Strategies and interventions to reduce children’s vulnerability to climate change: a scoping review

Abstract

Background

Climate change presents serious risks to children’s health worldwide, highlighting the need for effective interventions. This study aimed to map and categorize strategies that reduce the health impacts of climate change on children.

Methods

A scoping review was conducted following the Arksey and O’Malley framework. A systematic search of PubMed and Scopus identified peer-reviewed studies published in English between 2015 and 2025. Studies focusing on children and adolescents (0–18 years) and reporting climate-related health interventions, strategies, or policy responses were eligible for inclusion.

Results

A total of 33 studies met the inclusion criteria. Identified interventions were categorized into seven groups: preventive, adaptive, integrated preventive–adaptive, community-based, educational and awareness-based, mental health resilience, and disaster preparedness interventions. Most studies focused on preventive strategies, particularly those addressing exposure to air pollution, heat, and vector-borne diseases. Community-level interventions were predominant, while individual-level, structural, and mental health–focused strategies were less frequently reported. Methodological rigor varied across studies, with economic modeling approaches generally providing stronger evidence than many behavioral or community-based programs. Significant evidence gaps were identified, particularly concerning infants, marginalized populations, and urban poor children.

Conclusions

Current evidence highlights a predominance of preventive and community-based approaches to reducing children’s vulnerability to climate change, alongside notable gaps in equity-focused and mental health interventions. More integrated, multi-level strategies supported by standardized evaluation frameworks are needed to strengthen the effectiveness and equity of climate-related health interventions for children.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-026-27472-4.

Introduction

Climate change is widely acknowledged as one of the defining global challenges of the twenty-first century, with complex and far-reaching consequences that disproportionately affect vulnerable populations [9, 15, 18]. Among these, children represent one of the most at-risk groups due to their physiological and cognitive immaturity, limited adaptive capacity, and reliance on adult protection [4, 6, 31, 45]. The impacts of climate change on children are multifaceted, including direct threats, such as exposure to extreme weather events and vector-borne diseases, as well as indirect consequences like food insecurity, displacement, disrupted education, and increased psychological stress [23, 37, 40]. According to the United Nations Children’s Fund (UNICEF), nearly one billion children, approximately half of the global child population, are at “extremely high risk” from climate change effects [38]. This crisis extends beyond environmental concerns, encompassing critical issues of child rights, public health, and sustainable development [49]. Over the last decade, research has increasingly explored the intersection between climate change and child well-being, emphasizing the urgent need for targeted, evidence-based, and equity-centered responses [7, 37, 39]. In response, international frameworks such as the Sendai Framework for Disaster Risk Reduction, the Paris Agreement, and the United Nations Sustainable Development Goals (SDGs) have acknowledged the unique vulnerability of children and emphasized the need for inclusive, equitable, and child-sensitive climate action [11, 12, 20, 50]. Despite these policy commitments, current interventions often remain fragmented, reactive, and inadequately tailored to address children’s specific needs and rights [29]. Moreover, there is considerable variability in how countries integrate child-centered considerations into climate policies, and little is known about the effectiveness, scalability, or geographic distribution of existing strategies [5]. To address this critical gap, this scoping review systematically maps and characterizes the existing evidence by identifying climate change-related risk factors affecting children, associated health outcomes, and the characteristics of strategies, policies, and interventions aimed at reducing children’s vulnerability. By providing a comprehensive overview across geographical regions and sectors—including health, education, urban planning, and disaster risk reduction—this review identifies prevailing patterns, highlights evidence gaps, and informs the development of effective, equitable, and child-centered climate adaptation and mitigation policies. Understanding the current landscape of child-focused climate initiatives is essential to both minimizing adverse impacts and empowering children as active participants in building climate-resilient societies.

Materials & methods

A scoping review was conducted following the initial five stages outlined by Arksey and O’Malley: (1) formulating the research question, (2) identifying relevant studies, (3) selecting studies, (4) charting the data, and (5) collating, summarizing, and reporting the findings [2].

Identifying the research question

The search aimed to address the following research questions:

1. What strategies and interventions currently exist to reduce children’s vulnerability to the effects of climate change?

2. What are the prevailing patterns and trends in these initiatives regarding sectoral focus and levels of implementation over the past decade?

3. Which gaps exist within the current evidence and practice landscape that need to be addressed to inform the development of effective, equitable, and child-sensitive climate strategies and interventions?

Identifying relevant studies

This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PRISMA flow diagram summarizing the identification, screening, eligibility assessment, and inclusion processes is presented in Fig. 1. A comprehensive and systematically structured literature search was undertaken across two major electronic databases—PubMed and Scopus—to identify recent, high-quality primary studies addressing children’s vulnerability to climate-related health risks and associated interventions or policy responses.

Fig. 1.

Prisma flowchart of the study selection process

The search covered publications from January 2015 to June 2025, ensuring the inclusion of contemporary evidence aligned with recent climate dynamics and evolving public health strategies. In PubMed, a rigorously developed Boolean search strategy incorporating both MeSH terms and free-text keywords was applied across three core conceptual domains:

1. climate change–related health risks or vulnerabilities,

2. pediatric populations, and

3. intervention strategies, programmes, or policy responses.

Filters were applied to exclude review articles (systematic, narrative, or meta-analytic) as well as studies primarily examining pregnancy, fetal, or maternal outcomes. This search yielded 235 unique records. A parallel search in Scopus was conducted using TITLE-ABS keyword combinations, restricted to peer-reviewed journal articles published in English and excluding review articles and research focusing on maternal or prenatal health. The Scopus search generated 358 records. The full search strategy for each database is provided in Supplementary File 1.

To ensure methodological transparency and reproducibility, explicit inclusion and exclusion criteria were defined a priori as follows:

Inclusion criteria

Studies were eligible for inclusion if they met all of the following conditions:

• Primary empirical research, including quantitative, qualitative, or mixed-methods designs.

