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. 2026 Jul 2;21(7):e0352978. doi: 10.1371/journal.pone.0352978

Health impacts of climate change on children and adolescents: A protocol for review of reviews

Rilwan Yahaya 1,*, Salifu Sharif Alhassan 1, Rosemary Sitsofe Ayebi-Arthur 1, Regina Boatemaa Berchie 1, Edward Wilson Ansah 1
Editor: LS Katrina Li2
PMCID: PMC13327113  PMID: 42391250

Abstract

Introduction

Climate change is a contemporary phenomenon of grave concern to global public health. Climate change events such as droughts, wildfires, tornadoes, heatwaves, floods, sea level rise, hurricanes, tropical cyclones, landslides, extreme rainfall, typhoons, dust storms, and desertification significantly affect local, regional, and global living conditions. In Sub-Saharan Africa, the most disturbing of these are desertification, droughts, and floods, which directly threaten water supplies, food security, and the livelihoods of millions of people. The climate crisis affects the health of older people, adults, children, and adolescents. However, climate-related events are gravely affecting the current and future health and well-being of children and adolescents. Although evidence exists, its integration is vital for policy and practice to protect children and adolescents in the ever-changing climate. Therefore, this review aims to map the existing reviews of the impact of climate change on the health and well-being of children and adolescents.

Method

This review will be conducted according to Arksey and O’Malley’s [36] recommendations and will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Scopus, JSTOR, Web of Science, PubMed, Embase and Cochrane Library will be searched to identify relevant records for inclusion in this review. Additional searches will be conducted in Google Scholar and Google for other relevant articles. The review protocol is registered at Open Science Framework: (https://doi.org/10.17605/OSF.IO/A7DEQ).

Analysis

Extracted data will be analysed using thematic content analysis, where data are summarised and qualitatively synthesized according to the recommendations of PRISMA-ScR and Tricco et al. [37]. The results and findings regarding the impacts of climate change on the health and safety of children and adolescents will be compiled, categorized, and presented using a qualitative narrative synthesis.

Introduction

Climate change has become a major global public health of the twenty-first century, affecting individuals of all age groups, from children to adolescents, to adults, and the elderly [1–3]. The present and future health and well-being of children and adolescents are disproportionally threatened by global climate change crisis [4], because children grow optimally in stable homes, communities, schools, and neighbourhoods [5], settings that are being compromised by the climate crisis.

Climate change refers to a gradual shift in atmospheric conditions, manifesting in extreme weather patterns, including rising temperatures, droughts, wildfires, tornadoes, heatwaves, floods, rising sea levels, hurricanes, tropical cyclones, landslides, extreme rainfall, typhoons, dust storms, desertification, food insecurity, and other phenomena that profoundly and negatively affect local, regional, and global living conditions [6,7].

Research indicates that the climate crisis is predominantly driven by human activities, including the burning of fossil fuels for energy production, industrial operations, rapid urban expansion, and large-scale deforestation, all of which are intensifying harmful changes in the Earth’s atmosphere [6–10]. The consequences of these activities are felt most by the very vulnerable people, such as children and adolescents.

The rate and severity of life-threatening weather events like droughts, storms, floods, heatwaves and wildfires have increased considerably owing to the adverse changing climate further causing community disruptions, property damage, climate-related illnesses, and fatalities, becoming more frequent, and intense [11–13]. For example, The 2023 wildfires in Hawaii and floods in Vermont demonstrated how climate change is intensifying the frequency and severity of extreme weather events, causing devastating impacts on lives, infrastructure, and the natural environment [13–15]. Climate change has already pushed over 600 million people, approximately 9% of the global population, outside the ‘human climatic niche’, the range of temperatures historically conducive to human settlement and wellbeing. Projections indicate that under current warming trajectories of approximately 2.7°C, between one and three billion people could be living outside these habitable climate conditions by the end of this century, facing escalating exposure to extreme heat, food insecurity, and potential displacement. [16,17]. Unfortunately, Children and adolescents are disproportionately vulnerable to the health impacts of climate change, as they are physically and physiologically less equipped than adults to withstand extreme weather events and climate-sensitive diseases such as cholera, malaria, dengue, and Zika. According to WHO estimates, children under five bear 88% of the global climate-related disease burden. [18–20].

