partners with expertise in the health needs of children like their local American Academy of Pediatrics Chapter to provide this training

Conclusion

Overall, the listening session discussion showed that the threat landscape over the next five years may not be dissimilar to current threats. Stakeholders have an opportunity to be proactive and build upon current planning work by adding in considerations tailored to the unique needs of children. ASTHO remains ready to assist health agencies to incorporate ideas from this listening session into existing preparedness plans and engage stakeholders to effectively protect children during public health emergencies.

Additional Resources