Children’s health: Why poor air quality matters for kids

When summer temperatures rise, many families look forward to spending more time outdoors. But along with sunny days can come another seasonal concern: poor air quality.

Wildfire smoke, ozone pollution, and other airborne particles can make the air unhealthy to breathe, even when the sky looks clear. For children whose lungs are still growing and developing, poor air quality can have a bigger impact than it does on adults.

“Children are more vulnerable when it comes to air pollution,” said Dr. Avani Shah, pediatric pulmonologist and medical director of the High-Risk Asthma Program at Lurie Children’s. “Their lungs are still developing and therefore more susceptible toxins. In addition, injury to the airways in childhood has the potential to have an impact on lung function in adulthood.”

Children are especially at risk because they spend more time playing outside. Exposure to poor air quality can irritate airways, trigger inflammation, and worsen existing respiratory conditions such as asthma, cystic fibrosis, and chronic lung diseases.

One of the most important tools parents can use to keep their child safe in unpredictable conditions is the Air Quality Index, or AQI. Developed by the Environmental Protection Agency, the AQI measures how clean or polluted the outdoor air is on a given day. The higher the number, the greater the health concern.

While healthy adults may not notice symptoms when air quality begins to decline, children can be affected sooner. Pediatric specialists generally recommend limiting prolonged outdoor activity once air quality reaches the orange category on the AQI scale.

Certain children face even greater risks.

For children with asthma, air pollution is one of the most common triggers for flare-ups. Even moderate air pollution can cause coughing, wheezing, or shortness of breath.

“We often see an increase in asthma symptoms when air quality worsens,” said Lauren Cullum, High-Risk Asthma Program coordinator and pulmonary nurse at Lurie Children’s. “Parents should make sure their child’s asthma action plan is up to date and that rescue medications are always available.”

Children with weakened immune systems, including those receiving chemotherapy, taking immune-suppressing medications or recovering from organ transplantation, may also be more vulnerable. Poor air quality can increase the risk of respiratory infections and other complications.

Parents should also know the signs that suggest air pollution may be affecting their child. Symptoms are not always severe and can sometimes be mistaken for seasonal allergies or a mild illness.

Warning signs include: frequent coughing, throat irritation, watery or itchy eyes, runny or stuffy nose, wheezing, shortness of breath, headaches, or unusual tiredness after outdoor activities.

“If your child seems more fatigued than usual after being outside or develops a cough without another obvious cause, poor air quality could be playing a role,” said Dr. Shah.

Fortunately, there are several simple steps families can take to reduce exposure to poor air quality.

Experts recommend checking local air quality each morning before making outdoor plans. Free resources such as AirNow.gov and air quality apps can provide real-time information and forecasts.

When air quality is poor, families should keep windows and doors closed and use air conditioning if available. Running a HEPA air purifier in bedrooms and other frequently used spaces can also help remove harmful particles from indoor air.

If outdoor activities are necessary, timing matters. Air pollution levels, especially ozone, are often lower in the morning and higher later in the day when temperatures rise.

“For children who need to be outdoors during smoky conditions, a properly fitted N95 or KN95 mask can provide protection,” said Alexandra Kacena, APRN-NP, nurse practitioner at Lurie Children’s High-Risk Asthma Program. “Cloth masks and standard surgical masks do not effectively filter the tiny particles found in wildfire smoke and other forms of air pollution.”

Parents of children with asthma should make sure daily controller medications are taken as prescribed and should not wait until symptoms worsen to act. Staying hydrated can also help keep airways moist and support the body’s natural defenses. It is also important to avoid using over-the-counter cough medications without talking to your child’s healthcare provider.

Schools can play an important role as well. Many school districts have policies that limit outdoor recess and sports when air quality reaches unhealthy levels. Parents may want to check with their child’s school to understand what procedures are in place. They can also ask their child’s doctor or healthcare provider to communicate with schools if their child is at higher risk.

While most children experience only mild symptoms from poor air quality, severe reactions can occur. Families should seek emergency medical care if a child has significant difficulty breathing, develops blue lips or fingernails, cannot speak because of breathlessness, or does not respond to rescue asthma medication.

As poor air quality events become more common across the country, experts say preparation is key.

“Try not to panic when air quality worsens,” said Dr. Shah. “By paying attention to reports and having a plan in place, you can help keep your children healthy and safe while still enjoying the summer season.”

• Children's health is a continuing series. This column was provided by Ann & Robert H. Lurie Children's Hospital of Chicago.