Climate change significantly affects the well-being, health, and safety of adolescents and children because of their sensitivity to environmental risks. Damage sustained during these crucial periods may have long-term effects on them [19–22]. Moreover, children are particularly vulnerable to environmental changes because of their smaller stature, physiological and cognitive fragility, and complete reliance on caregivers for safety and protection [21,23]. Children have the right to survival, education, good health, quality nutrition, and welfare, recognized and upheld by the Sustainable Development Goals (SDGs) and the Convention on the Rights of the Child [22–25]. Unfortunately, climate events are threatening and undermining children’s and adolescents’ fundamental human rights. For example, Climate change contributes to increased risk of malaria transmission, childhood undernutrition, diarrheal disease, and adverse mental health outcomes. These climate-sensitive health risks are associated with higher under-five mortality and with rising rates of childhood wasting and stunting in vulnerable regions. [24–27].

Recent reviews demonstrate that climate change affects children’s health through both direct and indirect pathways, thereby increasing morbidity and mortality from climate-sensitive diseases [21,27–29]. Although these findings are significant, the evidence remains scattered and incomplete, making it hard to draw clear conclusions for policy and practice. Therefore, a comprehensive review of existing reviews is needed to better understand how the climate crisis affects the short- and long-term health of children and adolescents, and to guide future policies and interventions. A review of existing reviews is necessary to thoroughly examine the available evidence on how climate change affects the health of children and adolescents, helping to build a clearer and more complete picture to guide future research, policy, and practice. Fortunately, a number of scoping, narrative, and other forms of review have made meaningful contributions to the existing body of knowledge, offering preliminary insights into the impacts of climate change on the health and well-being of children and adolescents [21,27,28]. These reviews suggest that children and adolescents from low-income and vulnerable communities are most severely affected by climate change. In addition to physical health risks, climate change increases their likelihood of developing mental health problems, substance addiction, and suffering unintentional injuries [30–32].

Although research on climate change and child health is expanding, comprehensive, review-based syntheses remain limited [33,34], creating crucial gaps in the evidence. The health effects of climate change on children and adolescents have not been fully explored, especially for those in low- and middle-income countries (LMICs), and indigenous communities, who are often overlooked in existing reviews. While some reviews provide valuable evidence [24,27,28,35], differences in their methodologies hinder comparison and reduce their usefulness for policy and practice. Therefore, a review of reviews is needed to compile the current evidence into a clear, accessible resource for policymakers and practitioners and to systematically identify existing gaps. This will assist in establishing priorities for future research.

Protocols are an important approach to providing a comprehensive method for reviewing existing evidence. Protocols like the current one serve as methodological maps for the main review, which aims to aid future researchers who may want to replicate the study. When protocols are published, they help other researchers with similar ideas avoid duplicating existing reviews and instead identify gaps in the literature. Therefore, there is a need for up-to-date critical evidence to strengthen the case for research, policy, and evidence-based interventions that protect and promote the health, safety, and well-being of children and adolescents amid ever-worsening climate variability. Other researchers, government officials, and policymakers will find this helpful synthesis. The aim of the review is to gather current evidence from existing reviews on the effects of climate change on the well-being, health, and safety of children and adolescents.

Method and materials

This review of reviews follows the guidelines of Arksey and O’Malley [36]. The review includes the following steps: (1) identifying and stating research objectives; (2) identifying relevant studies; (3) study selection; (4) data collection; (5) data summary and synthesis of results; and (6) consultation. We report the results and findings of this review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) standards [37]. The review protocol is registered on the Open Science Framework (https://doi.org/10.17605/OSF.IO/A7DEQ).

The Arksey and O’Malley guidelines provide a clear, systematic methodological framework for conducting a scoping study and ensure thorough evaluation by requiring researchers to document their activities and decisions systematically [36]. The guidelines facilitate collaboration among researchers by providing a common framework and terminology for conducting and reporting scoping reviews. Arksey and O’Malley’s framework can be applied across a wide range of subjects, making it an excellent resource for researchers. These principles guide future research and policy decisions while emphasising the need to identify research gaps and areas that require further exploration. The guidelines also promote transparency in the review process, which could increase the validity and trustworthiness of review results [36].

Research questions

The review will be guided by the following three research questions: (1) What are the impacts of climate change on the health and safety of adolescents and children? (2) What factors make adolescents and children more vulnerable to climate change impacts? (3) What health promotion and public health interventions are available to protect adolescents and children from climate change impacts?

