Ethics statement

Ethical approval was obtained from the Ethics Commission in Heidelberg, Germany (S-171/2023). All interested participants were provided with pertinent details about the study, such as the risks and benefits [47], purpose, and expected duration prior to establishing informed consent [48,49] to participate. The study was voluntary for all participants, and they had the option to withdraw [48] their consent at any point in the process. Following transcription, all recordings were deleted, and no personal identifiers were included in the transcripts to ensure confidentiality [50]. The names of the respondents and all other confidential information are subject to the General Data Protection Regulation (GDPR) [51] provisions.

Study design and participant recruitment

We conducted online, semi-structured, in-depth interviews for primary data collection. The recruitment aim was to engage a wide range of stakeholders who - through their employment, research, or advocacy - had knowledge regarding the adoption of NAPs in their country of residence. Through purposive sampling [52], we initially identified countries based on the findings of our previous policy document analysis of 160 national adaptation plans [26], which assessed the inclusion of child-specific adaptation measures. Countries with comparatively higher levels of child health inclusion were purposively selected to explore the drivers and barriers underlying these policy approaches and to identify transferable lessons for child-centered climate change adaptation. To maximize diversity, we also sought variation in geographic region, World Bank income classification, governance context, and climate change vulnerability, recognizing that these factors influence national adaptation priorities and policy development.

Ministries of Health (MOH) and Ministries of the Environment (MOE), or the designated lead institutions responsible for NAP development identified through publicly available government documentation, were contacted via their publicly available official email addresses and invited to participate. We contacted stakeholders in over 50 countries; due to limited response rates, snowball sampling [53] was subsequently used to identify additional participants with direct experience of NAP development, implementation, or climate change adaptation policy.

Data collection

Semi-structured [54], in-depth interviews [55] (IDI) took place with participants online via Zoom. A pre-determined interview guide was prepared with questions and topics [26], identifying drivers and barriers of child health inclusion in national adaptation planning. The semi-structured nature allowed for flexibility with open-ended questions to enable more spontaneous, natural, and authentic conversations for rich data collection [54]. Data collection took place over a one-year period, from 01/05/2023 to 30/04/2024. One-to-one interviews were conducted by two researchers in either English or German, lasted 45–90 minutes and were recorded. To build trust and ensure participants felt comfortable throughout discussions in the interview process, they could opt out [48] of answering any questions if they wished. Following each interview, a debriefing session [48,56] took place with the leading three co-authors (KEZ, CWC, MA) to identify recurring themes, refine interview techniques, and reflect upon the interview itself to strengthen the research process.

Data analysis

Each interview was transcribed verbatim using MAXQDA software and translated, into English through Deepl translator. Proof-check of transcription and translation was conducted line-by-line by two authors (KEZ and MA). Multiple rounds of review occurred and were verified by two researchers to ensure data accuracy and validity [57]. Interviews were analyzed by following a 5-step framework approach [58]: 1) Familiarization with the data, 2) Identifying a thematic framework, 3) Indexing, 4) Charting, and 5) Mapping and Interpretation. Two researchers (KEZ and CWC) read through every transcript and did descriptive coding [59] of each interview. Both authors reviewed each other´s descriptive coding, compared differences, and agreed upon a final set of codes. Descriptions were then brought through two rounds of review (KEZ, CWC, MA) to organize the data to determine overarching themes and patterns [59] related to the drivers and barriers for integrating child health adaptation into climate change policies. This process facilitated thematic analysis [60,61], which is the basis of the results section for this article. Once emerging frameworks were identified, senior authors were consulted to refine the ideas supported by broader literature. The frameworks were adapted into a logical narrative to guide analysis and align with the study’s aims.

A - Attract Allies

In order to create inclusive adaptation strategies for child health, stakeholders highlighted a need to foster collaborative governance, stakeholder engagement, and international networks. These collaborations should span multiple levels of governance—supranational, transnational, translocal, and intersectoral [61].

B - Beware Biases

Stakeholders conveyed a broad range of perceptions, priorities, and gaps in relation to children’s needs in NAPs. Several themes emerged highlighting these biases, such as a lack of consideration for children as stakeholders, assumptions about their capabilities, and limited integration of children’s perspectives in policy planning.

Austria (AT03) further explained how they had a

… “minister, two years, but that was enough, because … she was really [adamant] that (…) climate change is not an issue in Austria, it still isn't. They're more of a climate change denier, yes”.

Biases from individuals in leadership positions, including climate change denial, posed barriers to advancing climate change priorities, including child-centered-and-benefitting’ priorities, within NAPs (FI11).

