By the morning of July 20, the campfire smell had lifted, and the sky looked almost normal. But the air quality index was still in the 130s, in the range the EPA calls “unhealthy for sensitive groups.” Children are a sensitive group, and I, Victoria, had my sons both scheduled for local camps.
My 4-year-old’s camp had moved activities completely indoors with windows closed and an air purifier running. My 7-year-old’s camp had made no changes, with outdoor time as scheduled. I sent my 4-year-old in and kept my 7-year-old home.
I’m a physician who spent 12 years living and practicing in California and Washington, and I’m familiar with wildfire smoke and its health effects. That morning, I became my kids’ air-quality officer. But that’s a job no parent should have to do.
Local organizations are doing their best given the Midwest isn’t accustomed to wildfire smoke. But with no statewide standard in Illinois for children’s outdoor activity in poor air quality, it’s not surprising that program policies represent a patchwork. Where rules exist, without explicit guidance, there is often little nuance, and it turns into “carry on” or “cancel.”
Illinois requires daily recess and encourages schools to hold it outdoors. The Illinois Board of Education advises when it’s too hot or cold for recess outside, but says nothing about poor air quality. Chicago Public Schools responded to an air quality alert earlier this month by moving summer programming indoors using its extreme heat plan.
The Illinois High School Association refers to national guidance, which recommends following state and local health departments. And the Illinois Department of Public Health refers back to EPA guidance. Illinois has defaulted to federal guidance without determining whether it serves children here.
But EPA guidance can be hard to interpret and apply in real life. At some air quality index levels it suggests less intense activity, but only in general terms: more breaks, walking instead of running. The same advice covers a 5-year-old and a 17-year-old. A statewide standard matters precisely because the EPA guidance leaves too much open to interpretation.
I first noticed the gap coaching park district T-ball. I had to decide whether to hold practice for a team of 3- to 5-year-olds when the forecasted index was 101 to 150, in the “unhealthy for sensitive groups” range.
The Park District of Oak Park’s air quality plan says outside work and activities proceed as scheduled when the index is 101 to 150, with frequent breaks. Just across the city line, the Chicago Park District does the same.
But above an index of 150, they part ways. The Chicago Park District moves programming indoors where feasible and may cancel outdoor events. PDOP only encourages camps to reduce time outside or remain inside, and doesn’t require programs to move inside until the index exceeds 200.
Both are defensible readings of the same federal guidance. The EPA’s school guidance, written in 2014, doesn’t recommend moving all children indoors until the index is above 200, in the “very unhealthy” range. Below that, it advises keeping kids outside with modifications.
But 3- to 5-year-olds sprint when they feel like it. For that group, the modify option doesn’t reliably exist.
Also, above an index of 100, every child is considered sensitive because children’s lungs keep developing into their early 20s. Kids also breathe in more air than adults relative to their body weight, contributing to greater exposure.
EPA’s guidance is organized around acute symptoms, such as coughing and wheezing, that develop in close proximity to exposure. It doesn’t account for what repeated exposure adds up to over a childhood.
States on the West Coast, where communities have lived with wildfire smoke far longer, have already built robust statewide policies, based on newer research showing that smoke harms children at lower exposures than previously believed. In June, Oregon updated its policy on exactly that basis. California’s Education Department built a tiered framework for schools, and Washington maintains a detailed children-and-youth guide that includes examples of activities for different intensity levels.These are graduated frameworks, not on-off switches.
King County Public Health, which covers Seattle, has more conservative guidance. It tells sensitive groups, including all children under age 18, to stay indoors as much as possible when the index hits 100.
Canceling outdoor programs has real costs, and they fall hardest on families with the least slack — parents who can’t miss work, kids who rely on a program for lunch or supervision. That’s why the answer is a well-defined, tiered, statewide standard.
The standard should include explicit index thresholds, clear age groups and concrete activity examples, so park district supervisors and camp directors don’t need to guess. It should recognize that younger children can’t reliably modify their activity the way federal guidance assumes. And it should default to caution: We don’t yet fully understand the long-term harms of exposure, and the least protective option shouldn’t be the automatic one.
With wildfire smoke exposures similar to Chicago’s, Milwaukee’s Health Department tells schools, daycares and sports teams to develop indoor alternatives once the air quality index passes 100, pointing families to King County’s guidance.
Illinois should learn from places that have already done this work and build a comprehensive standard for children’s outdoor activity in poor air quality.
Parents already have their hands full and shouldn’t have to be air quality officers. The smoke will come again, and our children deserve a plan that protects them.
Dr. Victoria Johnson, MPH, is an internist in Oak Park, where she volunteers as a T-ball coach. Dr. Sheetal Khedkar Rao is an internist and assistant professor of clinical medicine at the University of Illinois Chicago, where she teaches about the impact of climate change on health.
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