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Cold Facts on Frostbite

Children are more susceptible to frostbite than adults. Dr. Timothy O'Connor, Pediatric Emergency Specialist at Le Bonheur Children's Hospital, discusses facts about cold weather and how to protect your child.
Cold Facts on Frostbite
Timothy O'Connor, MD
Timothy O'Connor, MD is a Pediatric Emergency Specialist at Le Bonheur Children's Hospital. 

Learn more about Timothy O'Connor, MD

Bill Klaproth (Host):  Did you know that children are more susceptible to frostbite than adults? Well, they are. And here to tell us more is Dr. Timothy O’Connor, a Pediatric Emergency Specialist at Le Bonheur Children’s Hospital. He will explain why and give tips on how to protect your child this winter. This is the Peds Pod by Le Bonheur Children’s Hospital. I’m Bill Klaproth. Dr. O’Connor thanks for your time.  So, exactly what is frostbite?

Timothy O’Connor, MD (Guest):  Well Bill frostbite is basically it’s freezing of the tissues that results when we’re exposed to extreme cold and our natural defenses are kind of overcome.

Host:  So, this is when our skin actually freezes?

Dr. O’Connor:  Exactly.

Host:  So, we hear this term frostnip. What is the difference between frostbite and frostnip?

Dr. O’Connor:  Well frostnip is just the mildest form of frostbite. So, frostbite they grade it one through four from superficial injury to deep injury and frostnip is just the mildest form basically.

Host:  So, frostnip is the mildest form. Does that mean frostbite is the most severe?

Dr. O’Connor:  Well frostbite can be mild, moderate or severe. When it’s the mild form, you can say grade one frostbite, or you can say frostnip. They mean the same thing. Once you start having blistering of the tissues or other severe signs then you are into higher levels of frostbite.

Host:  So, let’s talk about what causes frostbite. That may sound like a simple question. Well it’s cold out, you are going to get frostbite. But is that when our body can’t keep up with the cold and our body can’t keep our skin from freezing?

Dr. O’Connor:  Well it’s correct and so it obviously depends upon the severity of the cold, even thing like wind can make the cold more dangerous. You’ve heard the windchill issue. And then of course how well we are prepared for it. So, if you are not appropriately clothed or not in appropriate shelter then you are obviously at greater risk for frostbite.

Host:  So, exposed flesh. When it’s exposed and the conditions are extreme enough, that’s when your skin can freeze.

Dr. O’Connor:  Correct. And so, as a result, like the most common places that get frostbite are the feet, the hands, the nose, the cheeks, and the ears. And the feet, even though the feet are not exposed, they are in contact with the cold ground and so they tend to get colder.

Host:  Right and they are the farthest away from your core body which makes them more susceptible. So, how do you prevent frostbite? I know that sounds like a silly question. Well wear hats and gloves. But there’s more to it than that, right?

Dr. O’Connor:  There is. So, the first decision is should I even go outside. And luckily, in this area, here in Memphis, we don’t tend to have really severe cold. So, it’s rare that we have to make that decision. But certainly if you live somewhere where you are having temperatures below zero degrees Fahrenheit, that’s a very legitimate question. Should I even be going outside at all. And then it’s also just a matter of how long are you going to be outside. So, if you are walking down to the mailbox and back, probably you are pretty good. But if you are going to be out in the weather for quite a while; the risk goes up as well.

Host:  Sure, if you are working outside. That makes sense.

Dr. O’Connor:  I do want to say you mentioned wearing hats and gloves and just keeping the core body warm is our body’s priority. So, we want to keep our core body temperature up and our body naturally will – that will take precedence over preventing frostbite. And so, when the weather is really cold, our body naturally will send warm blood to the extremities when we are not at risk for hypothermia, when we are not at risk for our core body – and so intermittently, our blood vessels will stay constricted for the most part but intermittently they will dilate so that warm blood will go out and keep them from freezing.

But, when we are at risk for our core body temperature dropping; our body stops doing that, stops sending the warm blood out to the extremities because keeping the core body temperature up is more important. So, when you are really cold for a long time, you lose that protective mechanism.

Host:  So, when your core body temperature drops, you are more at risk for frostbite.

Dr. O’Connor:  Correct. But you can get frostbite without getting hypothermia and vice versa. So, they don’t have to go together.

Host:  So, let’s talk about children now. What puts children more at risk for frostbite?

Dr. O’Connor:  Well there are a few things. Certainly small children can’t make the important decisions about what do I wear, should I be going outside, that sort of thing. And so puts them at increased risk. But also, children just have more body surface area per body mass than an adult does. And so they have more surface exposed to the elements. And so that puts them at increased risk.

Host:  Dr. O’Connor, could you explain then again, wouldn’t an adult have more surface area?

Dr. O’Connor:  No, you are looking at a ratio of body surface area to body mass. And it’s that ratio that is greater in children.

