Parents need to know the signs of frostbite

The adventurous 6-year-old was properly dressed when he left the house to play out in the snow on the cold winter's day. He threw snowballs, made snowmen, constructed snow forts and really didn't seem to notice the cold while he was out having fun.

When the boy finally ran out of steam, he trudged back to the house, suddenly realizing that he couldn't feel his hands.

Mom gently took off the sobbing boy's cold wet clothing, and put him in a warm bath. As he started soaking in the water, she watched in dismay as several of his fingers turned white. She put in a call to the office to see if there was anything else she needed to do to help her son, but by that time, the fingers had all returned to their normal color and temperature.

Capillary refill was fine - she pressed on the fingertips and they blanched in color, and then pinked up immediately - so circulation was good. Mom also reported that though two fingers were still mildly swollen, the boy was able to manipulate small objects and move his fingers with ease.

I assured the mother that she had already done a good job of warming her son back to normal. All she needed to do now was observe him closely and keep him warm for the rest of that afternoon and evening.

Mom found out later that the little guy had discarded his gloves sometime during his outdoor playtime. That just goes to show that you can bundle them up before they go outside in the cold, but that's no guarantee that your kids will keep all their warm winter clothes on when they're out of sight. When it's bitterly cold out and kids are exposed to the cold for a prolonged period of time, or when they get wet and cold, kids run the risk of frost injury.

Pediatric specialists at the Children's Hospital of Pittsburgh describe three stages of frostbite. Frostnip is the quaint term used for the first level of cold weather injury typically affecting the areas most likely to be exposed when a child plays outside. When an affected boy or girl finally comes indoors, parents will notice that the tips of their little one's fingers, toes, cheeks, nose or ears are numb and appear white.

In early frostbite, this white skin begins to feel hard to the touch and the child's feeling of numbness is accompanied by an uncomfortable burning sensation. Finally, blue splotchy skin indicates the presence of severe frostbite - a true medical emergency.

For minor cold injury, the Pittsburgh experts recommend prompt soaking in warm water set at approximately 101 to 104 degrees - a temperature that should be comfortable for you when you test with an elbow. Keep your child in the warm water until color returns to the affected area and the skin appears red, not white. Do not rewarm by using potentially damaging dry heat sources such as heating pads or hair dryers, and avoid vigorous rubbing of the injured areas.

If you suspect frostbite, immediately change your little one into warm dry clothing and head to the nearest emergency department for further evaluation and treatment.