Climate change is driving a global increase in extreme weather events, with uncontrolled wildfire becoming more frequent and intense worldwide. These fires pose serious health risks to vulnerable populations, particularly children and older adults.

The Spanish Association of Pediatrics (AEP) has issued an urgent warning about the growing threat of wildfire smoke to pediatric and geriatric health, emphasizing the heightened susceptibility of individuals in these groups due to their physiological vulnerabilities and exposure patterns.

Ferran Campillo i López, MD, pediatrician in the Pediatric Environmental Health Unit at Fundació Hospital d’Olot i Comarcal de la Garrotxa in Olot, Spain, said, “Children are particularly vulnerable to wildfires because their respiratory and immune systems are still developing. Children inhale more air per kilogram of body weight than adults and spend more time outdoors. Detoxification capacity is limited, and reliance on adults for safe environments combined with lower awareness of risks further increases higher risk from wildfire smoke exposure.”

Campillo i López also coordinates the Environmental Health Working Group of the Catalan Society of Pediatrics and serves on the Environmental Health Committee, ie, Comité de Salud Medioambiental (CSM) of the AEP.

Children and adolescents remain at risk even far from wildfire zones as smoke and pollutants can travel hundreds of kilometers away.

In response to recent fires in northwest Spain, the AEP, through the CSM, published a technical report titled “Smoke from Forest Fires: A Growing Threat to Child and Youth Health,” Campillo i López said.

The report warns that wildfire smoke can cause both acute and chronic effects in children and adolescents. The report provides practical guidance and preventive measures to reduce exposure, based on a review of medical literature and resources from Pediatric Environmental Health units.

Health Implications

Smoke produced from burning large amounts of forest biomass “increases concentrations of pollutants — including fine and ultrafine particulate matter (PM_2.5 and PM₁), carbon monoxide, hydrogen cyanide, aldehydes, and other potentially carcinogenic volatile organic compounds,” said Campillo i López.

Exposure to these pollutants is linked to an increased risk for chronic illness, especially respiratory illness, due to irritation of the bronchi and alveoli and short-term impairment of lung function. Exposure to carbon monoxide or hydrogen cyanide can cause severe poisoning, with symptoms such as dizziness, headache, shortness of breath, drowsiness, changes in heart rate, seizures, coma, or death.

Smoke exposure has been linked to the worsening of conditions such as asthma and allergic rhinitis and an increase in acute respiratory infections and hospitalizations after smoke exposure. Early recognition and treatment are crucial to prevent life-threatening and long-term neurodevelopmental consequences, including difficulties with concentration and memory, as well as an increased risk for sleep disorders and mental health conditions.

Other health complications from wildfires include burns from direct contact with flames or nearby hot objects, mucous membrane irritation such as conjunctivitis (itchy, red, watery eyes, and a gritty sensation), coughing, hoarseness, and increased secretions, sometimes dark.

Long-term or repeated exposure to wildfire smoke can trigger chronic inflammation, particularly affecting the respiratory and cardiovascular systems and increasing the risk of developing asthma and other respiratory diseases.

Such exposure can also impair immune defenses by disrupting natural protective mechanisms and may cause neurotoxic effects that interfere with neurological development and mental health.

“As with other disasters, mental health consequences such as anxiety and posttraumatic stress disorder have been observed, especially in children and adolescents, along with an increased cardiovascular risk that can persist into adulthood,” said Campillo i López.

Prevention remains central to reducing these risks.

The CSM of the AEP outlined 10 safety recommendations for families and healthcare professionals to reduce health risks from wildfire smoke exposure:

• Follow alerts: Stay updated through civil protection and emergency services. Keep local emergency numbers accessible.
• Check air quality: Verify the Air Quality Index through official websites, apps, or national monitoring platforms.
• Improve indoor air quality: Keep windows and doors closed, use high-efficiency air purifiers, and set air conditioning for recirculation.
• Avoid indoor pollution: Do not smoke or use wood stoves, gas appliances, candles, or barbecues during smoke exposure.
• Use face masks: Filtering Face Piece 2 masks can help reduce exposure to particulate matter. These are suitable for children aged ≥ 2 years, if tolerated.
• Prepare supplies: Stock water, nonperishable food, and rescue medications for chronic conditions such as asthma. Consult a pediatrician if needed.
• Evacuate if necessary: Follow official recommendations or leave if home conditions are unsafe and move to designated shelters with air conditioning and filtered air.
• Watch for poisoning: Smoke exposure can cause carbon monoxide or hydrogen cyanide poisoning. Signs include dizziness, drowsiness, difficulty breathing, and behavioral changes. Seek emergency care immediately.
• Check before returning: Ensure that your home is safe, essential services such as water and electricity are available, and clean thoroughly before allowing children to return.
• Support mental health: Fires can have lasting psychological effects on children. Monitor emotional or behavioral changes, and seek professional help if necessary.

The recommendations are available for professionals (@aepediatria) and families (@AEP_EnFamilia, Instagram: @enfamiliaaep), concluded Campillo i López.

This story was translated from Univadis Spain.