Host:  Okay, now I got it. Thank you. So, at what point is frostbite diagnosed?

Dr. O’Connor:  First of all, there has to be the history of exposure to freezing temperatures. You don’t get frostbite at temperatures above freezing. So, you have to have exposure. And then the milder cases, the skin may just look really pale or a pale yellow color and then after it’s rewarmed it will get really red which is kind of a normal – body’s normal response. And then in the more severe forms like the next level up; you will get blistering of the skin and the little blisters can be filled with clear or milky colored fluid. And then even more severe frostbite, they will get blisters with more purplish like bloody looking fluid in them.

So, when you see that kind of blistering, you definitely need to seek medical attention.

Host:  Yeah, that makes sense. So, can frostbite be treated at home first?

Dr. O’Connor:  You know the mildest cases where you are not really having any blistering of any kind, and you know that you’re not going to be exposed to freezing temperatures again anytime soon; then yes, heating the extremity like in just warm water, the foot, the hand or whatever in warm water to warm it back up is certainly appropriate. And it doesn’t necessarily need to see a physician unless there’s skin changes that go along with it.

Host:  Okay. Got you. So, speaking of seeing a physician then, how is frostbite treated in a clinical setting?

Dr. O’Connor:  There’s a lot of similarities to how a burn looks for instance and it can look very similar to a burn but the treatment is daily warm baths to improve circulation and frostbite also causes a bunch of inflammatory changes to occur so there’s anti-inflammatories are given as well and then when it comes to you can actually lose fingers and toes and that sort of stuff from severe frostbite. But it’s recommended to wait quite a long time before making that decision because sometimes there’s tissue that looks like it’s dead which will actually survive if given enough time. So, they don’t recommend early surgical intervention. It’s more of a kind of wait and watch type of a situation until it’s very clear what tissue is going to survive and what’s not going to survive.

Host:  So, earlier, you said watch for changes in the color of the skin. What are some of the other signs of frostbite?

Dr. O’Connor:  During the actual exposure, a lot of times the area in question will just go numb like you just – you can’t feel anything. And then once you are in a situation where it can be rewarmed; a lot of times it can be very itchy or very painful during the rewarming process. And that’s probably a sign that there has been at least some mild frostbite that has occurred. I do want to say that its’ really important that you never rewarm something that’s frostbitten if you are at risk for it freezing again. It’s more dangerous to rewarm it then freeze again and so if your feet are already frozen and you are out in the wilderness, it’s not a good idea to warm it by the bonfire if you know you have a two day hike out yet and you may have more refreezing ahead of you. It’s better to let it stay frozen than it is to rewarm it and let it freeze again.

Host:  Okay. Really good point and something for us to remember. So, then you just mentioned somebody can lose a finger or a toe or amputation. I mean how severe can untreated frostbite become?

Dr. O’Connor:  It can be quite severe. But most of the time, this is not something we see a lot of in children. It’s mostly adults who either are exposed to the elements because of homelessness, coupled with drug or alcohol abuse or endurance athletes or mountain climbers who really get exposed to the really severe cold who are at greatest risk.

Host:  So, getting back to children Dr. O’Connor. If you fear your child has frostbite; when should you contact your pediatrician?

Dr. O’Connor:  So, if your child has been exposed to freezing temperatures and if whatever part was exposed is having some visible changes in their skin, then they should call their doctor.

Host:  I know you touched on this briefly before but I’m sure there’s a lot of confusion. Is frostbite related to hypothermia in anyway? Could you talk just a little bit more about that?

Dr. O’Connor:  Well yes and no. So, they are both obviously due to exposure to the cold. But you can become hypothermic being exposed to temperatures well above freezing and so even if – especially if you are in a cold wet environment, for instance if you are in a lake holding on to the underside of your overturned boat or even if you are just being rained on and you are out in the wilderness without any shelter and again, children are at increased risk for reasons we talked about before and our bodies can shiver but they can only shiver for about three or four hours until they run out of the energy to shiver anymore. So, unless you have enough food as well, if you are stoking the furnace with food you can probably shiver even longer. But if you are in a situation where you don’t have food and you don’t – and you’re really cold; you will only shiver for so long. And in addition to that, little babies can’t even shiver. They generate heat a completely different way.

Host:  So, that’s really important for parents to be mindful of that as well. Dr. O’Connor this has been really informative. Thank you for your time today.

Dr. O’Connor:  You’re welcome Bill. I appreciate you having me.

Host:  That’s Dr. Timothy O’Connor, a Pediatric Emergency Specialist at Le Bonheur Children’s Hospital. And to learn more, visit And be sure to subscribe to the Peds Pod in Apple Podcasts, Google Play or wherever you listen to your podcasts. You can also check out to view the full podcast library. And if you found this podcast helpful, please share it on your social channels. This is the Peds Pod by Le Bonheur Children’s Hospital. Thanks for listening.