Search strategy

A comprehensive search will be conducted across six databases: Scopus, PubMed, Cochrane Library, Web of Science, JSTOR, and Embase. The goal is to identify relevant review articles for the current review. An additional search will be conducted in Google Scholar and Google for other relevant articles that could be selected for inclusion in the review. We developed a search strategy that used keywords, Medical Subject Headings (MeSH) terms, and controlled vocabularies for the initial PubMed search (see S1 Table in S1 File). After that, the search terms were modified to allow further database searches (Scopus, Web of Science, JSTOR, Embase, and Cochrane Library). This is necessary because each database has a unique search strategy that requires specific search terms to retrieve highly relevant results.

We intend to extract appropriate peer-reviewed English-language papers published after January 2000 to retrieve up-to-date, relevant articles for the current review. This is because, although climate change issues have been published for several decades, the popularity of health-related climate change literature has increased in recent years. The main study is expected to be completed by the end of June 2026. Details on the timeline can be found in S1 Appendix in S1 File.

Study selection

The retrieved records will be imported into Mendeley, where duplicate records will be removed. Moreover, a three-stage screening process will be applied to the remaining records to select appropriate published reviews for the study. First, six graduate students will screen the titles and abstracts of the retrieved records to identify full-text records for further screening. This stage of the screening will be supervised by authors RY and RSAA. The second stage will involve authors RBB, SSA, and RSAA searching the reference lists of selected full-text records to identify further pertinent articles for assessment. This is important because full-text articles are assumed to contain a highly relevant list of references that researchers can use to find additional articles for their current study. The third stage will involve independently screening the full-text records by two groups of authors (RY and SAA; RSAA and RBB), according to the eligibility criteria (See S2 Table in S1 File). These processes ensure that only the most relevant published evidence synthesis peer-reviewed articles are included in the current review. Additionally, there will be cross-over screening, where another group cross-checks the screening done by a group. This process helps to provide valid and reliable results and findings for the review. Led by author EWA, researchers will have weekly meetings to discuss the screening process, and any discrepancies will be resolved by consensus. See the PRISMA flow diagram that represents the selection process (See S1 Fig in S1 File).

Data extraction and charting

As in primary research, data extraction is a key component of conducting a systematic review. However, while a researcher may collect data in primary research, data extraction for a review requires multiple individuals. There is also a need to prepare, review, and pilot-test the data extraction sheet (See S2 Appendix in S1 File) in line with the study objective or research questions. The aims are to increase consistency in data extraction and improve study validity. It is important to note that the data extraction sheet is not fixed; it evolves as new variables arise while reading the selected articles.

Two authors (RY and RAT) will independently extract data, which will be reviewed by authors SSA and EWA to ensure data accuracy, reliability, and consistency. Author RY will extract data on authors, publication year, study objectives, and the type of review (systematic review, scoping review, rapid review, living systematic review, umbrella review, topical review, and others). Author RBB will gather data on climate change events (extreme heat, floods, droughts, etc.) and the effects of climate change on the health, safety, and well-being of adolescents and children from the selected review articles. Moreover, author RSAA will extract data on reported vulnerability factors and on health promotion or public health initiatives intended to protect adolescents and children from the negative impacts of climate change on their well-being and health. Authors will cross-validate the extractions performed by other authors, and author EWA will review the extracted data to finalise the dataset. The purpose of the review and cross-validation is to improve the consistency and reliability of the extracted data. This also helps ensure that the extracted data are complete and accurate and represent our stated research questions.

Quality assessment

Methodological quality assessment is important for the review articles that are selected and included in synthesised studies. Thus, we will use AMSTAR – a measurement tool to assess the methodological quality of the selected and included reviews [38]. AMSTAR is an 11-item validated quality appraisal instrument [39] for assessing published review papers. The 11-items for assessing review studies included; whether review questions and inclusion criteria established before the review; duplicate study selection and data extraction performed; comprehensive literature search performed; publication (i.e., grey literature) used as an inclusion criterion; list of studies (included and excluded) provided; characteristics of the included studies provided; scientific quality of the included studies assessed and documented; scientific quality of the included studies used appropriately in formulating conclusions; methods used to combine the findings of studies appropriate; likelihood of publication bias assessed; and whether conflict of interest stated [39]. Each of the 11-item assessment criteria is used to rate published review articles as Yes, No, I don’t know, or Not Applicable [39], which we applied to assess the quality of the included review articles.

To ensure reporting transparency and strict adherence to protocols, a finalised PRISMA-P 2015 checklist is provided for this scoping review of reviews examining the health impact of climate change on children and adolescents (See S3 Appendix).

