Children's Hospital Colorado

Frostbite

Urgent or Emergency Care?

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  • Frostbite is a cold injury to the skin

Symptoms of Frostbite

  • Symptoms of mild frostbite (or frostnip) are cold, tingling and painful skin.
  • True frostbite causes white, hard, numb skin. It can be serious. It always needs medical care after re-warming.
  • Common sites are toes, fingers, tip of the nose, the outer ear or cheeks.

Cause of Frostbite

  • The nerves, blood vessels and skin cells are frozen for a short time.
  • The ears, nose, fingers, and toes are most often affected.

Frostbite Severity - Frostbite can be classified like burns:

  • Frostnip (mild frostbite). Cold, tingling and painful skin. No skin changes after re-warming.
  • 1st Degree. White and waxy (hard) while frozen. Mild redness and swelling after re-warming. No blisters.
  • 2nd Degree. Same as 1st degree plus blisters after 24 hours.
  • 3rd Degree. Blood-filled blisters leading to skin damage and scarring.

Hypothermia

  • Frostbite and hypothermia are two different medical problems.
  • Frostbite results from a cold injury to the skin. The body's core temperature can be normal.
  • In contrast, hypothermia signals a marked decrease in the body's core temperature. Frostbite may or may not occur. Hypothermia is defined as a body temperature less than 95° F (35° C) rectally. It can be deadly without intervention.

Factors Leading to Frostbite

  • Medical Conditions. Patients with diabetes, Raynaud's disease, and previous frostbite are all at greater risk.
  • Type of Contact. Frostbite is made worse if the skin and clothing are wet. Touching bare hands to cold metal during freezing weather can cause frostbite right away.
  • Time of Contact. The longer the exposure, the greater the heat loss and the chance of frostbite. The wind-chill index also plays a part in how quickly frostbite occurs.

Call 911 Now

  • Can't wake up
  • Speech is slurred
  • Acts or talks confused
  • Stumbling or falling
  • Body temperature is less than 95° F (35° C) rectally
  • Body temperature is less than 94° F (34.4° C) by mouth
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • You think your child has a serious injury
  • White, hard, numb skin (before rewarming)
  • Skin color and feeling does not return to normal after 1 hour of rewarming
  • Severe shivering still present after re-warming and drying
  • Severe pain still there after rewarming and taking pain medicine
  • You think your child needs to be seen, and the problem is urgent

Call Doctor Within 24 Hours

  • Frostbite skin gets blisters
  • Blisters start to look infected (spreading redness or pus)
  • You think your child needs to be seen, but the problem is not urgent

Call Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Mild frostbite

Care Advice for Mild Frostbite

  1. What You Should Know About Frostbite:
    • Frostbite means the nerves and skin were frozen for a short time.
    • Most frostbite is mild. Most often, it gets better with warming up.
    • Here is some care advice that should help.
  2. Rewarming With Wet Heat:
    • Move into a warm room.
    • For Frostbite of Fingers or Toes. Place the body part in warm water. A bathtub or sink is often the best method. The water should be very warm (104° to 108° F, or 40° to 42° C). It should not be hot enough to burn. Keep soaking in the warm water for about 30 minutes. A pink flush means circulation has returned to the body part. At this point, the numbness should be gone.
    • For Frostbite of the Face (such as ears, nose). Put a warm wet washcloth on the area. You should keep doing this for about 30 minutes. A pink flush means circulation has returned to the area.
    • With more severe frostbite, the last 10 minutes of rewarming can be painful.
    • If not using a tub, keep the rest of your child's body warm. Cover with blankets.
  3. Common Treatment Mistakes:
    • A common mistake is to put snow on the frostbitten area or to rub it. Both can cause damage to thawing tissues.
    • Do not re-warm with dry heat. Do not use heat lamps, heating pads or electric heaters. Reason: Skin that has frostbite can't sense burning.
    • Do not re-warm if could freeze again in the next few hours. Freezing-warming-freezing causes more harm than freezing-warming.
  4. Drink Warm Liquids:
    • Have your child drink lots of warm liquids such as hot chocolate.
  5. Ibuprofen For Pain:
    • For true frostbite, give an ibuprofen product (such as Advil) for pain relief.
  6. Aloe Vera Ointment for Pain:
    • Put aloe vera ointment on the frostbite.
    • Use twice daily for 5 days.
  7. What to Expect:
    • Frostnip does not cause any damage to the skin. After rewarming, skin feeling, color and softness come back in less than 1 hour.
    • Mild frostbite: After rewarming, the skin may be flushed and tingly. This lasts for a few hours.
  8. Prevention of Frostbite: (especially important in children with previous frostbite)
    • Cold sensitivity and recurrent frostbite is common following severe frostbite.
    • Dress in layers for cold weather. The first layer should be thermal underwear. The outer layer needs to be waterproof. The layers should be loose, not tight. Mittens are warmer than gloves. Do not use tight gloves or shoes. They might interfere with circulation.
    • Wear a hat, because over 50% of heat loss occurs from the head.
    • Change wet gloves or socks right away.
    • Teach your child to know the first warning signs of frostbite. Tingling and numbness are signs to go indoors.
  9. Call Your Doctor If:
    • Color and feeling do not return to normal after 1 hour of re-warming
    • Frostbite gets blisters
    • You think your child needs to be seen
    • Your child becomes worse

Disclaimer

The information contained in these topics is not intended nor implied to be a substitute for professional medical advice, it is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Always seek the advice of your physician or other qualified healthcare provider before starting any new treatment or discontinuing an existing treatment. Talk with your healthcare provider about any questions you may have regarding a medical condition. Nothing contained in these topics is intended to be used for medical diagnosis or treatment.

  • Not a Substitute - The information and materials in Pediatric HouseCalls Symptom Checker should not be used as a substitute for the care and knowledge that your physician can provide to you.
  • Supplement - The information and materials presented here in Pediatric HouseCalls Symptom Checker are meant to supplement the information that you obtain from your physician. If there is a disagreement between the information presented herein and what your physician has told you -- it is more likely that your physician is correct. He or she has the benefit of knowing your child's medical problems.
  • Limitations - You should recognize that the information and materials presented here in Pediatric HouseCalls Symptom Checker have the following limitations, in comparison to being examined by your own physician:
    • You can have a conversation with your child's doctor.
    • Your child's doctor can perform a physical examination and any necessary tests.
    • Your child could have an underlying medical problem that requires a physician to detect.
    • If your child is taking medications, they could influence how he experiences various symptoms.

If you think that your child is having a medical emergency, call 911 or the number for the local emergency ambulance service NOW!

And when in doubt, call your child's doctor NOW or go to the closest emergency department.

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