-->PONE-D-25-69159-->-->Health Impacts of Climate Change on Children and Adolescents: A Protocol for Review of Reviews-->-->PLOS One

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-->-->Please clearly address the points and suggestions raised by the two peer reviewers to improve clarity of this protocol and transparency of the proposed methodology of this umbrella review. -->-->Additionally, please clarify if forward citation searching (i.e. search to see if the included studies are cited by more recent publications that may meet your review's eligibility criteria) will be conducted. -->--> -->-->Please submit your revised manuscript by Jun 20 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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PLOS One

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Reviewers' comments:

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-->Comments to the Author

1. Does the manuscript provide a valid rationale for the proposed study, with clearly identified and justified research questions?

The research question outlined is expected to address a valid academic problem or topic and contribute to the base of knowledge in the field.-->

Reviewer #1: Partly

Reviewer #2: Yes

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-->2. Is the protocol technically sound and planned in a manner that will lead to a meaningful outcome and allow testing the stated hypotheses?

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Reviewer #1: Partly

Reviewer #2: Partly

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-->3. Is the methodology feasible and described in sufficient detail to allow the work to be replicable?

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: No

Reviewer #2: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above and, if applicable, provide comments about issues authors must address before this protocol can be accepted for publication. You may also include additional comments for the author, including concerns about research or publication ethics.

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(Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This will make a valuable contribution to the understanding of climate change and children's health. I am unclear if publication of the protocol is necessary or valuable prior to the review being completed.

The language is good but needs substantial revisions prior to publication. I am unable to name all the recommended changes due to number. The abstract and pages 8-10 need to be checked closely for grammar and fluency. I have listed below some specific comments, however these are not exhaustive.

Abstract-"Climate change events such as extreme heat, rising sea levels, floods, food insecurity, and others significantly affect local, regional, and global living conditions." These are not all "events"

"Therefore, this review aims to re-map the existing reviews of the impact of climate change on the health and well-being of children and adolescents." Have the reviews already been mapped? If not then this is a first "mapping" of all reviews rather than "re-map".

1. "Climate change refers to a gradual atmospheric shift"- I have not heard this description before. It may be accurate but I'm not certain.

References 5 and 6 likely should be national/international expert reports such as from IPCC/US National Climate Assessment rather than articles focused on single issue (agriculture) or by single author.

2. "Evidence suggests that the climate crisis is largely anthropogenic"- this should be more definitively stated. Per IPCC AR6 "Human activities, principally through emissions of greenhouse gases, have unequivocally

caused global warming"

3. "The rate and severity of life-threatening weather events..." the reference is only re extreme rainfall and drought, not the other listed weather events. Each of these events is different, and not all are increasing in both frequency and severity. References should support the statement for each listed event.

4. "the 2023 wildfires in Hawaii and the floods in Vermont were intense and frequent"-more frequent does not make sense here. It would be better to reference the article referenced by the book for this statement rather than the whole book.

5. Please confirm the accuracy of this statement. 3 billion is a high percentage of the world population. "Accordingly, heatwaves will displace up to three billion people by the end of this century [14]."

6. Page 9:"For example, the recent rise in malaria, malnutrition, diarrhea, mental health challenges, and

the risk of under-five mortality, as well as increases in wasting and stunting, are associated with climate change [21,23,24]." Are all of these increasing? I do not see that these references support the broad statement.

7. Page 9 is confusing for a variety of reasons.

- "implications for higher morbidity and mortality from various climate-related diseases"; "diseases" is not the correct term here, could be "conditions" to include injuries, interruption in education etc.

-"However, although these results are important, they are fragmented and limited in their collation of evidence, making it difficult to draw conclusions for policy and practice." It should be more explicitly explained why the prior reviews are insufficient and a new review is needed. This is unclear.

-"These reviews concluded that adolescents in vulnerable populations, especially those living in low-income areas, are disproportionately affected by climate change events." Only adolescents were found affected? What about younger children?

And per next sentence, are the effects mostly mental health? One referenced article (#27) is from 2014, well before the reviews were conducted.

-" The health impacts on adolescents and children in low- and middle-income countries (LMICs), indigenous communities, and individuals with preexisting health conditions are also not addressed in the existing reviews." What about ref #8?

I am unable to assess the methods due to lack of expertise. This should be assessed by a different reviewer.

Reviewer #2: Thank you for asking me to review this protocol. I would like to congratulate the authors on this interesting and important research topic. I have some suggestions for consideration.

• As you are proposed an umbrella review (review of reviews), shouldn’t that be a systematic review? What is your justification for your scoping review?

• There are a range of terms used when it comes to climate change such as planetary health, environmental sustainability, environmental change etc. It would be good to flag there and talk about how these align or vary across the overarching concept of climate change.

• Why particular focus on adolescents in the research question? Wouldn’t the broad term of “children” capture all (infants, toddlers, teenagers etc)?

• What is JSTOR?

• What about other databases such as CINAHL, Embase, Cochrane Library etc?

• Why the date limit from January 2020? Who says literature published since then is contemporary? What about December 2019?

• Will there be any other limits imposed such as language?

• Why not search organisational websites, forward and backward citation etc?

• Are you not using any keywords or subject headings for reviews?

• What is your understanding of grey literature as Google and Google Scholar are grey literature and you are planning on excluding grey literature?

• How will you account for the same publications appearing in multiple reviews? Are you planning on undertaking a CCA (the Corrected Covered Area (CCA) is a metric used in umbrella reviews to quantify the degree of overlap (shared primary studies) among multiple systematic reviews)?

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Reviewer #1: No

Reviewer #2: No

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Health Impacts of Climate Change on Children and Adolescents: A Protocol for Review of Reviews

PONE-D-25-69159R1

Dear Dr. YAHAYA,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

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Kind regards,

LS Katrina Li

Academic Editor

PLOS One

Additional Editor Comments (optional):

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