Data analysis and synthesis

Extracted data will be analysed using thematic content analysis, where data are summarised and qualitatively synthesised according to the recommendations of Arksey and O’Malley [36] and PRISMA-ScR [37]. As a result, we will summarise, categorise, and present the results and findings on the interactions between climate change events and the health, safety, and well-being of children and adolescents. This is a methodical procedure in which the data is coded and categorised into themes and sub-themes in accordance with the stated questions [40,41]. The initially provided descriptive codes serve as the basis for creating more detailed codes to answer the stated research questions [41]. This approach aims to enhance understanding of how climate change events affect the health and well-being of children and adolescents, as reported in published review papers.

The findings from the analysis then allow us to synthesise, present, and provide an in-depth discussion to draw conclusions and recommendations concerning the effects of climate change on the health and well-being of children and adolescents, as well as the policy and practice relevance of the findings. Using a qualitative synthesis enables the researcher to explore the short- and long-term effects of climate distress on the health and well-being of children and adolescents. Besides, this qualitative synthesis and narrative analysis help distil the gap in the research literature and highlight the needed directions for future research, as discussed in our review of the findings.

Ethical approval and informed consent

Ethical approval is not required because no primary data will be collected and no patient involvement will occur. We expect to publish the findings of this article in a reputable journal and/or present them at climate change conferences and workshops. The protocol is registered with OSF (https://doi.org/10.17605/OSF.IO/A7DEQ).

Consultation

Consultations are important for carrying out scoping reviews. We consulted Dr Mustapha Amoadu, a Research Fellow, who also reviewed both the search teams and the search strategies and may review the extracted data. He is a review expert and a researcher in climate change and health. Additionally, we are consulting a chartered librarian at the Sam Jonah Library of the University of Cape Coast, who is helping to design the search and to locate relevant records.

Supporting information

S1 File. S1 Table.

This legend explains the search strategies used across six databases (PubMed, Web of Science, Scopus, JSTOR, Cochrane Library, Embase) for a scoping review on climate change impacts on children and adolescents. Core components: #1 = Climate change terminology (global warming, floods, droughts, air pollution, etc.) #2 = Health outcomes (disease, mental health, respiratory, cardiovascular, malnutrition, etc.) #3 = Pediatric populations (children, adolescents, youth, infants, schoolchildren). #4 = Review study types (systematic reviews, scoping reviews, meta-analyses, evidence syntheses). Combined logic: (#1 AND #2 AND #4 NOT animal) OR (#1 AND #3 AND #4 NOT animal). Technical elements explained: Field descriptors – How to search specific record sections (e.g., [tiab] = title/abstract, TS = topic search, [MeSH] = controlled vocabulary). Boolean operators – AND (narrow), OR (broaden), NOT (exclude). Wildcards – * for multiple characters (e.g., flood* catches flooding, floods, flooded). Filters: English language only, publications from 2000 onwards. S2 Table. This table presents the eligibility criteria for a scoping review on climate change’s health impacts on children and adolescents. Inclusion: Peer-reviewed reviews (scoping, systematic, rapid, etc.) published in English from 2000–2025 examining how climate change physically and mentally affects ages 0–19. Exclusion: Studies focused only on adults, grey literature, primary research, non-English publications, and incompatible review types (meta-analyses, reviews of reviews, etc.). S1 Fig. PRISMA flow diagram of the study selection process for identifying relevant review articles on the health impacts of climate change on children and adolescents. Records were identified by searching six electronic databases (Scopus, PubMed, Cochrane Library, Web of Science, JSTOR, and Embase), supplemented by searches of Google Scholar and Google. Following deduplication in Mendeley reference management software, records underwent three sequential screening stages: (1) title and abstract screening by six graduate students supervised by authors RY and RSAA; (2) reference list searching of eligible full-text records conducted by authors RBB, SSA, and RSAA; and (3) independent full-text screening by two author groups (RY and SAA; RSAA and RBB) against the pre-defined eligibility criteria. Cross-over screening and consensus-based resolution of discrepancies, led by author EWA, were applied throughout. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. S1 Appendix. Timelines for the review process. This table presents the planned schedule for each major phase of the scoping review of reviews on the health impacts of climate change on children and adolescents, from literature searching and proposal registration through to manuscript finalisation and journal submission, covering the period January to June 2026. S2 Appendix. Scoping Review Data Extraction Sheets. Sheet 1: Captures bibliographic details (authors, year, title) and methodological scope (databases, search dates, number of studies, climate exposures, research questions). Sheet 2: Extracts health outcomes (mental and physical), vulnerability factors, interventions/initiatives, evidence gaps, policy/research recommendations, and authors’.