Stakeholders described efforts to address these biases, including engaging in collaborative dialogue among researchers to reconcile differing views and advocate for policy changes (FI11, AT03). Recognition of these dynamics underscored the importance of fostering diverse teams with broad perspectives to ensure comprehensive and equitable consideration of child health in adaptation strategies.

C - Collaborate with children

Some stakeholder discussions underscored the importance of recognizing children as capable, active agents in CCA. Oftentimes only adolescents were considered for inclusion, with little attention given to the meaningful participation of younger age groups (JO04, NZ09, DE10, PH14, SE17). This highlighted a gap in considering younger children in adaptation efforts.

Reframing adaptation through a Children In All Policies approach [67]

Children are particularly vulnerable to the impacts of climate change [2–5,7], which poses significant risks to their health and well-being. Insights from our stakeholder discussions across various countries suggest the need for advocacy to ensure that child health is systematically included in all climate change policies. This finding supports on other established frameworks, such as “Health-in-All-Policies” (HiAP) and “Children In All Policies 2030” (CAP-2030) [68,69]. HiAP promotes cross-sectoral collaboration to prioritize health considerations beyond the healthcare sector, while CAP-2030’s networked approach [69] emphasizes coalition-building to center children’s perspectives and voices in all policies. Taken together and alongside the results of our study, these frameworks suggest that collaborative, intersectoral approaches are necessary for tackling holistic problems in child health, and can set the standard for an inclusive approach to environmental decision-making.

A climate change focused Children In All Policies approach must also recognize the specific needs of indigenous children, as they face compounding vulnerabilities from climate change [70,71], yet are often excluded from policy development and decision-making processes [72]. Policies grounded in indigenous knowledge systems and developed in partnership with indigenous communities, can offer key solutions to mitigate the unequal impact of climate change on left out and marginalized populations [73–75]. Beyond public health and children's rights, our findings can also be interpreted through the lens of contemporary environmental justice. Schlosberg [76] argues that environmental justice extends beyond the equitable distribution of environmental harms and benefits to encompass recognition, meaningful participation, and the protection of people's capabilities to flourish [77]. From this perspective, children experience a double injustice in the context of climate change: they are disproportionately affected by its health consequences while simultaneously remaining under-recognized within adaptation governance. Their exclusion therefore represents not only a distributive injustice but also a failure of recognition and procedural justice. This interpretation is further supported by Nussbaum's Capabilities Approach [78], which argues that justice should be evaluated according to people's genuine opportunities to live healthy, flourishing lives and to participate in decisions affecting them. For children, climate change adaptation policies shape fundamental capabilities - including health, bodily integrity, education, play, affiliation, and participation - that influence both their present well-being and their future life opportunities. Viewed through this lens, a Children in All Policies [69] approach extends beyond protecting a vulnerable population; it represents an ethical commitment to creating governance systems that recognize children as present rights-holders and future citizens whose capabilities should be actively safeguarded and promoted through climate change adaptation.

Centering the concerns of children and indeed future generations can be seen as an intervention to improve overall health outcomes. For instance, the UK’s Soft Drink Industry Levy [79], a key component of its childhood obesity strategy, led to a statistically significant reduction in obesity rates among young girls, with potential life-course benefits given evidence that lower sugar intake in early life reduces later risks of diabetes and hypertension [80,81]. When it comes to environmental policies, the life-course effects for children are also poised to be significant not to mention that all people benefit from cleaner and healthier environments. Prioritizing child health in policies can yield measurable, long-term health benefits and underscores the importance of incorporating this perspective into CCA strategies [82].

Challenging institutional adultism

Despite widespread recognition of the importance of child participation, our findings suggest that barriers extend beyond identifying appropriate participatory methods. Stakeholders supported in varying degrees involving children in climate change adaptation planning, yet few described institutional mechanisms through which children's perspectives systematically informed policy decisions. In many examples, children were consulted only after key decisions had already been made or participated through processes with limited influence on policy outcomes. These findings indicate that participation remains constrained not only by procedural challenges but also by broader institutional assumptions about children's role in governance.

Recent scholarship describes these assumptions as forms of institutional adultism, whereby adult perspectives are implicitly prioritized while children's competence and political agency are underestimated [15,36]. As a result, children are frequently positioned as future beneficiaries of climate change action rather than present rights holders and contributors to adaptation planning. Our findings mirror this tension: while stakeholders recognized the importance of children's participation, few described mechanisms through which children's perspectives systematically informed decision-making.

This interpretation complements The HART Ladder and Lundy's Model of Participation, which both argue that meaningful participation requires more than providing children with opportunities to express their views - it also requires genuine influence over decision-making [88,92]. Likewise, studies of youth participation in international climate change governance have shown that representation alone is insufficient when institutional structures fail to enable meaningful engagement or shared decision-making [38,41].