• Focused on children or adolescents aged 0–18 years.

• Examined climate change–related exposures, such as heat, air pollution, extreme weather events, or environmental changes attributable to climate variability.

• Reported interventions, strategies, programmes, policies, or response mechanisms designed to address health-related vulnerabilities or risks.

• Published in peer-reviewed journals.

• Published in English between 2015 and 2025.

Exclusion criteria

Studies were excluded if they met any of the following conditions:

• Classified as review articles, including systematic reviews, narrative reviews, scoping reviews, or meta-analyses.

• Primarily focused on pregnancy, fetal development, perinatal outcomes, or maternal health.

• Lacked an explicit reference to climate change or climate-related environmental determinants.

• Represented non-primary sources, such as commentaries, editorials, letters, or conference abstracts.

• Published prior to 2015 or not accessible in full text.

Study selection

A total of 593 records were retrieved. After removing 230 duplicates, 363 articles were screened by title and abstract. Of these, 222 were excluded. Ultimately, 141 articles were retrieved for eligibility. The articles were divided among two authors (NT& HJ) for full article review. Several articles were excluded at this stage for not being primary studies, not mentioning climate change, or being outside the inclusion timeframe. Decisions to exclude were reviewed by at least one other member of the research team. Finally, 33 articles were selected for detailed review and analysis.

Data extraction table

A data extraction table was developed following the scoping review framework to systematically capture key variables from each included study. The extracted information comprised: article identification, title, authors, publication year, study location, type of climate exposure (e.g., air pollution, heatwaves), associated health conditions and outcomes, demographic details (such as age and gender), nature and content of interventions or strategies, reported results, study design, level of intervention, primary objectives, target populations, evidence-based status of interventions, intended policymakers or organizations, financial and infrastructural factors, and assessments of effectiveness. Additionally, the table recorded whether each study addressed climate change and child health directly or indirectly. Data extraction was independently performed by at least two reviewers (NT, SZ, SHN, KM), with any disagreements resolved through consultation with a third reviewer to reach consensus. This approach ensured a structured and comprehensive analysis of the findings. The detailed data extraction table is provided in Supplementary File 2.

Results

Geographical distribution of studies

Figure 2 illustrates the scope of the reviewed studies. The selected articles cover a wide range of countries and regions, with a strong presence from the United States and other high-income countries (e.g. [3, 9, 10, 13]). However, a substantial number of studies from developing countries, particularly in Asia and Africa, highlight growing attention to climate vulnerability in these regions (e.g. [22, 32, 48]). This diversity offers a valuable foundation for international comparison, identification of intervention models, and policy analysis.

Fig. 2.

Geographical distribution of the included studies. Note: One study, conducted by researchers from Cameroon, included data from 107 countries

Study design

A total of 33 studies were included in the scoping review and were categorized according to their primary study design. The most common study designs were qualitative research and quantitative/statistical analyses, each represented in 4 studies (11.8%). Qualitative approaches, such as in-depth interviews and focus group discussions, were particularly employed to explore perceptions, community experiences, and social determinants related to climate and health [3, 5, 16, 17, 42]. Conversely, quantitative analyses often involve regression modeling, climatic datasets, and health indicators to establish statistical associations and trends. Experimental or interventional studies accounted for 17.64% (n = 6) of the included research, comprising randomized controlled trials (RCTs), factorial experiments, and pre-post interventional assessments [1, 9, 25, 26, 32, 46]. These designs were instrumental in evaluating the effectiveness of specific interventions, such as behavior change strategies, health system responses, or adaptive practices in response to environmental hazards. Survey-based or empirical research designs were observed in three studies (8.8%), reflecting a reliance on primary data collection through structured questionnaires and fieldwork [27, 35, 36]. Participatory and community-based approaches accounted for 5.8%, highlighting the importance of stakeholder engagement and local knowledge in understanding vulnerabilities and adaptive capacities [48]. A similar proportion (5.8%) used mixed-methods approaches [7, 23], providing integrated quantitative and qualitative insights, while an additional 5.8% consisted of case studies focusing on location-specific interventions or climate–health interactions [34, 41]. Likewise, economic evaluations and health impact assessments (HIAs) represented 5.8% of the included studies, emphasizing efforts to quantify health co-benefits or model policy impacts [10, 13]. Only one study (2.9%) employed a simulation model-a microsimulation of labor market and health inequalities [19], and another (2.9%) was a conceptual or theoretical commentary [28]. Notably, four studies (11.8%) did not clearly align with a conventional study design and were therefore categorized as unconventional or unspecified. These included real-time monitoring approaches, prototype frameworks, and hybrid assessments [6, 7, 15, 40]. The findings reveal a diverse methodological landscape, indicative of the interdisciplinary nature of research at the intersection of climate, environment, and health. The relatively balanced representation of qualitative and quantitative approaches reflects the dual necessity of capturing both measurable impacts and the socio-cultural dimensions of climate-related challenges. Similarly, the small number of model-based and economic evaluation studies highlights the need for further work in predicting, policy modeling, and cost-effectiveness analysis, key areas for informing climate-resilient health systems. Moreover, the presence of unconventional and unspecified designs points to a methodological fluidity in the field, which, although potentially innovative, may hinder systematic evidence synthesis if study designs are not clearly articulated.