(ZIP)

pone.0352978.s001.zip (133.2KB, zip)
S3 Appendix. A completed PRISMA-P 2015 checklist detailing protocol adherence and transparent reporting standards for this scoping review of reviews.

The checklist includes 17 items covering protocol registration, review rationale, objectives, eligibility criteria, information sources, data extraction methodology, and planned analyses, ensuring comprehensive and reproducible review conduct.

(DOCX)

pone.0352978.s002.docx (57.2KB, docx)

Acknowledgments

Dr Mustapha Amoadu of the Biomedical and Clinical Research Centre, UCC, for the input into the review. We are equally grateful to the librarian at the Sam Jonah Library who assisted us in designing our search terms.

Declarations: Patient and public involvement. This study has not involved, nor will it involve, any patients or members of the public in its design or implementation.

Data Availability

Materials used for this manuscript are included and available in the manuscript.

Funding Statement

The author(s) received no specific funding for this work.

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PLoS One. 2026 Jul 2;21(7):e0352978. doi: 10.1371/journal.pone.0352978.r001

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16 Jan 2026

Decision Letter 0

LS Katrina Li

6 May 2026

-->PONE-D-25-69159-->-->Health Impacts of Climate Change on Children and Adolescents: A Protocol for Review of Reviews-->-->PLOS One

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**********

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**********

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Reviewer #1: This will make a valuable contribution to the understanding of climate change and children's health. I am unclear if publication of the protocol is necessary or valuable prior to the review being completed.

The language is good but needs substantial revisions prior to publication. I am unable to name all the recommended changes due to number. The abstract and pages 8-10 need to be checked closely for grammar and fluency. I have listed below some specific comments, however these are not exhaustive.

Abstract-"Climate change events such as extreme heat, rising sea levels, floods, food insecurity, and others significantly affect local, regional, and global living conditions." These are not all "events"

"Therefore, this review aims to re-map the existing reviews of the impact of climate change on the health and well-being of children and adolescents." Have the reviews already been mapped? If not then this is a first "mapping" of all reviews rather than "re-map".

1. "Climate change refers to a gradual atmospheric shift"- I have not heard this description before. It may be accurate but I'm not certain.

References 5 and 6 likely should be national/international expert reports such as from IPCC/US National Climate Assessment rather than articles focused on single issue (agriculture) or by single author.

2. "Evidence suggests that the climate crisis is largely anthropogenic"- this should be more definitively stated. Per IPCC AR6 "Human activities, principally through emissions of greenhouse gases, have unequivocally

caused global warming"

3. "The rate and severity of life-threatening weather events..." the reference is only re extreme rainfall and drought, not the other listed weather events. Each of these events is different, and not all are increasing in both frequency and severity. References should support the statement for each listed event.

4. "the 2023 wildfires in Hawaii and the floods in Vermont were intense and frequent"-more frequent does not make sense here. It would be better to reference the article referenced by the book for this statement rather than the whole book.

5. Please confirm the accuracy of this statement. 3 billion is a high percentage of the world population. "Accordingly, heatwaves will displace up to three billion people by the end of this century [14]."

6. Page 9:"For example, the recent rise in malaria, malnutrition, diarrhea, mental health challenges, and

the risk of under-five mortality, as well as increases in wasting and stunting, are associated with climate change [21,23,24]." Are all of these increasing? I do not see that these references support the broad statement.

7. Page 9 is confusing for a variety of reasons.

- "implications for higher morbidity and mortality from various climate-related diseases"; "diseases" is not the correct term here, could be "conditions" to include injuries, interruption in education etc.

-"However, although these results are important, they are fragmented and limited in their collation of evidence, making it difficult to draw conclusions for policy and practice." It should be more explicitly explained why the prior reviews are insufficient and a new review is needed. This is unclear.

-"These reviews concluded that adolescents in vulnerable populations, especially those living in low-income areas, are disproportionately affected by climate change events." Only adolescents were found affected? What about younger children?

And per next sentence, are the effects mostly mental health? One referenced article (#27) is from 2014, well before the reviews were conducted.

-" The health impacts on adolescents and children in low- and middle-income countries (LMICs), indigenous communities, and individuals with preexisting health conditions are also not addressed in the existing reviews." What about ref #8?

I am unable to assess the methods due to lack of expertise. This should be assessed by a different reviewer.