Recognizing these institutional barriers shifts the focus from simply increasing opportunities for participation toward addressing the governance structures and power relations that determine whose knowledge is considered legitimate. The predominance of perspectives from policymakers and technical experts within our interviews also reflects existing governance structures, in which decisions regarding children's health are primarily negotiated among adult institutional actors. While these perspectives provide valuable insight into policy processes, they also illustrate how institutional authority shapes which forms of knowledge are prioritized and whose voices are considered to being included within climate change adaptation planning. Viewed through this lens, the ABC framework extends beyond promoting child participation by highlighting institutional conditions that support more equitable, child-centered climate change adaptation governance.

Addressing these institutional barriers also requires ethical frameworks that recognize children as legitimate contributors to decision-making rather than passive recipients of protection. The Childhood Ethics Framework by Thompson et al. [102] advocates for recognizing children as active agents with rights, capabilities, and meaningful contributions. This perspective challenges traditional notions of children as mere “becomings” or “incapable” individuals, instead emphasizing their role as “beings” and active agents, framing childhood as a dynamic social construct shaped by context, culture, and time [103,104]. Although there have been advancements in child-inclusive ethical frameworks, they have not been widely applied in CCA policies, due to priorities surrounding adult-centric principles and overlooking specific vulnerabilities of children.

As such, the framework offers a critical lens for re-evaluating ethical standards to ensure that children’s rights, agency, and interests are effectively integrated into decision-making in climate change policies.

Strengthening collaborative institutional approaches for child-centered adaptation

Addressing child health in the context of climate change requires a connected governance approach that moves beyond the fragmented landscape of policymaking [33]. Climate change impacts all social domains, including health, education, infrastructure, and livelihoods. At the same time, we found that that governance structures addressing these impacts often operate in silos [105,106], which weakens the effectiveness of policies intended to safeguard vulnerable populations, particularly children. Building on concepts from polycentric climate change governance [107], we can identify opportunities and challenges across supranational, transnational, and translocal levels, which must be streamlined to address climate change impacts on child health more effectively.

Supranational entities, such as the UNFCCC, aim to set overarching agendas for CCA and shape national policies. The UNFCCC’s NAP process, for instance, encourages countries to develop cohesive CCA strategies, which theoretically promotes coherence across national approaches. However, the influence of supranational frameworks often does not translate seamlessly to national structures, where ministries frequently operate without coordination, resulting in fragmented responses across CCA policies. Participants consistently described climate change governance as organized through sector-specific mandates, despite recognizing that climate change impacts transcend environmental, health, social, transport, energy, and infrastructure sectors. This fragmentation limited the integration of child health considerations into adaptation planning and reinforced siloed approaches to climate governance. Likewise, research suggest that for frameworks like the NAP process to be effective, supranational actors must emphasize cross-sectoral integration and support countries in fostering inter-ministerial collaboration [108]. Without such support, countries risk developing policies that overlook the intersecting social determinants of child health.

At the transnational level, knowledge sharing and collaboration across countries and organizations present an opportunity to strengthen climate resilience and child health adaptation. However, adaptation literature consistently highlights that these efforts remain constrained by fragmented governance arrangements, limited institutional mechanisms for sustained knowledge exchange, inconsistent monitoring and evaluation frameworks, and the absence of harmonized adaptation indicators for tracking adaptation progress across countries [109–112]. As a result, successful adaptation approaches are often exchanged through ad hoc collaborations rather than systematically evaluated, adapted, and scaled across contexts [113,114]. When countries and organizations are equipped with robust networks and resources for cross-border cooperation, they can implement more effective child health policies [115–117]. Given that climate change exacerbates existing inequities, transnational cooperation and knowledge exchange – exemplified by initiatives such as UNICEF’s Children’s Environmental Health Collaborative – are essential to safeguarding children’s health and rights [118].

The interviews demonstrated that integrating translocal perspectives—those of local actors, communities, and grassroots organizations—into CCA governance is essential. Local actors play a pivotal role in translating national policies into meaningful action within communities, mobilizing efforts to address child health vulnerabilities exacerbated by climate change impacts. This local engagement is particularly crucial, as research underscores the importance of cultural and community-specific nuances in effective climate change and health interventions [119].

The challenge, however, lies in overcoming the fragmented policy-making structures at each level of governance and between these levels. Polycentric climate change governance provides a promising approach for bridging these divides. When all levels of governance—supranational, national, and local—engage in a multilevel framework, climate change policies gain flexibility, responsiveness, and contextual relevance, essential for safeguarding child health [120]. It integrates top-down guidance from supranational organizations with innovations and insights from local actors, thus creating more effective policies. Importantly, as governance scholars have highlighted [107,108,119,121,122], grounding CCA strategies in both cross-border perspectives and local realities enhance their effectiveness and promotes sustainable child health resilience against climate change.

