UCLA

In the U. S., predictive climate models indicate temperature increases of 1.7 to 6.7 °C by the year 2100 leading to additional deaths in vulnerable populations including infants and children (Smith, 2019). The World Health Organization predicts child mortality related to climate change will exceed 100,00 deaths per year by 2050 (Smith, 2019). Predicted increases in global temperatures intensify the urgent need to address environmental heat exposures that children encounter through microclimates such as unshaded play areas, and inside vehicles (Vanos, 2014). Young children, exposed to environmental heat inside of a vehicle, may overheat and experience Pediatric Vehicular Heatstroke (PVH) because of the inability to quickly thermoregulate in extreme heat. The National Highway Traffic Safety Administration (NHTSA) identified PVH as the leading cause of non-crash related vehicle fatalities for children under the age of 14 years in the U. S. (Glen et al., 2019). Currently, there are limited data to guide best approaches for increasing public health awareness and informing clinicians, community, and public health professionals how to promote child safety in relation to environmental heat. To address the need for information to guide best approaches for prevention strategies, this study used qualitative inductive content analysis. The specific aims were to: (1) explore perceptions of adult parents/caregivers about behaviors related to young children and adverse environmental heat, and (2) identify adult parents’/caregivers’ knowledge about adverse environmental heat and risks to health of children aged newborn to four-years. A public health model applied to prevent child maltreatment along with Haddon’s Matrix were used as a theoretical framework. Fourteen parents and two non-parent caregivers completed a short demographic survey and participated in a 40-60-minute semi-structured interview. Open-ended questions were asked about child safety, environmental heat exposures, and Pediatric Vehicular Heatstroke (PVH). The data analysis process utilized open coding, developing categories, abstraction, and memos. The perceptions of the parents and other caregivers of children were derived from the following five categories that emerged: 1) general child safety concerns, 2) physical location and scenarios for environmental heat exposure, 3) parental behaviors and observations, 4) parental experiences and anticipatory fears/feelings, and 5) thoughts about other parents/caregivers. Seven knowledge categories emerged: 1) general knowledge, 2) receiving information about PVH, 3) parents questioning and judging other parents, 4) parental accountability, 5) environmental concerns, 6) social support for parents, and 7) community partnering to increase awareness. Participants described child safety as an interconnection between home, public, and emotional spaces but did not spontaneously include weather-related heat environments when discussing providing safe environments for young children. They shared perceptions that: parenting can be overwhelming, stressful and full of distractions that may contribute to young children being left in hot environments. Overall, participants shared the perception that it is important for caregivers to receive emotional, physical and educational support to help prevent young children from being left unattended in cars or in unshaded areas on hot days. They also identified societal and cultural forces that may contribute to adverse environmental heat exposures of young children. Participants expressed having limited knowledge regarding heat exposure on children’s health and reported that news or social media was a main source for information about PVH. Overall, participants expressed the need for increasing public awareness and education about environmental heat and young children. Participants suggested partnering with pediatricians, pediatric nurses, community leaders, community organizations, and anyone who works with children. Parents/caregivers provided insights that could help develop strategies to prevent adverse environmental heat exposures in young children. Strategies to pursue include partnering with pediatric clinicians, community organizations, and public health officials to modify practice guidelines for well-baby/child check-ups to include a heat risk assessment, and information on heat microenvironments and PVH. Another strategy is to encourage political engagement to increase green spaces and shaded play areas for children. Policies could be instituted for employees at community parks and other outdoor spaces where children play to inform them about prevention of adverse heat exposures and how to communicate this information to parents/caregivers.