KUALA LUMPUR, July 2 — The ongoing El Niño, which has brought soaring temperatures across much of the world, has become a growing concern for homemaker Norul Akmah Abdullah.

The 41-year-old mother of three, whose children are aged between four and 10, recalled how her second child, eight-year-old Muhammad Irfan Sufian Muhammad Noor, suffered heat exhaustion last year after prolonged exposure to the midday sun during his school’s sports day.

“At the time, my husband and I had no idea he was experiencing heat exhaustion. When he came home complaining of a headache, fever and vomiting, we rushed him to the hospital immediately.

“The doctor later told us that the symptoms he had were signs of heat exhaustion. He also said that prolonged exposure to intense heat and direct sunlight could have progressed to heat stroke,” she said.

She told Bernama that since the incident, she and her husband have limited their children’s outdoor activities, allowing them to play outdoors only in the morning or evening when temperatures are cooler.

Another parent Shirley Ng, 43, said she takes preventive measures by ensuring her two children, aged eight and 11, bring enough drinking water to school every day.

“We always make sure they carry extra water to school or when they’re out playing, and we remind them to drink it.

“At home, I also make sure they stay well hydrated because the weather is extremely hot. Even being inside a car can increase the risk of heat exhaustion and heat stroke if the body isn’t getting enough fluids,” she said.

On June 24, Malaysian Meteorological Department National Climate Centre director Dr Ahmad Fairudz Jamaluddin said monitoring of global weather forecast models showed a high probability of a drastic increase in sea surface temperatures in the Pacific Ocean.

He also said the current weak El Niño conditions could potentially develop into a Super El Niño by the end of the year and advised the public to prepare for the transition to extreme weather conditions, which increase the likelihood of prolonged heatwaves and a corresponding rise in heat-related illnesses.

The warning has heightened concerns among vulnerable groups, particularly parents of children aged 12 and below. Experts say children are especially susceptible to extreme heat because their bodies heat up more quickly and cool down more slowly than those of adults.

Impact of heatwaves on children

According to the Ministry of Health Malaysia, a total of 15 heat-related cases were reported nationwide between Jan 1 and March 24 this year. All the patients recovered except for a child who died from heat stroke after being left unattended in a vehicle.

The United Nations Children’s Fund (Unicef), in its Children’s Climate Risk Report 2026 released on June 16, revealed that almost all children worldwide are now exposed to at least one major climate hazard, including coastal flooding, drought, extreme heat, wildfires, heatwaves, river flooding, sand and dust storms, and tropical storms.

The report found that nearly half of the world’s children, about 1.1 billion, are exposed to at least three overlapping climate hazards, placing their health, education and survival at risk. More than four million children are exposed to as many as six overlapping climate-related threats.

Unicef Malaysia Climate and Disaster Data coordinator Jonathan Lee said the report showed that in Malaysia, out of its 9,239,261 children, 85.9 percent are exposed to drought, 68.04 percent to heatwaves, 6.7 percent to extreme heat and 90.12 percent to air pollution.

“What we see is that the traditional assumption that climate risk is limited to only floods is no longer true… air pollution and heatwaves are increasingly affecting children across the country, including in spaces where they spend long hours, such as classrooms and playgrounds near neighbourhoods,” he told Bernama in a Zoom interview recently. 

Unicef Malaysia Climate and Environment specialist Nasha Lee said heatwaves pose significant risks to children as prolonged exposure increases the likelihood of dehydration, heat exhaustion and heat stroke because children’s bodies heat up faster and cool down more slowly than those of adults.

She said these risks are further compounded during haze episodes as children's lungs are still developing and they breathe more rapidly than adults, making them more vulnerable to the immediate and often more severe effects of poor air quality.

“While the impacts of heat and haze are frequently seen in clinics and emergency rooms, they are also reflected in missed school days and disrupted daily routines.

“The impact on learning is significant. Heat makes it harder for them (children) to concentrate and it also drains energy and slows cognitive function. Repeated exposure to extreme heat, polluted air and environmental uncertainty can also increase stress, fatigue and anxiety among children,” she said.

Underestimated

Echoing the concern, paediatrician Dr Naveen Nair Gangadaran of Hospital Tuanku Ja’afar, Seremban, said the number of heat-related illnesses reported in Malaysia remains relatively low, but the actual burden is significantly underestimated.

He said many heat-related cases involving children present as mild, such as fatigue, irritability, reduced appetite and poor concentration, and are often overlooked.