Operationalizing the ABC framework for policy and practice

The ABC framework offers a practical governance approach for translating child-centered climate change adaptation from principle into practice. While existing participation frameworks, such as Lundy's model of participation, emphasize the conditions required for meaningful engagement - including providing children with space, voice, audience, and influence [92] - our findings demonstrate that these conditions cannot be achieved without broader institutional change. Stakeholders consistently described governance structures characterized by fragmented responsibilities, sectoral silos, and participation processes that frequently remained consultative rather than influential, suggesting that meaningful child participation is as much a governance challenge as it is a participatory one.

From this perspective, the three domains of the ABC framework provide complementary priorities for institutional action. Allyship calls for permanent collaboration across sectors responsible for children's health and well-being, including health, education, environment, urban planning, disaster risk reduction, and finance, while extending partnerships to researchers, civil society, children's rights organizations, and affected communities to reduce fragmented decision-making and support more coherent, child-responsive adaptation strategies. Bias Recognition requires institutions to critically examine how child health evidence is generated, interpreted, and translated into policy. Our findings highlight substantial gaps in child-specific data, fragmented evidence across sectors, and institutional assumptions that may underestimate children's distinct vulnerabilities and capacities. These biases shape which adaptation priorities become visible and whose needs are ultimately addressed. Operationalizing this domain therefore requires not only strengthening the child health evidence base but also critically evaluating how evidence is produced, interpreted, and weighted within climate change adaptation processes to ensure that children's needs are systematically and equitably considered.

Finally, Child-Centeredness positions children not only as beneficiaries of climate change adaptation but as legitimate contributors throughout the policy process. Our findings indicate that children and young people were often invited to participate only after priorities had already been established, limiting their ability to influence policy outcomes. This reflects a form of institutional adultism in which participation risks becoming symbolic rather than substantive. Operationalizing this domain requires involving children from agenda setting through implementation and evaluation, using developmentally appropriate participatory approaches, and establishing transparent feedback mechanisms that demonstrate how children's perspectives informed decisions. In this respect, the ABC framework complements Lundy's emphasis on influence by drawing attention to the governance structures and institutional conditions necessary for meaningful, ethical, and sustained child participation.

The ABC framework extends existing literature by embedding children's participation within broader systems of governance rather than treating it as a discrete engagement activity. Achieving child-centered climate change adaptation therefore requires institutional arrangements that foster cross-sector collaboration, strengthen the evidence base on children's health, critically address structural biases in decision-making, and establish accountable processes through which children's perspectives can genuinely shape adaptation policies. Rather than asking whether children should participate, the more important question is how governance systems can be designed so that children's knowledge meaningfully informs climate change adaptation decision-making.

Limitations

Climate change policies are evolving rapidly across contexts; consequently, priorities and frameworks may have shifted since data collection. Participants’ responses may also have been constrained by institutional or political challenges, or by competing priorities. In addition, the relatively small sample may limit its transferability. Although children’s perspectives could have enriched the findings, their limited engagement in NAP processes placed them outside the scope of the present study. Likewise, because the study aimed to explore experiences of stakeholders directly involved in the development and implementation of NAPs, interviews focused primarily on representatives from ministries, governmental agencies, and affiliated technical experts. Consequently, perspectives from civil society organizations, children's rights organizations, NGOs, and community-based actors were not included. These stakeholders offer important complementary insights into accountability, advocacy, and participatory governance. Future research should examine how their perspectives align with or challenge those of institutional policy actors.

Conclusion

As climate change increasingly threatens children's health and well-being, adaptation policies must move beyond recognizing children as a vulnerable population towards engaging them as legitimate stakeholders in adaptation governance. Our findings demonstrate that while stakeholders widely acknowledge the importance of child participation, institutional barriers—including fragmented governance, sectoral silos, and participatory processes that often remain consultative rather than influential—continue to constrain children's ability to shape adaptation policies.

The ABC framework contributes to this debate by extending child participation beyond individual engagement activities to the broader governance systems in which adaptation decisions are made. By emphasizing Allyship, Bias Recognition, and Child-Centeredness, the framework complements established participation models by highlighting the institutional conditions required for children's perspectives to meaningfully inform policy. In doing so, it shifts attention from whether children participate to how governance structures enable their participation to influence decision-making.

Operationalizing child-centered climate change adaptation therefore requires more than creating opportunities for consultation. It calls for sustained intersectoral collaboration, critical reflection on institutional biases that perpetuate tokenistic participation, and transparent processes that involve children throughout agenda setting, implementation, and evaluation. Embedding these principles within adaptation governance has the potential to strengthen not only children's participation, but also the relevance, equity, and effectiveness of climate change adaptation policies.