Frostbite

What is frostbite?

Frostbite is a severe, localized cold-induced injury due to freezing of tissue. It commonly occurs when tissue is exposed to temperature below 32°F (0°C) for long enough to form ice crystals. The injury is similar to injuries caused by burn and those when blood supply is temporarily reduced to other body parts.

What are the signs and symptoms of frostbite in children?

Frostbite does not present until long after exposure. The cold can create a numb area masking symptom. Therefore, many patients do not realize the injury until after the exposure and injury has already occurred. Prevention is the key.

Symptoms of frostbite

• Pain - Stinging, burning and throbbing
• Hypo - or anesthesia
• Loss of fine or large muscle dexterity
• Joint pain

Signs of frostbite

• Favorable: normal color, clear fluid blisters, edema.
• Unfavorable: non-blanching cyanosis, firm skin, hemorrhagic vesicles/blisters

What are the most common risks of frostbite in children?

• Inadequate clothing/shelter
• Dehydration
• Tight clothing (too many socks)
• Immobility
• Previous frostbite injury

How to treat frostbite in children

At home

Do

• Remove clothing, especially if cold and wet
• Splint extremity to avoid further injury
• Rewarm by placing in companion’s armpit or groin and replace dry clothing
• Take low-dose aspirin (ASA)  and ibuprofen
• If you have a source of supplemental oxygen (O2), use at high altitudes
• Only try rewarming site if there is no risk of refreezing and no need to use affected tissue (e.g. walk)
• Seek medical care immediately if pain, swelling, re discoloration do not immediately resolve or blisters/wounds develop

Do NOT

• Rub the affected area/frozen extremity
• Warm by contact with hot surface or with exposure to fire
• Thaw/rewarm if risk for refreezing
• Use tobacco products

What to expect when hospitalized

• Rewarm affected areas in warm water at 37-41 °C (99-105 °F) for 15-60 minutes
• Elevate extremity
• Administer appropriate tetanus prophylaxis
• Padding between fingers/toes
  • Aloe Vera every 6 hours
  • Consider advanced therapies to restore blood flow, Children's Wisconsin has an on call team that can provided life and limb saving interventions
• Long-term problems of frostbite in children
  • Cold sensitivity
  • Sensory loss
  • Hyperhidrosis
  • Chronic pain
  • Loss of function
  • Poor bone growth