Target populations of strategies

It is important to note that several studies addressed more than one target group, resulting in overlapping classifications. Children (general) accounted for 20.6% (n = 7) of the studies, making them the most frequently targeted population [6, 10, 14, 27, 35, 47]. These studies generally addressed children’s vulnerabilities without further specifying age groups or socio-economic conditions. This broad categorization reflects the widespread recognition of children as a universally at-risk population in climate change and disaster preparedness interventions. However, the lack of granularity may limit the effectiveness of interventions tailored to specific subgroups, such as preschool versus school-aged children. Vulnerable children, including those affected by poverty, disabilities, or conflict, comprised 17.6% (n = 6) of the studies [7, 8, 19, 20, 28, 40]. These investigations explicitly focused on children living under adverse conditions, often incorporating tailored strategies addressing education, healthcare access, and social support within marginalized communities. This trend underscores a growing awareness of intersectional vulnerabilities, where risk is shaped not only by age but also by socioeconomic and political factors. Nevertheless, more detailed approaches, such as disability-specific interventions, remain underdeveloped. Children under five years of age represented 2.9% (n = 3) of the reviewed studies [19, 20, 44]. This group is particularly physiologically vulnerable, with interventions frequently centered on maternal and child health in contexts such as climate-induced food insecurity and increased disease exposure. Despite their recognized public health importance, the relatively low representation of this age group highlights a gap in the development of focused, age-appropriate disaster risk reduction (DRR) strategies [44]. School-aged children were the focus of 17.6% (n = 6) of the studies, with interventions frequently delivered through educational institutions [15–17, 21, 23, 26, 44, 48]. These included disaster preparedness education, management of asthma triggered by environmental factors, and climate change awareness programs. Schools provide structured and scalable platforms for intervention delivery; however, there is scope for stronger integration with formal education systems and for evaluating long-term outcomes related to knowledge retention and behavior change. Adolescents aged 12–18 years also comprised 15.2% (n = 5) of the studies, which primarily targeted resilience building, psychosocial adaptation, and gender-specific vulnerabilities to climate impacts [24, 33, 36, 41]. Adolescents were recognized as both a vulnerable group and a potential agent of change. Although the attention given to this group is encouraging, many interventions lack developmentally appropriate psychological and cognitive frameworks that distinguish adolescents’ unique needs. Social and gender vulnerabilities, particularly among young women, were explicitly addressed in 2.9% (n = 3) of the studies [3, 5, 36]. These investigations often focused on reproductive health, empowerment, and gender-sensitive climate adaptation strategies. This reflects an increasing emphasis on gender-responsive disaster risk reduction, although such approaches remain comparatively underrepresented. The observed overlap with adolescent-focused studies suggests the importance of integrated frameworks that account for intersecting factors such as age, gender, and sociocultural context. Households and families accounted for 14.7% (n = 5) of the targeted population [36]. These studies highlighted the family unit’s role in modeling behaviors and decision-making processes related to disaster preparedness. While household-level interventions offer scalability, they risk diluting the specific needs of individual members, such as children or older adults, unless disaggregated analyses are conducted. Combining household-level strategies with school- or community-based approaches may enhance overall intervention efficacy. Cross-generational interventions targeting children alongside adults or elderly populations accounted for 5.8% (n = 2) of the studies [1, 13]. These approaches aimed to engage communities broadly, often in areas affected by environmental hazards like air pollution. While this inclusive targeting can foster community-wide engagement, it may inadvertently obscure the specific vulnerabilities and needs unique to different age groups, underscoring the need for age-differentiated program components within a shared framework. Urban poor and residents of informal settlements were the focus of only 2.9% (n = 1) of the studies, representing a notably under-researched population given the escalating climate risks they face, such as flooding and urban heat islands [30]. This indicates a significant gap in research and intervention efforts tailored to spatially and infrastructurally disadvantaged populations. Finally, broadly defined marginalized groups appeared in 5.8% (n = 2) of studies, where terms such as “vulnerable groups” were used without clear operational definitions [3, 34]. This lack of specificity limits the applicability and replicability of findings. Future research should prioritize clear inclusion criteria and contextual descriptions to enhance policy relevance and scientific rigor. Children, particularly in general terms and within school settings, remain a central focus in disaster and climate-related intervention strategies. There is growing recognition of layered vulnerabilities, combining age, socioeconomic status, and gender, yet the operationalization of intersectionality remains inconsistent across studies. Notably, critical groups such as urban poor populations, infants, and the elderly are underrepresented, highlighting an urgent need for targeted, equity-focused research and programming. To advance the field, future interventions should incorporate precise definitions of target populations and develop tailored approaches that address overlapping vulnerabilities within diverse social contexts.

Climate change exposure types and related health effects

Climate change manifests through diverse environmental exposures, each of which can have profound and distinct impacts on human health. These exposures, ranging from extreme heat and air pollution to sea-level rise, contribute to a wide spectrum of health outcomes, including both physical and mental effects. The extent and type of health implications vary depending on the nature and intensity of exposure, as well as the vulnerability of affected populations.

Air pollution exposure

Air pollution, particularly from particulate matter such as PM_2.5 and PM₁₀, ambient and household air pollution, emerges as a prominent climate change-related exposure that adversely affects respiratory health in children and vulnerable populations. Studies consistently report increased risks of asthma exacerbations, respiratory infections, and adverse birth outcomes, including low birth weight and stunting [10, 19]. Interventions reducing air pollution, such as transitioning to electric school buses, demonstrated significant improvements in health outcomes, underscoring the co-benefits of climate mitigation strategies on public health [13]. This aligns with global evidence linking air pollution exposure to morbidity and mortality, particularly in urban environments experiencing climate-related increases in particulate pollution [1, 9]. The Mitigating the Health Effects of Desert Dust Storms Using Exposure-Reduction Approaches (MEDEA RCT) further showed that combined outdoor and indoor exposure reduction significantly improved asthma control and lung function in primary school children with asthma in Cyprus and Greece [26].

