Ask the Pediatrician
Enjoy the outdoors, but take precautions against frostbite
Q: After sledding on a very cold day, my daughter got a round, white, hard rash on her cheek. She complained that it was painful. We took her to the ER and they told us it was "frost nip." What is frostnip? How does it differ from frostbite? What should we do to treat it? Will it scar?
A: Parents will often keep their children inside on cold days. However, cold weather brings snow, and snow is really fun. Whether you're skiing, sledding, ice skating or just building a snowman, it is an adventure you can't miss.
But the cold can bring a few dangers and frost nip and frost bite are two of them.
Frostbite results from a freezing of tissue. Previously it was divided into "degrees" of frostbite, but more current care just classifies it either superficial or deep. Superficial frostbite, or "frostnip" produces numbness and a central area of paleness surrounded by redness. This type of frostbite does not cause any permanent damage and is relieved with simple rewarming.
Deeper freezing is characterized by the appearance of blisters within 24 hours, and there also is a great deal of swelling, redness and pain.
Frostbite can occur any time the temperature is below freezing. A child's risk of frostbite is increased by the following things: prolonged cold exposure, wind exposure, topical exposure to metals (licking a cold flagpole is really stupid despite what they do on TV) and dampness or wetness. Anything that causes skin to be moist including what are considered "protective" ointments can actually increase the incidence of frostbite.
The most common body parts to receive frostbite are ears, nose, cheeks, chin, fingers and toes. Kids will first complain of numbness and then pain. Frostnip may itch a little bit due to immune response.
If you think your child has frostbite seek medical attention immediately. If you think your child has frostnip or mild frostbite:
lBring him inside immediately. Take off any wet or constrictive clothing. Slowly rewarm the area in question by immersing it in water that is warm ... NOT HOT WATER.
lDo not rub the area Do not walk on feet that are possibly frostbitten. If the area does not thaw quickly and begin to feel better, or if you see any blistering, seek medical help immediately.
lAfter the area has rewarmed it may be itchy or swollen. Ibuprofen and a low potency steroid cream (hydrocortisone) may be helpful.
lAfter cold injuries, refreezing can lead to more tissue damage. So it is recommended that after any frostbite injury, cold exposure to that area should be avoided for six months for minor injuries and 12 months for major ones.
As always, prevention is best. Pay attention to weather forecasts, including wind chill. In the setting of extreme cold (below zero), avoid time outside. Have your child wear appropriate clothing, including materials that are moisture- and wind-resistant. Change wet clothing as soon as possible.
Cold weather is not an excuse to stay inside. Go outside and play but protect your child from the cold and mind the temperatures.
Take any suspicion of frostbite seriously. Most likely, the only thing you will need after sledding or skiing is some hot cocoa.
One more thing: A frequently forgotten source of frostbite is ice packs. I have seen frostbite from a frozen teething ring. Do not put ice directly on skin -- there should always be a cloth or plastic barrier between the two surfaces. And, do not allow more than 20 minutes straight of icing, no matter how severe the injury is.
Dr. Pia Fenimore, of Lancaster Pediatric Associates, answers questions about children's health on the Ask the Expert feature at LancMoms.com. You can submit questions there or by sending an email to sun news@Lnpnews.com.