The defining characteristic of child abuse, be it physical, emotional, or through neglect, is that the child suffers significant harm. At its extreme child abuse is fatal. As a species, through neglecting the ecological determinants of health we have killed millions of children and are in the process of killing many thousands more, while condemning millions to ongoing physical and emotional suffering.

Already, 920 million children suffer from water scarcity, with numbers rising. By 2030 there may be more than 100,000 additional deaths in children under five due to malnutrition attributable to climate change, and an additional 7.5 million children with moderate to severe stunting of their growth. Children have suffered and died due to extreme weather events—floods, cyclones, heatwaves, and consequent wildfires. Climate change is now a leading cause of forced migration, disrupting children’s home and family lives, education, and healthcare. Hundreds of thousands of children under the age of five die as a result of ambient air pollution each year, and hundreds of thousands more due to household air pollution. 

Breathing faster, children inhale more of any pollutant per unit of body weight than adults. Their developing organs are particularly vulnerable in the womb and in early life. Recent estimates suggest exposure to air pollution during pregnancy may be responsible for nearly three million low birth weight and nearly six million premature births per year. Low birthweight and prematurity are key risk factors with potential irreversible impacts on health and wellbeing throughout life. This is significant physical harm on a global scale, with no safeguarding panels, or child death reviews. 

There are emotional impacts too. While having limited agency to change the trajectory of climate change themselves, children and young people will live to see more of its impact than those of us already a fair way through our lives. Anxiety is a rational response.

We know from surveys that many thousands of young people are feeling sad, anxious, angry, powerless, helpless, and guilty about climate change. “How dare you?” roared Greta Thunberg in 2019, “you have stolen my dreams and my childhood.”

Ella Kissi-Debrah isn’t roaring. She died in 2013 from severe asthma, exacerbated by her chronic exposure to high levels of air pollution in her neighbourhood by London’s South Circular road. We must roar on her behalf, and on behalf of all the other millions of children whose lives we are destroying. Call the global social services department and report ourselves for failing to change our ways, even when we knew we should. We are all perpetrators. At home, at work, weekdays, weekends, holidays, celebrations, with families, with friends—consuming, consuming, consuming. Depleting the global commons of natural resources our children will need, and increasing the burden of pollutants in our air, our water, and our land. We do this directly—sometimes burning fuel for the most frivolous of reasons, such as to avoid wearing another layer of clothing, or for our car to make the right vroom vroom noise. We do it indirectly too—we have learned to derive gratification from acquiring products whose manufacture, packaging, distribution, and disposal depletes and pollutes beyond our field of vision. Shortage of toys for Christmas? Fantastic—let’s do what genuinely makes us happy instead.

We have to change. We have to tackle climate change bottom up, top down, any which way we can. Child protection is everyone’s business, and climate protection is child protection. Climate risk assessments and mitigation protocols must be ubiquitous—every business, service, school, university, sports club, choir, band, event and so on should have these and be reviewed and audited against them. 

Health professionals, who fully understand the implications of destroying the ecological determinants of health, must lead from the front. People noticed when we all stopped smoking. They will notice when we take climate change seriously. 

The UN must be our global safeguarding committee. Each Conference of the Parties should include a child protection meeting, at which data and narratives on child suffering and deaths due to climate change are reviewed. At COP26 we must all be held to account.

There is no place of safety to which we can remove our children—no alternative world where climate change has been arrested and there is safe air, water, soil, food, and shelter for all. Everyone must play their part in rescuing this world to make it safe for children, and I for one will continue to roar until we do.

Lucy Reynolds is a community paediatrician living and working in Glasgow. Through the climate change and child health webinars run by the International Society for Social Paediatrics and Child Health she became involved in the Ride for Their Lives initiative and the RCPCH climate change working group. 

Competing interests: none declared.