At six in the morning you are in the kitchen, snapping the lid onto a lunch box, when you see Abah at the front door tying his shoelaces for his usual walk around the taman. Outside, the sky is the colour of dishwater. He says he has walked every morning for twenty years and a bit of jerebu is not going to stop him. You glance at the lunch box, at the school bag by the door, at the baby monitor on the counter, and realise that one household is holding at least four different kinds of "haze risk" at the same time.
That is exactly why this guide exists. It is the family guide to haze for Malaysian mums and caregivers: one clearly separated section for each person you look after, what to do for them at each API level, and when to get medical help. It builds on our main haze survival guide for Malaysian women, which explains how the Air Pollutant Index (API, or IPU) works, so here we spend our time on people rather than numbers.
What you'll learn
- Why children, pregnant women, people with asthma or heart disease, and older adults feel haze more than healthy adults, according to MOH, the DOE, WHO and the US EPA.
- What school closures and outdoor-activity rules mean for your children, and when you may keep them home.
- Practical steps for pregnancy, asthma and COPD, heart disease and diabetes, and for elderly parents.
- How to set up a family haze plan, including a clean-air room and a medicine checklist.
- The red-flag symptoms for each group that mean it is time to see a doctor.
Explore this topic (all related guides)
- Haze Survival Guide for Malaysian Women: Skin, Hair, Family and Everyday Health — Read when you want the basics first: what the API means, the bands, indoor air, hydration and everyday relief.
- Haze and Your Skin: Dullness, Breakouts and Pigmentation, and a Simple Routine (Including Hijab Wearers) — Read when your own skin needs a little care after a hazy week.
- Haze and Hair Fall: Itchy Scalp, Dryness and What Actually Helps (Including Under a Hijab) — Read when your scalp is itchy or you are worried about shedding.
- Haze Masks for Women: N95 vs Surgical, Getting a Good Fit Over a Hijab, and Avoiding Mask Breakouts — Read when you need to get masks for the adults in your household and want to fit them properly.
- Do Vitamin C and Antioxidant Supplements Protect You From Haze? What Women Should Know — Read when a relative or friend suggests vitamins for the whole family during haze.
- Can't Exercise Outside in the Haze? API Guidelines and Indoor Workouts to Keep Your Routine — Read when the school field or the morning walk is off the table and you need indoor ideas.
Why do families feel haze so differently?
Haze affects everyone, but not equally. Between them, the Department of Environment (DOE), the Ministry of Health (KKM) and the Malaysian Medical Association (MMA) describe vulnerable groups as children, the elderly, pregnant women, and people with respiratory problems or existing heart and lung disease. The US Environmental Protection Agency (EPA) gives a similar list and adds outdoor workers and people of low socio-economic status, who may have fewer ways to reduce their exposure.
Here is the API in one minute. The DOE bands it as 0–50 good, 51–100 moderate, 101–200 unhealthy, 201–300 very unhealthy and above 300 hazardous. Its own guide regards 100 as the safe limit. At 101–200 it advises high-risk people to restrict outdoor activities and everyone else to reduce vigorous outdoor activity; at 201 and above, the elderly and people with known heart or lung disease should stay indoors, and everyone else should avoid vigorous outdoor activity. For the full explanation, see the main guide.
The table below turns that advice into a family view. It uses only wording from the DOE, MOH, MMA, WHO and EPA sources listed at the end, and where a source gives no API-specific rule for a group, it says so.
The rest of this guide takes each row in turn.
Young children and school kids
Children are not just small adults. The World Health Organization (WHO) explains that children breathe faster than adults and so take in more pollutants, and that they live closer to the ground, where some pollutants peak, while their lungs and brains are still developing. The EPA says all children, even those with no chronic illness, are considered sensitive to smoke, partly because they spend more time outdoors, play more vigorously and inhale more air for their body weight. The EPA recommends limiting children's vigorous outdoor activities when the air is smoky.
What the school rules mean for you
The rules are clearer for schools than for most other places. On 30 August 2026 the DOE said that schools, kindergartens and childcare centres should close immediately when the API exceeds 200, that they should keep watching readings and prepare early when the trend is heading towards 200, and that outdoor activities should also be suspended when the API exceeds 100. The Education Minister said on 7 September 2026 that outdoor classroom activities stop at 100, schools close above 200, and parents who feel the air is a risk to their children may keep them home, provided they inform the school.
In practice that gives you a simple plan:
- Know where to look. The DOE's APIMS site shows the readings.
- Ask your child's school how it decides when to move PE indoors or close, so that you are not guessing.