Heatwave exposure

Exposure to elevated ambient temperatures and heatwaves has multifaceted health impacts, with children identified as particularly vulnerable to dehydration, heat exhaustion, and related complications [8]. Maternal exposure to heat stress is linked to increased risks of preterm birth and intrauterine growth restriction, leading to low birth weight and infant morbidity [22]. Furthermore, heatwaves contribute to psychological distress and school absenteeism, reflecting both physical and mental health burdens [27]. These findings emphasize the need for heat adaptation strategies targeting vulnerable groups, especially children and pregnant women, to mitigate these risks in warming climates [14].

Droughts exposure

Droughts significantly impact child nutrition and growth, often exacerbating malnutrition and stunting rates by compromising food security and water availability [7, 20]. The synergistic effects of drought and socio-economic stressors increase risks of maternal health decline and interrupted family planning, disproportionately affecting women and adolescents [15]. These results align with global research identifying drought as a critical climate hazard with far-reaching implications on child health, particularly in low-resource settings dependent on rain-fed agriculture [23, 34].

Floods exposure

Flood events linked to climate change increase the incidence of waterborne diseases and disrupt access to safe drinking water and sanitation facilities, heightening infection risks among children [3, 16, 17]. Additionally, floods pose direct physical risks and disrupt community infrastructure, which can lead to psychological stress and mental health challenges [30, 35]. Effective evacuation strategies and community preparedness have shown promise in reducing adverse outcomes, underscoring the importance of integrating disaster risk reduction with climate adaptation measures [28].

Extreme weather events exposure

Extreme weather phenomena such as cyclones and bushfires, increasingly frequent due to climate change, present complex health risks, including physical injuries, displacement, and long-term mental health sequelae like anxiety and post-traumatic stress disorder (PTSD) in affected populations [15, 28, 41]. The psychological burden is particularly pronounced in children, who may also face disruptions in education and social development [47]. Community engagement and advocacy have been effective in enhancing resilience and promoting recovery in disaster-prone regions [41].

Water and food security exposure

Climate-driven water scarcity and contamination contribute to the increased prevalence of waterborne diseases and compromised hygiene conditions [3, 16, 17]. The resulting health impacts include diarrheal diseases and other infections, especially in children with limited access to safe water. Integrated water, sanitation, and hygiene (WASH) interventions are vital to mitigate these risks [16, 17].

In parallel, climate‑induced shifts in agricultural productivity worsen food insecurity, contributing to undernutrition, anaemia, and heightened susceptibility to infectious diseases in children [34, 44]. These health challenges are further shaped by socio‑economic conditions influencing household adaptive capacity and nutritional outcomes. Moreover, reduced food security indirectly drives adverse social consequences—such as increased school dropout rates and child marriage—which in turn have additional negative impacts on child health and overall well‑being [23].

Sea-level rise exposure

Coastal communities face displacement and environmental degradation linked to sea-level rise, which disrupts livelihoods and access to health services [42]. Such disruptions can have cascading effects on physical and mental health, underscoring the need for tailored adaptation strategies in island and coastal settings.

General or mixed climate vulnerability exposure

Some studies emphasize the cumulative and intersecting effects of multiple climate exposures on child health, including increased infant mortality and reduced immunization coverage in highly vulnerable populations [20, 46]. These findings highlight the importance of multisectoral approaches that address complex vulnerability contexts rather than single exposure pathways.

Overall, the reviewed literature illustrates diverse and interconnected pathways through which climate change exposures adversely impact child and adolescent health. Respiratory, nutritional, mental health, infectious disease, and social developmental outcomes are repeatedly affected across multiple exposure types, with some interventions demonstrating promising co-benefits for health and climate mitigation. This evidence base reinforces the urgency of integrating health considerations into climate policy and adaptation planning, prioritizing vulnerable groups, particularly children, pregnant women, and marginalized communities.

Intervention strategies to mitigate the health impacts of climate change on children

The reviewed literature highlights a diverse range of interventions developed to mitigate the health effects of climate change on children. These interventions can be organized into seven primary categories based on their strategic orientation and implementation approach (Fig. 3). The description of intervention strategies to mitigate the health impacts of climate change on children is provided in Supplementary File 3. Preventive measures are the most commonly reported interventions. They seek to minimize children’s exposure to climate-related hazards such as air pollution, extreme heat, and vector-borne diseases, while also addressing malnutrition and food insecurity [6–8, 10, 13, 19, 27, 33, 40, 41, 44]. These strategies reflect a proactive public health perspective, emphasizing early action to reduce long-term risks. Adaptive interventions focus on building resilience within communities and households to help them cope with the impacts of climate change, including floods, droughts, and wildfires [1, 3, 5, 23, 28, 30, 33–35, 42]. These strategies are especially relevant in high-risk areas where exposure cannot be entirely avoided, and where local adaptation is essential for protecting child health. A third group of interventions combines both preventive and adaptive components, offering integrated approaches that address immediate threats while also strengthening long-term resilience. Examples include gender-sensitive programs, climate-resilient education systems, and community preparedness efforts, as well as strategies to mitigate children’s exposure to desert dust storms (DDS) through exposure reduction, wearable sensors, mobile monitoring, and early warning systems [9, 15–17, 20, 25, 26, 33, 35]. These hybrid strategies are often more comprehensive and effective in settings facing complex or multiple climate risks. Community-based interventions are another key approach. These involve actions at the population level, such as redesigning public spaces to promote health, supporting environmentally friendly behaviors, or reducing structural vulnerabilities linked to childhood obesity and infectious disease risks [30]. Such interventions benefit from local ownership and collective action, making them well-suited for sustained implementation. In parallel, educational and awareness initiatives seek to improve understanding of climate risks and promote protective behaviors. These include climate change education, public awareness campaigns, and communication efforts aimed at children, families, and educators [32, 42, 46, 48]. By fostering knowledge and engagement, these strategies help build a culture of preparedness and responsibility. An emerging category addresses mental health and emotional resilience, focusing on reducing climate-related psychological distress and promoting coping mechanisms. These interventions are particularly important as evidence grows on the emotional impacts of climate anxiety, especially among children [9, 47]. Ensuring psychological well-being is a vital, yet often under-addressed, aspect of climate adaptation in child health. Finally, disaster preparedness and response strategies aim to improve early warning systems, emergency planning, and recovery processes in the face of climate-related disasters such as floods, hurricanes, and wildfires [28, 34–36]. While often operationalized through programmatic activities, these interventions are deeply embedded in broader policy frameworks and health governance structures. Therefore, they may be appropriately considered under the umbrella of public health policy. Overall, this typology demonstrates the multidimensional nature of child-focused climate interventions. The integration of preventive, adaptive, and community-centered approaches reflects a growing recognition that effective climate-health responses require both technical solutions and systemic change.