Reviewer #2: Thank you for asking me to review this protocol. I would like to congratulate the authors on this interesting and important research topic. I have some suggestions for consideration.

• As you are proposed an umbrella review (review of reviews), shouldn’t that be a systematic review? What is your justification for your scoping review?

• There are a range of terms used when it comes to climate change such as planetary health, environmental sustainability, environmental change etc. It would be good to flag there and talk about how these align or vary across the overarching concept of climate change.

• Why particular focus on adolescents in the research question? Wouldn’t the broad term of “children” capture all (infants, toddlers, teenagers etc)?

• What is JSTOR?

• What about other databases such as CINAHL, Embase, Cochrane Library etc?

• Why the date limit from January 2020? Who says literature published since then is contemporary? What about December 2019?

• Will there be any other limits imposed such as language?

• Why not search organisational websites, forward and backward citation etc?

• Are you not using any keywords or subject headings for reviews?

• What is your understanding of grey literature as Google and Google Scholar are grey literature and you are planning on excluding grey literature?

• How will you account for the same publications appearing in multiple reviews? Are you planning on undertaking a CCA (the Corrected Covered Area (CCA) is a metric used in umbrella reviews to quantify the degree of overlap (shared primary studies) among multiple systematic reviews)?

**********

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Reviewer #2: No

**********

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PLoS One. 2026 Jul 2;21(7):e0352978. doi: 10.1371/journal.pone.0352978.r003

Author response to Decision Letter 1

15 Jun 2026

Response to Editor and Reviewers

Manuscript title: Health Impacts of Climate Change on Children and Adolescents: A Protocol for Review of Reviews

Journal: PLOS ONE

Manuscript ID: PONE-D-25-69159

Date: 30th May 2026

Dear Katrina Li,

Thank you for the opportunity to revise and resubmit our manuscript. We are grateful to the Editor and Reviewers for their thorough and constructive comments. The feedback has significantly strengthened the manuscript's rigor, clarity, and comprehensiveness.

Below, we provide a point-by-point response to each comment. All changes to the manuscript are indicated in the revised version. For ease of reference, each comment is reproduced in full, followed by our response and description of the corresponding revision.

REVIEWER #1: Comments and Responses

This will make a valuable contribution to the understanding of climate change and children's health. I am unclear if publication of the protocol is necessary or valuable prior to the review being completed.

1. The language is good but needs substantial revisions prior to publication. I am unable to name all the recommended changes due to number. The abstract and pages 8-10 need to be checked closely for grammar and fluency. I have listed below some specific comments, however these are not exhaustive.

Response 1

Issues with grammar and fluency in the Abstract and on pages 8-10 have been addressed.

2. Abstract-"Climate change events such as extreme heat, rising sea levels, floods, food insecurity, and others significantly affect local, regional, and global living conditions." These are not all "events"

Response 2

We have addressed this comment.

3. "Therefore, this review aims to re-map the existing reviews of the impact of climate change on the health and well-being of children and adolescents." Have the reviews already been mapped? If not then this is a first "mapping" of all reviews rather than "re-map".

"Climate change refers to a gradual atmospheric shift"- I have not heard this description before. It may be accurate but I'm not certain.

Response 3

We addressed the sentence on “remap” to reflect our intention of synthesizing existing revies.

Yes, our description of climate change is correct, but we provided further explanation for clarity.

4. References 5 and 6 likely should be national/international expert reports such as from IPCC/US National Climate Assessment rather than articles focused on single issue (agriculture) or by single author.

Response 4

References 5 and 6 have been improved to include expert reports.

5. "Evidence suggests that the climate crisis is largely anthropogenic"- this should be more definitively stated. Per IPCC AR6 "Human activities, principally through emissions of greenhouse gases, have unequivocally

caused global warming"

Response 5

This statement has been improved to address the concern raised.

6. "The rate and severity of life-threatening weather events..." the reference is only re extreme rainfall and drought, not the other listed weather events. Each of these events is different, and not all are increasing in both frequency and severity. References should support the statement for each listed event.

Response 6

More references have been added to support this statement.

7. "the 2023 wildfires in Hawaii and the floods in Vermont were intense and frequent"-more frequent does not make sense here. It would be better to reference the article referenced by the book for this statement rather than the whole book.

Response 7

The statement has been improved and an additional reference added.

8. Please confirm the accuracy of this statement. 3 billion is a high percentage of the world population. "Accordingly, heatwaves will displace up to three billion people by the end of this century [14]."

Response 8

The statements have been rephrased to clarify their accuracy.