- If the API is rising and you are uneasy, you do not have to wait for an official closure: parents may keep children at home after telling the school.
- Keep playtime gentle on unhealthy days. Board games, drawing, stretching and indoor dancing are fine substitutes for the field.
Babies and toddlers
There is less official guidance specifically for babies. The EPA notes that after wildfire smoke events, studies have found more emergency visits for asthma among children, especially infants and very young children. It also says children aged 2 and older can wear respirators, but that NIOSH-approved respirators do not come in sizes suitable for young children. So for babies and toddlers, the practical plan is simple: keep them indoors with windows closed on bad days, and ask your child's doctor or clinic nurse if you have questions about masks.
What to watch for in children
Cough, wheezing, difficulty breathing and chest tightness are the symptoms the EPA lists in children exposed to smoke. In late August 2026 KKM reported a rise in haze-related asthma and eye-irritation cases in a single week, which is a useful reminder that eyes and airways are the first to complain. Do not rub itchy eyes, and see a doctor if your child has trouble breathing, a cough that keeps getting worse, or eye pain. If your child has asthma, follow the action plan their own doctor gave you. The Malaysian asthma guideline we cite below is written for adults, so we do not apply its details to children.
Pregnancy and breastfeeding
Pregnancy changes how the body handles the air. The EPA says that the higher breathing rate and larger blood volume of pregnancy can raise vulnerability to environmental exposures. The WHO states that pregnant women exposed to polluted air are more likely to give birth prematurely and to have small, low birth-weight babies, and in an air quality guideline explainer it also reports an association between prenatal exposure to high levels of air pollution and developmental delay at age three.
It helps to keep this in proportion. Those findings are mostly about long-term exposure to polluted air, not a single hazy week. The EPA is candid that evidence on wildfire smoke and pregnancy specifically is limited. Still, KKM and the MMA both name pregnant women among those who should be more careful, which is reason enough to take sensible steps:
- Reduce time outdoors on unhealthy days, and keep windows closed at home. If you have a filtered-air room, spend time there.
- Ask your doctor before using a respirator. The EPA says people with heart or lung problems, or who are pregnant, should ask a doctor before using one, because wearing a respirator can make it harder to breathe. KKM and the MMA recommend an N95 if you must be outside; your doctor can help you decide what is right for you.
- Stay hydrated and stay cool. The Health Director-General advised drinking at least eight glasses of water a day in a 2023 haze advisory, and heat adds its own strain.
- Keep gentle activity going indoors. WHO says physical activity in pregnancy and after birth is linked to lower risk of problems such as pre-eclampsia, gestational diabetes and postpartum depression, with no adverse effects on birthweight. Ask your doctor what suits you.
Breastfeeding
We did not find any haze-specific official guidance on breastfeeding from MOH, the DOE or WHO, so we will not invent any. The general precautions above apply to you as they do to everyone else. If you have a concern about your own health or your baby's, talk to your doctor, nurse or a lactation counsellor.
Pregnancy red flags
See your doctor or go to the nearest clinic or hospital if you have shortness of breath, chest pain, palpitations, dizziness, a severe cough, or any symptom that worries you. Health Canada lists these as the more serious smoke-related symptoms that call for a health care provider or urgent care.
Asthma, COPD and other lung conditions
For people with asthma and other lung diseases, haze is not a minor irritation. The EPA says smoke can trigger breathing difficulty and flare-ups of asthma and chronic obstructive pulmonary disease (COPD), and studies of fine-particle pollution show more emergency visits and admissions for them. KKM reported in late August 2026 that haze-related asthma cases rose to 1,811 in one epidemiological week from 219 the week before. That is a dated snapshot, not a forecast, but it shows why preparing early matters.
The Malaysian asthma guideline from MOH, the Malaysian Thoracic Society and the Academy of Medicine (written for adult patients) gives a good checklist:
- Have a written asthma action plan. The guideline says every asthma patient should be offered self-management education that includes one.
- Know your zones. The sample plan has a "yellow: getting worse" zone, where you continue regular medicine and step up your reliever as the plan states, and a "red: alert" zone, where you use your reliever and go to the nearest hospital or clinic immediately or dial 999.
- Keep your reliever with you. The guideline names inhaled short-acting beta-2 agonists as the reliever of choice in stable asthma. A retired Health Ministry director quoted in The Star advised people with asthma or heart disease to carry their medication and consult their doctor before strenuous outdoor activity.
- Check your inhaler technique and keep taking regular medicine as prescribed. The guideline says inhaler technique and adherence should be reviewed at every asthma clinic visit.