Fig. 3.

Intervention strategies to mitigate the health impacts of climate change on children

Targeting strategies towards policymakers and specific organizations

The analysis of 33 peer-reviewed studies revealed a diverse array of proposed strategies to mitigate the health impacts of climate change on children. These strategies were categorized into several overarching themes, reflecting both structural and behavioral approaches (Table 1). A significant number of studies emphasized policy-level strategies aimed at addressing systemic vulnerabilities. For instance, Ashrafuzzaman et al. [3] and Atiqu et al. [5] underscored the need for improved water infrastructure and policy development for child protection in disaster-prone areas. These strategies reflect an understanding that sustainable health outcomes for children require integrated governance and institutional support. Technological and infrastructural innovations formed another cluster of strategies, such as the deployment of indoor environmental monitoring systems [6] and the transition to electric school buses [13]. These interventions aim to reduce direct environmental exposure and represent scalable, tangible solutions aligned with emission reduction goals. Another key category includes educational strategies and awareness-building initiatives, particularly those targeting children and communities. Studies such as those by Kabir et al. [24], Shalini et al. [46], and Soomro et al. [47] focused on school-based climate education to foster adaptive behaviors and environmental responsibility from an early age. Similarly, interventions that leverage communication, both within families [42] and via digital tools [9], seek to bridge knowledge gaps and promote behavioral change. Community-based and participatory approaches were also highlighted, particularly in post-disaster recovery and resilience-building efforts. Programs like the Royal Far West Bushfire Recovery [28] and localized civic action initiatives [41] demonstrate how empowering youth and engaging households can enhance climate adaptation efforts. In addition, a subset of strategies targeted health-specific outcomes, such as nutritional resilience and disease control. Baez et al. [7] proposed frameworks for targeting drought-related malnutrition, while Saavedra-Samillán et al. [40] advocated for context-specific malaria control programs. These interventions underscore the intersection between climate change and existing health inequities. Adaptive livelihood and coping strategies, such as asset liquidation and consumption adjustments, were documented in more vulnerable contexts [34], highlighting the urgent need for social protection systems in climate-sensitive regions. Similarly, the MEDEA randomized controlled trial [26] demonstrates how integrated preventive–adaptive measures—such as behavioral exposure‐reduction guidance, indoor protection, and technology-assisted monitoring—can effectively mitigate respiratory risks during desert dust storms. In sum, the reviewed literature reveals that effective climate-health strategies for children must be multifaceted, integrating policy action, technological innovation, education, community engagement, and targeted health responses. The success of these strategies depends on their contextual relevance, scalability, and inclusion of children as active participants in the adaptation process.

Table 1.

Categorization of strategies by intervention type

Strategy Type	Description	Reference
1. Policy and Governance	Focused on structural-level changes such as improving climate-resilient infrastructure (e.g., water and transportation systems), implementing emission caps to reduce air pollution and climate risk, and poverty reduction strategies that indirectly improve child health.	[3, 5, 10, 14, 16, 17, 20, 22, 26, 40]
2. Technological and Environmental Solutions	Interventions involving air quality monitoring, transition to cleaner energy or transportation, and agricultural adaptation practices. These aim to directly reduce environmental exposure.	[6, 13, 19, 23, 26]
3. Educational and Behavioral Change	These studies implemented educational programs, communication strategies, or classroom-based training to improve climate literacy, awareness, and adaptive behaviors among children and caregivers.	[9, 24, 26, 32, 33, 42, 46–48]
4. Community Engagement and Empowerment	Targeted at mobilizing communities through local engagement activities, youth empowerment, and community-level resilience building. Some focused on challenging gender norms or involving children in advocacy.	[15, 30, 36, 41, 48]
5. Adaptive Coping and Preparedness	These interventions emphasized coping strategies and preparedness for climate-related disasters, including flood drills, post-disaster recovery programs, and short-term household-level adaptations.	[1, 26, 28, 34, 35]
6. Public Health and Nutrition	Aimed at enhancing food and nutrition security as a response to climate variability, these strategies include targeting drought-affected populations and prioritizing regions for health intervention planning.	[7, 23, 44]
7. Infrastructure and School-based Protection	These interventions aim to protect children in schools or structured settings, such as ensuring hydration, improving heat preparedness in schools, or implementing community-wide obesity prevention programs.	[8, 27]

