The snowstorms, wind chills and subzero temps you're used to have returned.
No matter the temperature, a fresh blanket of powder is too much for most children to resist. They're itching to get outside to play in the snow. You're anxious to get them out of the house. Before you give them a gentle push out the backdoor, make sure you understand the risks of playtime in cold weather.
What is frostbite — can you even get it in Iowa?
Yes! This is not a condition seen only in the mountains or the movies. Central Iowa cold snaps regularly drop temps below freezing, which is 32° F. Extreme cold and wind plunges temperatures down into the negative numbers.
Frostbite is a cold injury to the skin that can occur at any subfreezing temperature. The colder it gets, the bigger the risk. In extreme conditions, your child can get frostbite in a matter of minutes.
"It can happen within minutes or take hours. It depends on the circumstances," says Dr. Sarah Holland, pediatrician at The Iowa Clinic on Alice's Road in Waukee. "It's a combination of cold temperatures and prolonged exposure. When clothing is damp or too tight, that makes the problem worse."
What does frostbite look like?
Frostbite is graded like burns — there are degrees. The more severe levels are the ones where your skin turns blue or black and you risk losing a limb.
"First-degree frostbite is superficial. You'll see pale, white or waxy skin. It might be kind of numb or swollen. But it goes away after they warm up," says Dr. Holland. "Then second degree, you'll see blisters. With third and fourth, it gets worse and worse."
First-degree frostbite is milder and comes with a milder name: frostnip. It's more common, especially in children. The signs you associate with a normal day out in the snow — cold, tingling, pain or numbness that goes away after you warm up — are actually symptoms of mild frostbite.
"Usually, kids complain about an area being cold or feeling numb. Or it feels kind of clumsy, like it won't work very well. Say their fingertips are really cold and they go to zip up their zipper. It feels like they can't. Those are actually the early warning signs of frostbite."
If your child complains of any of these things or you notice them on a family sledding outing to Waveland, you should seek a warm location. Get them in the house if they're in the neighborhood or give them a break in a warm vehicle if you're away from home.
Where do kids typically get it?
When your child is bundled up in winter gear, you assume they are warm and protected from the cold. But many areas are still exposed.
"The areas most frequently affected are kids' ears, nose, cheeks and chin. Those areas are commonly the most exposed. They just tend to be out," Dr. Holland says. "Fingers and toes are the other areas. Not because of exposure, but due to circulation."
Children are smaller and lose heat faster out in the cold, which makes them more likely than adults to get frostbite. They're also more likely to be outdoors for longer, playing in the snow in damp clothing or conditions. With enough exposure, they could get frostbite in any area that got too wet and too cold, freezing the skin.
What are the best ways to prevent frostbite?
You can't keep your kids out of the cold and snow. And you probably wouldn't want to. A little outside time is a great cure for cabin fever!
There are many things you can do to make sure your kids are ready to handle the cold. Follow all of these steps to prevent your children from developing frostbite.
1. Bundle them up!
Hats, mittens, snow boots, winter coats, snow pants, scarves — cover as much skin as you possibly can. Pick out winter gear that is meant for the snow and has good insulation and waterproof protection, advises Dr. Holland.
Dress them in layers for extra insulation and make sure the clothes fit, too. Winter attire that's too tight, especially gloves or snow boots — can cut off circulation to those areas. And any tight clothing that gets wet holds that cold, wet fabric close to the body, increasing the risk of frostbite.
2. Supervise outside time.
Monitor your child's playtime outside. Check in regularly to ask how they're feeling and see if any of their clothing has become too damp or coated in snow. Move them to areas out of the cold and wind to warm up. Take extra precautions with babies and infants who can't communicate how they're feeling.
"If it's warmer and your kids are busy playing, they may be fine. But you still need to keep in contact with them. Ask them if anything feels really cold, tingly, too tight or wet. Just look them over to make sure they're looking okay before they go back out to play, giving them a break from the cold every hour or so," Dr. Holland says.
If you can't be outside yourself, set time limits. There are no established guidelines on time or temperature, so use your best judgment based on the winter weather. Take the temperature, wind, wind chills and precipitation into consideration. The lower the temp and worse the conditions, the less time your kids should be outside. A cup of cocoa may be enough to coax them indoors to warm up before heading back out to play.
3. Watch for the warning signs.
Red cheeks, runny noses, cold and tingly fingertips and toes. It might seem like a normal day out in the wintertime. And it can be hard to see the difference between a face that's red from playtime exercise in the cold and one that's showing signs of mild frostbite. The key is to look when your kid starts warming up.
"If you have frostnip or mild frostbite, the symptoms you'll want to watch are cold, tingly or painful skin. Those should resolve with rewarming," says Dr. Holland. "Take a look at all the areas where your child may have been exposed to cold or snow when they come inside and pay attention to their fingers and toes."
What should I do if I think my child has frostbite?
Frostnip and mild frostbite go away on their own. Once your child is indoors and warmed up, their skin should look and feel normal and the tingling and pain will subside. Everything should be back to normal in under an hour. For mild frostbite, their skin may be flush and tingly for a few hours.
Symptoms that last longer are a cause for concern. You can try rewarming your child by putting frozen fingers and toes in warm water for 30 minutes. For areas that can't be easily dunked in water like the nose or ears, apply a warm, wet washcloth instead. When the skin turns flush and pink, that's a sign circulation has returned.
"If there's ever anything that don't resolve after you get your child rewarmed, then you should call your doctor. An area that's persistently symptomatic or a spot that is white, hard or numb — that's definitely worth a phone call," says Dr. Holland. "It could be serious and need emergency medical attention so I say always err on the side of giving your doctor a call."
SarahHolland , DO
Dr. Holland worked at the Blank Children’s Hospital Pediatric Emergency Department for seven years. In 2017, she decided to practice in a clinic setting and we are thrilled to have her at The Iowa Clinic. She enjoys talking with kids, incorporating play into her exams, helping new parents get settled into parenthood, and being involved in each child’s growth and development.
In her free time, Dr. Holland loves spending time with her husband and two boys, running outdoors, reading, and spending time with other family and friends.