9. Page 9:"For example, the recent rise in malaria, malnutrition, diarrhea, mental health challenges, and the risk of under-five mortality, as well as increases in wasting and stunting, are associated with climate change [21,23,24]." Are all of these increasing? I do not see that these references support the broad statement.

7. Page 9 is confusing for a variety of reasons.

- "implications for higher morbidity and mortality from various climate-related diseases"; "diseases" is not the correct term here, could be "conditions" to include injuries, interruption in education etc.

Response 9

The statement has been rephrased to ensure clarity, and another reference added.

10. "However, although these results are important, they are fragmented and limited in their collation of evidence, making it difficult to draw conclusions for policy and practice." It should be more explicitly explained why the prior reviews are insufficient and a new review is needed. This is unclear.

Response 10

The paragraph is comprehensively improved.

11. "These reviews concluded that adolescents in vulnerable populations, especially those living in low-income areas, are disproportionately affected by climate change events." Only adolescents were found affected? What about younger children?

And per next sentence, are the effects mostly mental health? One referenced article (#27) is from 2014, well before the reviews were conducted.

Response 11

These statements are revised to address the issue raised.

12. " The health impacts on adolescents and children in low- and middle-income countries (LMICs), indigenous communities, and individuals with preexisting health conditions are also not addressed in the existing reviews." What about ref #8?

Response 12

The statements have been rephrased to address the issues raised. We have removed ref #8 from this statement.

I am unable to assess the methods due to lack of expertise. This should be assessed by a different reviewer.

REVIEWER #2: Comments and Responses

Thank you for asking me to review this protocol. I would like to congratulate the authors on this interesting and important research topic. I have some suggestions for consideration.

1. As you have proposed an umbrella review (review of reviews), shouldn’t that be a systematic review? What is your justification for your scoping review?

Response 1

A scoping review of reviews is used because the aim is to map the breadth and scope of the existing review literature on the topic. It does not aim to synthesize conclusions or produce a definitive answer about effectiveness; it is exploratory rather than evaluative.

2. There are a range of terms used when it comes to climate change such as planetary health, environmental sustainability, environmental change etc. It would be good to flag there and talk about how these align or vary across the overarching concept of climate change.

Response 2

The suggested range of terms are included to avoid missing relevant reviews that use different but related terminology.

3. Why particular focus on adolescents in the research question? Wouldn’t the broad term of “children” capture all (infants, toddlers, teenagers etc)?

Response 3

The terms children and adolescents are used together throughout this work because their age ranges overlap across major international frameworks; the WHO and UNICEF define children as those below 18, while adolescents are defined as those aged 10 to 19. Since neither term alone adequately captures both groups in the literature, the two are used to ensure inclusive and accurate representation

4. What is JSTOR?

Response 4

Journal Storage (JSTOR) is a digital library and online database that provides access to thousands of academic journals, books, and primary sources across a wide range of disciplines, including the humanities, social sciences, and natural sciences. It is widely used by researchers, students, and educators for accessing peer-reviewed scholarly content.

5. What about other databases such as CINAHL, Embase, Cochrane Library etc?

Response 5

Six of the major databases were used; however, the Cochrane Library has been added to the list of databases to be searched.

6. Why the date limit from January 2020? Who says literature published since then is contemporary? What about December 2019?

Response 6

The search period is designed to capture reviews between January 2000 and December 2025. That is a period of 25 years.

7. Will there be any other limits imposed such as language?

Response 7

Yes, only reviews conducted in the English language will be considered.

8. Why not search organisational websites, forward and backward citation etc?

Response 8

The primary purpose of searching organizational websites (e.g., WHO, UNICEF, government ministries) is to retrieve reports, guidelines, and policy documents, content produced outside academic publishing pipelines and not peer-reviewed. This directly conflicts with the study's exclusion of grey literature.

9. Are you not using any keywords or subject headings for reviews?

Response 9

Keywords or subject headings for reviews have been included, and the search strategy has been improved.

10. What is your understanding of grey literature as Google and Google Scholar are grey literature and you are planning on excluding grey literature?

Response 10

Grey literature is any research work or information that has not undergone formal peer review or passed through traditional academic publishing channels. This study is a review of reviews; therefore, any research other than reviews is excluded. Similarly, reports, conference proceedings, and editorials are excluded.

11. How will you account for the same publications appearing in multiple reviews? Are you planning on undertaking a CCA (the Corrected Covered Area (CCA) is a metric used in umbrella reviews to quantify the degree of overlap (shared primary studies) among multiple systematic reviews)?