Evaluating the effectiveness of strategies

The effectiveness of strategies aimed at improving child health in the context of climate change varies significantly based on the type of intervention, the methodological rigor of evaluation, and the contextual factors taken into account (Table 2). Across the reviewed studies, a common challenge was the limited use of standardized evaluation frameworks, with many relying on implied outcomes or observational data. Preventive strategies generally showed strong potential, especially when assessed using quantitative or economic models. For instance, scenario modeling in Berberian et al. [10] demonstrated implied health co-benefits from emission caps and clean transportation, though no specific metrics were provided. In contrast, Choma et al. [13] utilized cost–benefit analysis to robustly support the replacement of diesel buses as both effective and economically efficient. Dimitrova et al. [19] employed policy assessment to link air quality interventions and clean cooking subsidies with a reduction in child stunting, an outcome grounded in developmental health indicators. Additional evidence from Kouis et al. [26] showed that indoor air filtration combined with exposure-reduction recommendations resulted in measurable improvements in asthma control—reflected in Childhood Asthma Control Test (c-ACT) scores, Forced Expiratory Volume in one second (FEV₁), and a reduced need for medication—representing one of the few rigorously evaluated clinical outcomes within preventive measures [26]. Preventive evidence was further supported by studies such as Baker et al. [8], who demonstrated the implied effectiveness of bioculturally appropriate hydration and cooling behaviors in reducing heat stress, and Baez et al. [7], who used predictive modeling to show that targeted drought-response strategies enhance nutrition security. However, some preventive interventions, such as those by Sehgal et al. [44] and Saavedra Samillán et al. [40], relied primarily on vulnerability analyses or observational studies, resulting in suggestive but unquantified outcomes. While both studies highlight the potential of nutrition security and localized disease control, the lack of robust impact metrics weakens the evidence for effectiveness. Adaptive strategies varied more widely in both content and evaluation rigor. Issahaku et al. [23] reported improved nutrition outcomes from agricultural adaptation, but the observational nature of the data limits causal inference. On the other hand, Ogallo et al. [34] highlighted the inadequacy of informal coping mechanisms such as asset liquidation, effectively serving as a negative control in adaptive strategy assessment. Emerging evidence from the same study further underscored that current coping strategies remain insufficient even when households diversify crops, engage in off-farm work, or shift planting dates, reinforcing the need for systemic adaptive support. In contrast, proposed but unevaluated adaptive tools—such as indoor environmental sensor networks [6]—remain conceptually promising yet untested. Similarly, adjustments in labor distribution and parenting roles [5] were noted but not empirically evaluated. Integrated preventive-adaptive approaches showed mixed results. Dasgupta et al. [14] modeled low-emission poverty reduction scenarios and identified potential health co-benefits, yet the findings remained inferential. Grace et al. [22] proposed the use of climate indicators in health planning, but without empirical assessment. Nguyen et al. [33], however, demonstrated a more concrete outcome, improved beliefs and intentions, through a pre/post behavioral assessment of communication strategies based on the Theory of Reasoned Action, offering a rare example of measurable behavioral impact. Community-based interventions also highlighted a disparity in evaluation depth. Muchiri et al. [30] and Tanner et al. [48] reported improved awareness and positive engagement through environmental education and cultural change, but lacked pre-/post-evaluation or health metrics. Devonald et al. [15] noted increased participation of girls in decision-making, but provided no outcome data, limiting the ability to assess strategic success. Youth-led advocacy and public-awareness initiatives [41] demonstrated successful engagement, offering qualitative but persuasive evidence of community impact. Educational and awareness programs were generally more rigorously evaluated. Shalini et al. [46] and Kabir et al. [24] demonstrated significant increases in climate-related knowledge through structured pre-/post-assessments. Ngo et al. [32] used an experimental design to confirm the effectiveness of congruent messaging in risk communication. Several studies emphasized the need for stronger communication strategies among adolescents [42], though valuable, lacked empirical follow-up, again raising concerns about untested frameworks. Mental health resilience strategies, an emerging but vital area, were evaluated with varying thoroughness. Soomro et al. [47] effectively used psychological scales to demonstrate that climate anxiety education reduces distress levels among children. Conversely, Benoit et al. [9] reported promise through participant feedback on multimedia interventions, but highlighted the need for further study. Lastly, disaster preparedness and response strategies were among the most actively implemented but inconsistently evaluated. McGill et al. [28], Peterson et al. [36], and Pawlik et al. [35] reported positive outcomes, ranging from increased child engagement to household adaptive actions, based on participant feedback and observational data. Yet, initiatives such as the childcare policy development by Atiqul Haq et al. [5] and water infrastructure engagement described by Ashrafuzzaman et al. [3] lacked formal assessment, illustrating a gap between policy implementation and measurable impact. Recent evidence also suggests that women’s political empowerment and female education can contribute to improved child health outcomes [20], while youth-focused skills-building, environmental programs, and WASH initiatives demonstrate implied benefits [16, 17]. In summary, strategies employing robust quantitative methods, such as cost–benefit analysis, predictive modeling, and experimental design, tended to provide the most compelling evidence of effectiveness [7, 13, 32]. Conversely, interventions lacking empirical evaluation, though conceptually promising, remain under-supported [6, 15, 22]. Future research should prioritize standardized outcome measures and longitudinal assessments to enable cross-context comparison and evidence-based scaling of successful interventions.

Table 2.

