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Heatstroke, dehydration, and missed voices: the hidden pediatric crisis in children with cerebral palsy amid Pakistan’s climate emergency

Pediatric Research (2025)Cite this article

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Children with cerebral palsy (CP) suffer from not only limitations in movement and communication, but also impaired thermoregulation due to underlying brain injury. Moreover, feeding difficulties, particularly dysphagia and impaired sensation, which make it harder for these children to feel or express thirst, frequently lead to inadequate fluid intake and dehydration, making them especially vulnerable to extreme temperatures.1 The studies evaluating the nationwide prevalence of cerebral palsy are limited, but a review of pertinent medical literature from Pakistan has quoted an overall prevalence of CP between 2.5 per 1000 children, with national estimates ranging from 1–6 per 1000. Therefore, based on a child population of about 96 million (under 18), it can be inferred that 240,000–576,000 affected children exist in Pakistan.2

Pakistan’s ultimate climate crisis is marked by the severe and frequent heatwaves that disproportionately affect vulnerable populations, including children with CP. For example, the 2022 heatwaves affecting Sindh and Punjab provinces raised temperatures up to 50°C, overwhelming healthcare systems and increasing heat-related morbidity. This vulnerability is compounded by a lack of targeted public-health measures. In Pakistan, national climate adaptation plans often do not address disability-specific needs, leaving families and health providers ill-equipped to deal with heat-related risks for CP children. Hence, ensuring high-standard medical care, which allows for the early detection of signs of dehydration or impending heatstroke, is essential for the affected population.3,4

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References

  1. Arvedson, J. C. Feeding children with cerebral palsy and swallowing difficulties. Eur. J. Clin. Nutr. 67, S9–S12 (2013).

    Article  PubMed  Google Scholar 

  2. Yaqoob, E., Javed, S & Khan, S, A. Trauma care in the face of climate change in Pakistan. The Lancet 401, 1769–1770 (2023).

  3. Saleem, F. et al. Population exposure changes to mean and extreme climate events over Pakistan and associated mechanisms. Geohealth 7, e2023GH000887 (2023).

    Article  PubMed  PubMed Central  Google Scholar 

  4. Siddiqi, D. A. et al. Assessing the impact of heat waves on childhood immunization coverage in Sindh, Pakistan: Insights from 132.4 million doses recorded in the provincial electronic immunization registry (2018–2024). Vaccine 61, 127424 (2025).

    Article  PubMed  Google Scholar 

  5. Dumas, S. Climate change and disability inclusion: A call for inclusive action at COP29 [Internet]. Action on Poverty; 2024 [cited 2025 Jun 21]. Available from: https://actiononpoverty.org/insights-en/cop29-climate-change-disability-inclusion

  6. Hussain, G. et al. Epidemiological data of neurological disorders in Pakistan and neighboring countries: a review [Internet]. eCommons@AKU. [cited 2025 Jun 21]. Available from: https://ecommons.aku.edu/pjns/vol12/iss4/12

  7. Lott, E. et al. Physician approaches to the pharmacologic treatment of dystonia in cerebral palsy. PEDIATRICS 154, e2023065512 (2024).

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Authors and Affiliations

  1. Khairpur Medical College, Khairpur Mirs, Pakistan

    Muhammad Umar

  2. Riphah International University, Islamabad, Pakistan

    Rayyan Nabi

  3. National Institute of Child Health, Karachi, Pakistan

    Aftab Ahmed Dero

  4. King Edward Medical University, Lahore, Pakistan

    Muhammad Talha

  5. Monument Health Heart and vascular institute, Rapid City, SD, USA

    Syed Moinnuddin

  6. Arnot Ogden Cardiology, Elmira, NY, USA

    Yassar Sattar

Authors
  1. Muhammad Umar
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  2. Rayyan Nabi
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  3. Aftab Ahmed Dero
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  4. Muhammad Talha
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  5. Syed Moinnuddin
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  6. Yassar Sattar
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Contributions

• Muhammad Umar: Supervision, data curation, reviewing, and writing. • Rayyan Nabbi: Data collection, writing, and reviewing. • Muhammad Talha: Reviewing and editing. • Aftab Ahmed: Providing conceptual input, information, and review.

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Correspondence to Muhammad Umar.

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Umar, M., Nabi, R., Dero, A.A. et al. Heatstroke, dehydration, and missed voices: the hidden pediatric crisis in children with cerebral palsy amid Pakistan’s climate emergency. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04433-y

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