“Children are particularly vulnerable because they generate more heat during activity and rely on adults to ensure adequate hydration and protection.

“Younger children are also less efficient at regulating body temperature. Even mild dehydration can impair cognitive performance, mood and physical endurance,” he told Bernama, adding that in severe cases, heat exposure can escalate into heat stroke, which can be life-threatening. 

Dr Naveen, who is also a Malaysian Paediatric Association council member, said children generate more metabolic heat during activity and have a higher body surface area relative to their weight, making them more vulnerable to heat gain.

“At the same time, their sweating mechanisms are less efficient than those of adults, reducing their ability to cool effectively. 

“Even mild dehydration — just one to two percent of body weight loss — has been shown to impair cognitive function, attention span and memory,” he said. 

He said prolonged exposure to high temperatures has also been associated with sleep disruption, reduced physical activity and potential long-term cardiovascular and metabolic risks.

“What we are witnessing is not just a temporary discomfort but a shift in how children grow, learn and function. This is no longer just about the weather; it is a public health challenge that requires coordinated action,” he said. 

Sunway Medical Centre consultant paediatrician Dr Ch’ng Tong Wooi also warned that repeated exposure to high temperatures, particularly during early childhood, may contribute to long-term health issues, including kidney impairment associated with chronic dehydration.

Heat-related illness

She added that parents should also be able to distinguish between heat cramps, heat exhaustion and heat stroke as the three conditions represent a spectrum of heat-related illnesses ranging from mild to life-threatening.

“Heat cramps are the mildest form of heat-related illnesses and usually present as painful muscle spasms in the abdomen, arms or legs after prolonged physical activity in hot weather, and they are often caused by excessive salt loss through sweating. 

“The child’s body temperature is usually normal, and treatment involves moving the child to a cooler place, allowing them to rest and replacing lost fluids and electrolytes,” she explained.

Dr Ch’ng said heat exhaustion is more serious and is typically characterised by extreme tiredness, weakness, nausea, headache, dizziness, heavy sweating and a rapid heartbeat, while heat stroke is the most dangerous form of heat-related illness and should always be treated as a medical emergency. 

“Heat stroke occurs when the body’s core temperature exceeds 40°C and is accompanied by neurological symptoms such as confusion, disorientation, seizures, loss of consciousness or even coma. 

“Immediate cooling and emergency medical treatment are critical as delays can lead to permanent organ damage or even death,” she told Bernama.

She advised parents not to wait if they notice warning signs of heat stroke.

“If a child becomes confused, unusually drowsy, loses consciousness, develops seizures or has a very high body temperature, parents should seek emergency medical attention immediately,” she said.

Dr Ch’ng also said that Malaysia should strengthen its long-term preparedness for heatwaves through school-based heat safety measures, improved healthcare surveillance and greater public awareness.

She said schools should consider adopting heat safety protocols such as adjusting outdoor activities during peak temperatures, improving ventilation and ensuring children have adequate access to drinking water, while parents should be educated on proper hydration, recognising early symptoms of heat-related illnesses and the dangers of leaving children unattended in vehicles.

Dr Naveen said class schedules can be adjusted to minimise schoolchildren’s outdoor exposure between 11am and 4pm, and access to clean drinking water must be ensured at all times. 

“Most importantly, parents should recognise early warning signs (of heat-related conditions) such as lethargy, dizziness, nausea or reduced urine output,” he added. 

Include children in capacity development 

Unicef Malaysia’s Nasha Lee, meanwhile, said the government should treat heat and air pollution with the same urgency and policy priority as floods or storms, not as stand-alone hazards but as interconnected, systemic risks to children’s development and daily lives. 

“Children’s climate adaptation needs should be integrated across key systems such as education, health, social protection and urban planning. Malaysia’s National Adaptation Plan is an opportunity to drive this shift by strengthening preparedness, particularly in how heat and haze affect children’s health, learning and well-being,” she said.

(The National Adaptation Plan, which is being developed by the Ministry of Natural Resources and Environmental Sustainability, is aimed at outlining strategies and measures to help the country withstand the impacts of climate change.)

She said schools must ensure they can cope with rising temperatures through basic measures such as ventilation, shaded spaces and access to safe drinking water. It also means linking early warning systems to timely, coordinated action for schools, clinics and families. 

“Climate adaptation must be grounded in the lived realities of children and young people. They are already navigating overheated classrooms, disrupted learning and unhealthy air. Listening to their experiences is not symbolic but essential to designing solutions that effectively protect their health, dignity and development,” she said. — Bernama