Evaluating the effectiveness of strategies

Category	Intervention	Evaluation Method	Evaluation Outcome	Reference
1. Preventive Measures	Emission caps, clean transportation	Scenario modeling	Health co-benefits implied	[10]
	Replace diesel buses	Cost–benefit analysis	Effective and cost-saving	[13]
	Air quality control, clean cooking subsidies	Policy assessment	Reduction in stunting suggested	[19]
	Nutrition security prioritization	Vulnerability analysis	Effectiveness implied	[43]
	Malaria control tailored to local needs	Observational	Impact discussed, not quantified	[40]
	Emissions reduction scenarios under TCI	Modeling	Health co-benefits and economic savings	[10]
	Indoor air filtration + exposure reduction recommendations	RCT/Experimental	Improved asthma control (c-ACT, FEV1, reduced medication need)	[26]
	Bioculturally-appropriate hydration & cooling strategies	Observational/Modeling	Effectiveness implied in reducing heat stress	[8]
	Drought-sensitive targeting framework	Predictive modeling	Effective targeting for malnutrition	[7]
2. Adaptive Measures	Agricultural adaptation	Observational	Improved nutrition	[23]
	Asset sales, consumption reduction	Observational	Found insufficient	[34]
	Indoor sensor networks	Not evaluated	Monitoring emphasized	[6]
	Crop diversification, off-farm jobs, shifting planting dates	Observational	Current coping insufficient; adaptation needed	[34]
	Agricultural practices: new varieties, mulching, intercropping	Observational	Higher adaptive capacity → better child nutrition	[23]
	Adjusting parenting roles/labor distribution	Observational/Conceptual	Effectiveness not explicitly evaluated	[5]
3. Combined Preventive + Adaptive	Poverty reduction in low-emission scenarios	Modeling	Health co-benefits implied	[14]
	Use of climate indicators	Conceptual	Strategy not evaluated	[22]
	TRA-based communication	Behavioral pre/post	Improved beliefs & intentions	[33]
	Message framing for climate change	Experimental	Congruent messaging more effective	[32]
4. Community-Based Interventions	Tree planting, community education	Observational	Improved awareness	[30]
	Challenging cultural norms	Community feedback	Positive engagement	[48]
	Girl participation in decision-making	Not evaluated	Strategy noted, not assessed	[15]
	Youth-led advocacy & public awareness	Observational/Qualitative	Successful advocacy; engagement increased	[41]
	Involving adolescents in communication and education	Conceptual	Need for improved communication highlighted	[42]
5. Educational & Awareness	Climate change education	Pre/post knowledge tests	Significant improvement	[46]
	School manual training	Pre/post assessment	Knowledge increased significantly	[24]
				[32]
				[42]
6. Mental Health Resilience	Emotionally varied videos	Participant feedback	Promise shown; further study needed	[9]
	Climate anxiety education	Psychological scales	Education reduced anxiety	[47]
7. Disaster Preparedness & Response	Bushfire recovery program	Feedback from participants	Positive effect on children	[28]
	Household preparedness via child advocacy	Observational	Adaptive actions increased	[36]
	ABM flood evacuation workshops	Engagement evaluation	High child engagement	[35]
	Disaster-related childcare policy	Not evaluated	Not assessed	[5]
	Water infrastructure + community engagement	Qualitative	Positive early impacts; further study needed	[3]
	Women’s political empowerment & female education	Observational	Improved child health outcomes	[20]
	Policies for youth skills-building, shelter, WASH, environmental projects	Observational/Policy analysis	Effectiveness implied	[16, 17]
	Public health interventions for nutrition security	Observational/Policy	Vulnerable districts prioritized	[44]

Intervention levels

Analysis of the reviewed studies revealed that interventions addressing climate-related health outcomes among children and adolescents were implemented across five distinct levels (Fig. 4): community, individual, structural, household, and a combination of levels. The majority of interventions (61.8%) were delivered at the community level, reflecting a strong focus on localized efforts that engage schools, families, and community actors (e.g., [1, 13, 28]). These interventions often emphasized education, behavior change, or environmental improvements, which are essential for building climate resilience at the population level. While such strategies are widely adopted and context-sensitive, their scalability and long-term impact require further investigation. Interventions at the individual level accounted for 17.6% of studies (e.g., [24, 32, 46]). These were primarily educational or psychological interventions targeting children, adolescents, or caregivers. They demonstrated effectiveness in enhancing awareness, risk perception, and behavioral intention. However, the evidence base remains limited in terms of outcome sustainability and applicability across diverse settings. The study by Kouis et al. [26] adds to this category by implementing individualized exposure-reduction strategies supported by wearable sensors and mobile applications, reinforcing the role of individual-level behavior in mitigating dust-related respiratory risks. A smaller proportion (11.8%) of studies implemented structural-level interventions, such as policy reforms or socioeconomic improvements, often through modeling or policy assessments (e.g., [10, 14]). Although fewer in number, these studies implied significant population-wide benefits and cost-effectiveness. They highlight the importance of upstream policy changes in mitigating health risks associated with climate change, particularly in low-resource contexts. Kouis et al. also contributed a structural component by incorporating environmental control measures—such as sealing windows and reducing indoor dust infiltration—which function as built-environment modifications aimed at reducing exposure during desert dust events [26]. Household-level interventions (5.9%) were less frequently reported (e.g., [10, 14, 23, 36]), focusing primarily on preparedness and adaptation within families. While these strategies can empower households to act autonomously, their limited coverage and reliance on individual agency may constrain overall effectiveness. The intervention by Kouis et al. also aligns with this level, as families were instructed to implement indoor exposure-reduction practices within the home environment [26]. A few studies (e.g., [3, 16, 17]) combined community and structural elements, suggesting that multi-level strategies may offer complementary benefits. However, the fragmented nature of evaluations across studies often limited cross-comparisons and generalizability. In summary, the landscape of climate-health interventions for children is heavily weighted toward community-based action, with structural interventions underrepresented despite their potential for systemic impact. The multi-level nature of the Kouis et al. intervention—simultaneously engaging individual behaviors, household practices, and structural environmental modifications—illustrates the value of integrated design in contexts where exposure pathways operate across multiple domains [26]. Future research should prioritize integrated, multi-level approaches that bridge policy, community, and individual domains. Equally important is the need for rigorous evaluation frameworks that move beyond descriptive assessments to quantify effectiveness across time and context.

Fig. 4.