- Do not smoke, and keep smoke out of the house. The guideline advises all asthma patients to quit smoking, and the Health DG's haze advice also warns against activities that worsen indoor air.
If you have COPD or another chronic lung condition, talk to your doctor now about what to do on a very unhealthy day, so the plan is ready before you need it. At API 101–200 the DOE guide says outdoor activities should be restricted for high-risk people such as those with heart or lung disease; at 201 and above, stay indoors, reduce physical activity and consult a doctor.
Heart disease and diabetes
It may not be obvious that air pollution affects the heart as well as the lungs, but WHO reports that around two-thirds of premature deaths linked to outdoor air pollution in 2019 (about 68 per cent) were from ischaemic heart disease and stroke. That is a global figure, not a Malaysian one. The EPA says people with heart disease may notice palpitations, unusual fatigue, lightheadedness, shortness of breath, chest tightness, or pain in the chest, neck or shoulder after exposure to particle pollution, and that fine-particle pollution has been linked to heart attacks, heart failure, stroke and abnormal rhythms. The EPA also notes that studies specifically of wildfire smoke and the heart have been less consistent, so keep your expectations measured.
The US Centers for Disease Control and Prevention (CDC) lists diabetes alongside asthma, COPD, heart disease and chronic kidney disease as conditions needing extra caution in smoke. We found no Malaysian haze guidance specific to diabetes, so the sensible approach is to follow your own care plan and ask your doctor about it.
What to do:
- Keep your medicines and prescriptions in date and within reach, and do not stop them on your own.
- Restrict outdoor activity at API 101–200 and stay indoors at 201 and above, as the DOE guide advises for people with heart or lung disease.
- Take warning signs seriously. Chest pain or pressure, severe breathlessness, fainting, or sudden weakness or speech problems are emergencies: call 999 or go to the nearest emergency department.
Older parents and grandparents
The EPA explains that older adults are more affected by short-term exposure to fine particles because heart and lung disease is more common, and because the body's defence mechanisms weaken with age. The DOE guide is direct: at 201–300 and above, the elderly should stay indoors and reduce physical activity.
Back to Abah and his morning walk. Telling a parent to stop an entire routine rarely works, so offer a swap instead:
- Move the walk indoors on unhealthy days, in the house or a clean indoor space, and save the taman for good-air mornings.
- Show him how to check the API on his phone or the DOE site, so the decision feels like his.
- Watch the heat and fluids. A UKM occupational health doctor quoted in The Star said that older adults, people with chronic conditions and those not well hydrated are at higher risk from heat; the Health DG advised at least eight glasses of water a day.
- Check medicines and a supply. Make sure repeat prescriptions are not about to run out.
- Phone or visit during a bad week, particularly if your parent lives alone.
- Talk to the doctor about masks. The EPA says people with heart or lung problems should ask their doctor before using a respirator.
Your family haze plan: a clean-air room and a medicine checklist
Having one simple plan means you do not have to think hard when the API jumps. Here is a checklist you can adapt:
- Pick one "clean-air room" (usually a bedroom or living room). Keep its windows and doors closed. If you have a HEPA air purifier, as the MMA suggests, run it in that room. The EPA says higher-efficiency filters trap smoke particles without making ozone, and that electronic air cleaners and ionisers are not recommended for smoke.
- Assign someone to check the API each morning and again before school pick-up.
- Write the school rule on the fridge: outdoor activities stop above 100; schools close above 200; you may keep children home after informing the school.
- Gather medicines: reliever inhalers, regular medicines for heart, lung or diabetes, and enough supply for a few weeks of disruption.
- Buy properly fitting N95 respirators for the adults who must go outside, as KKM and the MMA recommend, and check the fit using the mask guide. Do not rely on a mask for babies and toddlers.
- Stock water, and keep to the Health DG's advice of at least eight glasses of water a day.
- Note your clinic's number and your nearest hospital.
If you want to add skin, hair or exercise to the plan, our skin routine guide and indoor exercise guide are good next reads.
Red flags: when to see a doctor or go to the emergency department
Mild throat, nose and eye irritation is common in smoky air. Health Canada lists more serious symptoms as dizziness, wheezing, chest pains, a severe cough, asthma attacks, shortness of breath and heart palpitations, and advises talking to a health care provider or seeking urgent medical attention if you have them. Here is how that looks for each person at home:
- Children: difficulty breathing, wheezing, chest tightness, a cough that is getting worse, eye pain, or a child who seems very unwell.
