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Frostbite

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Definition

  • 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.
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When To Call

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

Go to ER Now

  • Skin color and feeling does not return to normal after 1 hour of rewarming

Call Doctor or Seek Care Now

  • You think your child has a serious injury
  • White, hard, numb skin (before rewarming)
  • Severe shivering still present after re-warming and drying
  • Frostbite suspected and No past tetanus shots. Note: tetanus is the "T" in DTaP, TdaP, or Td vaccines.
  • Severe pain still there after rewarming and taking pain medicine
  • You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

  • Frostbite skin gets blisters
  • Blisters start to look infected (spreading redness or pus)
  • Frostbite suspected and last tetanus shot more than 10 years ago
  • You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

  • You have other questions or concerns

Self Care at Home

  • Mild frostbite or frostnip
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Care Advice

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.

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 (98.6° to 102° F, or 37° to 39° 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.

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.

Drink Warm Liquids:

  • Have your child drink lots of warm liquids such as hot chocolate.

Ibuprofen for Pain:

  • For true frostbite, give an ibuprofen product (such as Advil) for pain relief.

Aloe Vera Ointment for Pain:

  • Put aloe vera ointment on the frostbite.
  • Use twice daily for 5 days.

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.

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.

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

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FIRST AID Advice - Frostbite

Rewarm the frostbitten area quickly with wet heat.

  • Move into a warm room.
  • For frostbite of fingers and toes: place the frostbitten part in very warm water. A bathtub or sink is often the fastest approach. The water should be very warm (104 to 108° F, or 40 to 42° C), but not hot enough to burn. Keep soaking in this warm water for about 30 minutes. A pink flush means circulation has returned to the body part.
  • For frostbite of the face (such as ears, nose): apply warm wet washcloths to frostbitten area of the face. Keep doing this until the frostbitten area turns to a pink flush. This signals the return of circulation to the frostbitten area (usually 30 minutes).

Special Notes:

  • Do not rewarm a frostbitten area if there is a chance of it refreezing.

Source: Self Care Decisions, LLC
Used with Permission from Schmitt Pediatric Guidelines LLC.

Barton Schmitt MD, FAAP
Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.
Copyright 2000-2024. Schmitt Pediatric Guidelines LLC.
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