Description of the different levels of intervention

Discussion

This scoping review highlights significant geographic and demographic patterns within the current evidence base on climate change and child health. Most studies were concentrated on climate-vulnerable regions, including South Asia, Sub-Saharan Africa, and parts of Latin America [3, 7, 34]. Research from high-income countries, particularly the United States and Australia, primarily focused on mental health impacts and educational interventions [28, 47]. Across all regions, school-aged children and adolescents received the greatest attention, whereas critical subgroups such as infants under five, the urban poor, and marginalized populations remain underrepresented [15, 34]. Also, the relatively limited use of experimental and interventional designs suggests a gap in the evidence on the effectiveness of adaptation strategies or health interventions in real-world conditions. Future research would benefit from more rigorous design reporting and an increased application of mixed-methods and transdisciplinary frameworks that bridge data-driven and community-centered insights. The findings underscore the complex and bidirectional relationship between climate change and child health. Climate-related exposures, including air pollution, extreme heat, vector-borne diseases, food insecurity, and environmental degradation, pose substantial risks to children’s physical, mental, and social well-being [10, 19, 40]. Simultaneously, poor health and undernutrition increase children’s vulnerability to climate hazards, creating reinforcing cycles of risk [7, 23]. In response, diverse interventions have been implemented, though with varying focus, scale, and effectiveness. Preventive strategies, such as air quality policies, clean transport initiatives, and environmental monitoring, demonstrate potential health co-benefits but often rely on modeling rather than empirical health outcome data [6, 10, 13]. Educational and awareness programs targeting individuals or schools have improved knowledge and behavioral intentions but lack evidence of long-term, sustained impact [25, 32, 46]. Adaptive interventions, including household preparedness, agricultural adaptation, and social protection mechanisms, provide context-specific resilience benefits, particularly in low-resource settings [7, 23, 36]. However, informal coping strategies such as asset liquidation remain ineffective and highlight the need for more robust, formal support systems [34]. The majority of interventions (61.8%) operate at the community level, reflecting the importance of localized, participatory approaches [1, 28, 30]. Structural-level interventions, though fewer (11.8%), suggest considerable potential for addressing systemic drivers of health inequities through policy reforms and socioeconomic improvements [14, 19]. Integrated, multi-level strategies that combine community action with structural change remain limited but appear most promising in addressing the interconnected nature of climate and health risks [3, 15]. Kouis et al. [26] contribute practical evidence on a child-focused intervention for air-quality–related climate exposures. Their randomized controlled study showed that combining individual exposure-reduction advice, basic household environmental measures, and real-time monitoring through wearable sensors and mobile applications can help reduce respiratory symptoms during desert dust storm events. The findings illustrate the potential of multi-component approaches—particularly those incorporating digital monitoring—to support short-term protection for vulnerable children without overstating broader impacts. Notably, mental health impacts, particularly climate anxiety among youth, are increasingly acknowledged yet insufficiently addressed within most adaptation efforts [9, 47]. This represents a critical gap, considering the long-term psychological vulnerabilities that climate change imposes on children and adolescents. Despite the diversity of strategies, the effectiveness of interventions is frequently constrained by limited empirical evaluation, context-specific challenges, and insufficient focus on equity. Vulnerability layering based on age, gender, and socioeconomic status is recognized in principle but rarely operationalized in practice [15, 34].The findings from Kouis et al. [26] further underscore this issue, as children with pre-existing asthma were disproportionately affected during DDS episodes, emphasizing the need for targeted, equity-oriented protection measures for clinically vulnerable subgroups. To advance the field, future research should emphasize intersectional frameworks, standardized outcome measures, and longitudinal evaluations. Multi-sectoral collaboration and integrated policies that link health, social protection, and environmental governance are essential to designing effective, scalable interventions that protect children and adolescents amidst escalating climate risks.

Conclusions

This scoping review highlights the complex and interconnected ways climate change affects the health of children and adolescents. It identifies a wide range of climate-related exposures, including air pollution, heat stress, vector-borne diseases, and food insecurity, which contribute to substantial physical, mental, and social health challenges. While intervention efforts largely focus on community-level actions, structural and multi-level strategies remain underutilized despite their potential to address systemic vulnerabilities. Preventive and adaptive interventions offer promising benefits for both health and climate resilience. However, their effectiveness is often limited by a lack of rigorous evaluation and challenges in scaling across diverse contexts. The current emphasis on general child populations overlooks vulnerable subgroups differentiated by age, socioeconomic status, and geography, revealing significant equity gaps. Addressing these gaps requires intersectional approaches and integrated policies that bridge health, social protection, and environmental governance. Mental health impacts, particularly climate anxiety among youth, are emerging concerns that demand greater attention in adaptation frameworks. To progress, future research should adopt standardized evaluation methods and longitudinal designs to assess intervention outcomes comprehensively. Multisectoral collaboration and inclusive policymaking are critical to developing scalable, evidence-based solutions that enhance resilience and protect child health amid worsening climate threats. Embedding child-centered health priorities into global climate policies is essential to reduce the disproportionate burden climate change imposes on younger generations.

Limitations

The articles included in this scoping review were highly heterogeneous, with diverse outcomes, populations, variables, and exposures, limiting the ability to draw generalized conclusions. Only studies published in English were included, so some relevant international research may have been missed. Geographical representation may also be influenced by differences in research priorities, the prevalence of grey literature, and a greater emphasis on empirical studies in regions facing more immediate vulnerabilities.

Authors’ contributions

GS Conceptualization, Methodology, Supervision, Writing – review & editing, Project administration. NT Conceptualization, literature search, data extraction, data analysis, interpretation of results, manuscript drafting, critical revisions, project coordination, and final approval of the manuscript. HJ Literature search, Data extraction, Data curation. GG Methodology and Validation. EJ Validation and Investigation. EH Methodology and Validation. MS Methodology and Validation. BCh Data curation and Formal analysis. MN Data curation and Formal analysis. SZ Literature search, Data extraction, Data curation. SN Literature search, Data extraction, Data curation. KM Literature search, Data extraction, Data curation. ASh Methodology and Validation. All authors reviewed and approved the final version of the manuscript.

Funding

This research received no external funding.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.