- Pregnant women: shortness of breath, chest pain, palpitations, dizziness, a severe cough or anything that worries you.
- Asthma and COPD: use your reliever as your plan says; if you reach the red zone, go to the nearest clinic or hospital immediately or dial 999.
- Heart disease and diabetes: chest pain, severe breathlessness, fainting or palpitations mean you should call 999 or go to the emergency department.
- Older adults: new confusion, unusual tiredness, breathlessness or dizziness.
KKM's advice to the public, and especially children, the elderly, pregnant women and people with asthma and chronic lung disease, is to reduce outdoor activities, wear an N95 if you need to be outside, drink enough water, and seek treatment promptly if you have shortness of breath, a persistent cough or eye irritation.
Common myths (quick reality check)
- Myth: Children are resilient, so a bit of haze will not affect them. Reality: The EPA says all children are considered sensitive to smoke, and WHO notes that they breathe faster and absorb more pollutants than adults.
- Myth: A pregnant woman should wear an N95 all day to be safe. Reality: The EPA says anyone who is pregnant or has heart or lung problems should ask their doctor before using a respirator, because it can make breathing harder. Reducing outdoor time is the first step.
- Myth: If Abah feels fine, he can keep his routine. Reality: The DOE guide says the elderly should stay indoors and reduce physical activity at 201 and above, and older adults often have heart or lung disease they do not notice until air quality worsens.
Frequently asked questions (FAQ)
Should my child go to school when the API is above 100?
Schools halt outdoor classroom activities above 100 and are told to close above 200, according to DOE and Education Ministry statements. You may also keep your child at home if you are worried, as long as you tell the school.
Can my child with asthma play outside during haze?
Follow the action plan your child's doctor gave you, and keep the reliever close. On unhealthy days the safer choice is to keep vigorous play indoors. If your child's breathing is getting worse, seek medical help.
Can pregnant women wear an N95 mask?
KKM and the MMA recommend an N95 if you need to be outdoors, while the EPA advises pregnant women to ask their doctor before using a respirator. Talk to your doctor, and limit outdoor time to what is necessary.
How can I tell whether a cough is from haze or an infection?
You cannot reliably tell at home. Mild irritation usually settles when you move to cleaner air, but a persistent, severe or worsening cough, or one with breathlessness or chest pain, needs a doctor.
Is it safe to use a HEPA air purifier in a baby's room?
The MMA recommends HEPA purifiers where available, and the EPA says higher-efficiency filters trap smoke particles. We did not find guidance specific to babies' rooms, so use a certified device that does not produce ozone and ask your child's doctor if you have questions.
Disclaimer and when to seek help
This article is general health education and is not medical advice. It is not intended to diagnose, treat, cure, or prevent any disease. Every family's situation is different, so please talk to your own doctor about haze plans for children, pregnancy, asthma, COPD, heart disease, diabetes or older relatives. If anyone in your family has difficulty breathing, chest pain, fainting, a severe or worsening cough or any symptom that worries you, go to the nearest clinic or emergency department straight away.
References
- A Guide to Air Pollutant Index in Malaysia (API) — Department of Environment Malaysia
- DOE: Close schools, kindergartens if API tops 200 — The Vibes, 30 Aug 2026
- Parents can keep children home from school amid haze concerns, says Fadhlina — The Vibes, 7 Sep 2026
- Jerebu: KKM tingkat pemantauan kesihatan awam — Portal Berita RTM (Bernama), 29 Aug 2026
- Health DG: Take preventive measures to reduce effects of haze on health — The Sun, 2 Oct 2023
- Haze: MMA advises vulnerable groups to limit outdoor activities — The Star, 24 Sep 2026
- 'Take precautions against haze, heat and rain' — The Star, 2 Oct 2026
- Management of Asthma in Adults: Quick Reference for Healthcare Providers — Ministry of Health Malaysia, Malaysian Thoracic Society and Academy of Medicine Malaysia
- Which Populations Experience Greater Risks of Adverse Health Effects Resulting from Wildfire Smoke Exposure? — US Environmental Protection Agency
- Protect Your Lungs From Wildfire Smoke and Ash (EPA-452/F-26-004) — US Environmental Protection Agency
- Wildfire smoke and your health — Health Canada
- Wildfires and Your Safety — US Centers for Disease Control and Prevention
- More than 90% of the world's children breathe toxic air every day — World Health Organization
- Ambient (outdoor) air quality and health — World Health Organization fact sheet
- What are the WHO Air quality guidelines? — World Health Organization
- Physical activity — World Health Organization fact sheet
