Emergency departments expect a spike in visits when outdoor temperatures rise or fall dramatically. Pediatric practices should expect same-day cancellations and no-shows when forecasts call for extreme heat or cold, a new LDI study shows.

LDI Senior Fellow Stephanie Mayne was intrigued by a paper showing associations between extreme temperatures and adults missing primary care visits. She searched for similar studies on children’s visits but found none, so she assembled a research team from her hospital’s Possibilities Project, which tests innovative ideas to improve pediatric care.

Mayne and colleagues, including LDI Senior Fellows Brian Jenssen and Alexander Fiks and LDI Associate Fellow Joniqua Ceasar, asked: Does extreme weather also affect pediatric preventive care visits? 

Their study confirmed earlier research indicating that children from lower socioeconomic settings, who may have unmet social needs, particularly related to transportation, are more likely to miss primary care visits. The new study also had some unexpected findings. 

“We were surprised to also see strong associations between missed visits and cold temperatures for kids from higher socioeconomic neighborhoods,” Mayne said.

Cold Weather Linked to Stronger Subgroup Differences

Mayne and colleagues measured missed preventive care visits from 2009 to 2023 for more than 500,000 children younger than 19. Their medical record data were limited to 32 practices in the Children’s Hospital of Philadelphia’s Pediatric Research Consortium, a primary care network covering Philadelphia, southeastern Pennsylvania, and southern New Jersey, including the Jersey Shore. County-level weather data were from the National Oceanic and Atmospheric Administration. Socioeconomic data came from the Childhood Opportunity Index. 

Overall, 13% of the more than 4.1 million scheduled preventive care visits were no-shows or same-day cancellations, equaling more than 540,000 missed visits over the study period. Generally, patients who had public or unknown insurance, received charity care, or lived in low socioeconomic neighborhoods had higher missed-visit rates, but extreme temperatures affected rates for all patient groups. 

Each 1-degree change below 41.5 degrees or above 88 degrees was associated with a 1% increase in missed appointments (Figure 1). Hotter temperatures appeared to have a slightly stronger effect on missed appointments for children from the lowest and second-highest categories of socioeconomic neighborhoods. Snow, of course, “had really big impacts” and was linked to a more than 33% increase in missed-visit rates, Mayne said.

Colder temperatures were associated with greater impacts on missed visits, particularly for children younger than 2. The researchers hypothesized that extreme temperatures would make it harder for children who lived in lower socioeconomic areas to attend scheduled visits, given the known link between transportation challenges and missed appointments. However, cold temperatures had the strongest effect on missed-visit rates for children with commercial insurance or those from high-opportunity neighborhoods.

Can Telehealth, Transportation, and Flexible Rescheduling Help?

Transportation options and the ability to reschedule may contribute to the unexpectedly high rates of missed visits during cold weather for children from higher-opportunity neighborhoods. 

The study data did not cover reasons for missed visits, Mayne said, “but we speculated that families in more affluent areas have easier access to a vehicle.” These families might have fewer challenges attending appointments on 100-degree days, while families who walk or use public transportation may hesitate to make the trip.

Icy days may have the opposite effect, creating challenges for families who drive. These caregivers may also have more flexible work arrangements that allow them to reschedule. In addition, the lower baseline rates of missed visits for children with commercial insurance or those from higher-opportunity neighborhoods made temperature-influenced changes easier to detect.

Mayne and colleagues are developing personalized, actionable findings for their network practices so they can find ways to work with families to keep appointments during extreme weather. 

“Clinicians on our team mentioned potential solutions, including flexible rescheduling policies, proactive outreach to patients during extreme weather, and transportation assistance,” Mayne said. Telehealth might be an option for preventive care that can be done remotely when insurance reimbursement is possible.

This pilot study did not report outcomes from skipped visits, Mayne said, so the effects of missed visits on vaccinations, lead screenings, growth and development checks, and other preventive care are unknown. Investigating these downstream effects could be the next step for this research team.

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The study, “Extreme Temperatures and Missed Pediatric Preventive Care Visits,” was published on April 27, 2026, in JAMA Network Open. Authors include Stephanie L. Mayne, Janani Ramachandran, Priyani Sharma, Joniqua Ceasar, Maura Powell, Brian P. Jenssen, and Alexander G. Fiks.

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