Response 11

The Corrected Covered Area (CCA) would not be used because this review does not focus on the individual studies included in the various reviews. It is aimed at mapping the breadth and scope of existing reviews to identify gaps, inconsistencies, and future research priorities.

We thank the reviewers.

Rilwan Yahaya

Corresponding Author

Attachment

Submitted filename: Response to Reviewers.docx

pone.0352978.s004.docx (22.1KB, docx)

Decision Letter 1

LS Katrina Li, LS Katrina Li

18 Jun 2026

Health Impacts of Climate Change on Children and Adolescents: A Protocol for Review of Reviews

PONE-D-25-69159R1

Dear Dr. YAHAYA,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

LS Katrina Li

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Acceptance letter

LS Katrina Li, LS Katrina Li

PONE-D-25-69159R1

PLOS One

Dear Dr. YAHAYA,

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Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    S1 File. S1 Table.

    This legend explains the search strategies used across six databases (PubMed, Web of Science, Scopus, JSTOR, Cochrane Library, Embase) for a scoping review on climate change impacts on children and adolescents. Core components: #1 = Climate change terminology (global warming, floods, droughts, air pollution, etc.) #2 = Health outcomes (disease, mental health, respiratory, cardiovascular, malnutrition, etc.) #3 = Pediatric populations (children, adolescents, youth, infants, schoolchildren). #4 = Review study types (systematic reviews, scoping reviews, meta-analyses, evidence syntheses). Combined logic: (#1 AND #2 AND #4 NOT animal) OR (#1 AND #3 AND #4 NOT animal). Technical elements explained: Field descriptors – How to search specific record sections (e.g., [tiab] = title/abstract, TS = topic search, [MeSH] = controlled vocabulary). Boolean operators – AND (narrow), OR (broaden), NOT (exclude). Wildcards – * for multiple characters (e.g., flood* catches flooding, floods, flooded). Filters: English language only, publications from 2000 onwards. S2 Table. This table presents the eligibility criteria for a scoping review on climate change’s health impacts on children and adolescents. Inclusion: Peer-reviewed reviews (scoping, systematic, rapid, etc.) published in English from 2000–2025 examining how climate change physically and mentally affects ages 0–19. Exclusion: Studies focused only on adults, grey literature, primary research, non-English publications, and incompatible review types (meta-analyses, reviews of reviews, etc.). S1 Fig. PRISMA flow diagram of the study selection process for identifying relevant review articles on the health impacts of climate change on children and adolescents. Records were identified by searching six electronic databases (Scopus, PubMed, Cochrane Library, Web of Science, JSTOR, and Embase), supplemented by searches of Google Scholar and Google. Following deduplication in Mendeley reference management software, records underwent three sequential screening stages: (1) title and abstract screening by six graduate students supervised by authors RY and RSAA; (2) reference list searching of eligible full-text records conducted by authors RBB, SSA, and RSAA; and (3) independent full-text screening by two author groups (RY and SAA; RSAA and RBB) against the pre-defined eligibility criteria. Cross-over screening and consensus-based resolution of discrepancies, led by author EWA, were applied throughout. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses. S1 Appendix. Timelines for the review process. This table presents the planned schedule for each major phase of the scoping review of reviews on the health impacts of climate change on children and adolescents, from literature searching and proposal registration through to manuscript finalisation and journal submission, covering the period January to June 2026. S2 Appendix. Scoping Review Data Extraction Sheets. Sheet 1: Captures bibliographic details (authors, year, title) and methodological scope (databases, search dates, number of studies, climate exposures, research questions). Sheet 2: Extracts health outcomes (mental and physical), vulnerability factors, interventions/initiatives, evidence gaps, policy/research recommendations, and authors’.

    (ZIP)

    pone.0352978.s001.zip (133.2KB, zip)
    S3 Appendix. A completed PRISMA-P 2015 checklist detailing protocol adherence and transparent reporting standards for this scoping review of reviews.

    The checklist includes 17 items covering protocol registration, review rationale, objectives, eligibility criteria, information sources, data extraction methodology, and planned analyses, ensuring comprehensive and reproducible review conduct.

    (DOCX)

    pone.0352978.s002.docx (57.2KB, docx)
    Attachment

    Submitted filename: Response to Reviewers.docx

    pone.0352978.s004.docx (22.1KB, docx)

    Data Availability Statement

    Materials used for this manuscript are included and available in the manuscript.

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