Cold Facts on Frostbite

Winter activities like skiing, snowboarding, and ice skating are popular during the cold months. Unfortunately, with the fun comes the danger of frostbite. Children often face a greater risk for frostbite than their adult counterparts, for a number of reasons.

“Small children can’t make the important decisions about what to wear or if they should even be going outside, so that puts them at increased risk. Also, in children, the ratio of body surface area per body mass is higher than in adults,” says Dr. Timothy O’Connor, a Pediatric Emergency Specialist at Le Bonheur Children’s Hospital.

Listen to a podcast interview on this topic with Dr. O’Connor. 

Frostbite 101

Frostbite can be mild, moderate, or severe and is graded on a one-to-four scale. The mild form, or grade-one frostbite, it’s often referred to as frostnip. When blistering of the tissues or other severe signs occur, that indicates higher levels of frostbite.

Wind can impact severity, as can inappropriate clothing for the conditions or being in an exposed area void of shelter. Dr. O’Connor says it’s important to judge the conditions and simply choose to stay inside if frostbite might be a possibility.

“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,” he notes. “But, certainly if you live somewhere with temperatures below zero degrees Fahrenheit, that’s a very legitimate question. Should you even be going outside at all? It’s also a matter of how long you’re going to be outside. If you are walking down to the mailbox and back, you are probably good. But, if you are going to be out in the weather for quite a while, the risk goes up.”

The most common areas frostbite occurs include the feet, hands, nose, cheeks, and ears. Even if the feet are not exposed, they are in close contact with the cold ground. Wearing protective clothing (hats, gloves) can help, but it’s also important to consider what happens with core body temperature.

“When the weather is really cold, our body will naturally send warm blood to the extremities. Our blood vessels will stay constricted for the most part but intermittently will dilate so that warm blood will go out and keep the skin from freezing,” explains Dr. O’Connor. “But, when our core body temperature is at risk of dropping, the body stops sending 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 period of time, you lose that protective mechanism.”

Treatment Options

In mild frostbite cases, the skin may look pale or take on a pale yellow color and then become very red when rewarmed. Instances like this can be treated at home by soaking the affected area in warm water. A doctor’s visit typically isn’t necessary, unless skin changes start to appear.

In more severe forms, blistering of the skin occurs and blisters fill with clear or milky-colored fluid. With the most severe frostbite, blisters will have purplish or bloody-looking fluid. “When you see that kind of blistering, you definitely need to seek medical attention,” warns Dr. O’Connor.

Medical treatment varies based on the severity of the frostbite, ranging from warm baths and anti-inflammatories to surgical intervention. Dr. O’Connor cautions against jumping to surgery too quickly.

“It’s recommended to wait before making that decision, because sometimes tissue that looks like it’s dead will actually survive if given enough time. So, we don’t recommend early surgical intervention. It’s more of a ‘wait and watch’ situation until it’s very clear what tissue is going to survive and what’s not going to survive.”

While children are at a greater risk than adults in what would be considered “normal” circumstances, Dr. O’Connor says the greatest risk occurs in adults who are exposed to the elements because of homelessness, coupled with drug or alcohol abuse, or endurance athletes or mountain climbers who are exposed to severe temperatures.