Tuesday, November 21, 2006

Exposure to Cold Air

Dear Lisa,

Is it okay to take a child out into the night air?

“Child exposed to Cold Air”

Dear “Child exposed to Cold Air”,

Many parents are concerned about bringing their children outdoors during the cold winter months. This is a legitimate concern because children are at risk for cold related illness and proper precautions should be taken.

Many parents feel if they take their child outdoors that their child will “catch a cold”. This old wives tale is not 100% true but definitely has some wisdom. Viruses and colds are transmitted through the exchange of respiratory secretions. They are spread through respiratory droplets such as coughing and sneezing. Theoretically, the cold air doesn’t have anything to do with a child “catching a cold”. Although it is true that many viruses thrive in the cold weather and are more prevalent during the winter months. For example, the Influenza virus thrives in the freezing cold weather and is more prevalent in the United States between the months of October and March.(1)

In addition, the body of a child that is exposed to cold is put under a lot of stress to maintain a normal body temperature. A child’s defense mechanisms can become inadequate during periods of stress and therefore make him more susceptible to acquiring an infection. Therefore, in a sense, it is true that a child who goes out in the cold is more at risk for developing an infection. So it is understandable why people through the generations have commonly associated “catching a cold” with the cold air.

It is important to remember that children are more than just tiny adults. Like most systems in their body, their temperature regulatory system is not fully developed. Children's bodies are not able to readily adapt to the extreme changes in temperature the way that adults can. Their temperature control systems are not matured. This is particularly true for newborns, premature babies and low birth weight babies. (2)

Infants lose their heat quickly when exposed to cold air because they have a large body surface area as compared to body mass, a thinner layer of subcutaneous fat and a lower metabolic rate. (2) Young children also have a greater body surface area-to- mass ratio.(3) These characteristics put children more at risk for Hypothermia (a temperature of 95 degree Fahrenheit or less) as compared to adults.

Therefore care needs to be taken regarding the proper dress and prevention of heat loss in young children when exposed to the cold night air. In particular, infants under one year old need to wear a hat at all times when they go outside in the cold air. They lose most of their heat from their head and can very quickly become Hypothermic if they go out in the cold air without a hat.

Appropriate outdoor clothing for children includes layers of light clothing under appropriate outerwear.(4) Children playing outdoors should wear two pairs of socks, a hat, and mittens. It is also important to not let young school age children play outside in extremely low temperatures. Older children should be taught the early signs of Frostbite which include tingling and loss of skin sensation. (3,4) When they experience these symptoms, they should come indoors.

So to answer your question, children can go out in the night air for short periods of time if they are properly dressed and closely monitored by an adult. It is a good idea to limit Infant’s exposure to the cold night air because they are at the highest risk for cold related illnesses. Prolonged or extended exposure in any child regardless of the age is not recommended because children are at a particular risk for Hypothermia. In addition, parents should take into consideration the wind chill factor and precipitation, since water and wind increase a child’s risk for developing a cold related illness.(3)

Hypothermia should be taken very seriously because it can be life-threatening. The majority of deaths due to Hypothermia occur during the months, November through February. Even though children under 1 year old are at the highest risk, older children can also develop Hypothermia. Children at high risk include boys in early adolescence and inadequately dressed older adolescents who abuse alcohol or illicit drugs. (3)

Children exposed to extreme cold can also develop a localized cold injury such as Frostbite.(3) Frostbite is the freezing that occurs when a body part is exposed to extreme cold. Local damage occurs when the tissue temperature drops to 0 degrees Celsius or 32 degrees Fahrenheit.(3) The most common places on the body to develop Frostbite include the ears, nose, toes and fingers.(3) It is important for parents to remember that children are at particular risk for developing Frostbite because they do not know how to sense early signs of exposure. Since they do not sense the early signs of exposure, they continue to play outdoors in an environment that puts them at risk.(4)

The tissue damage that occurs because of Frostbite is similar to a burn. Frostbite is categorized into different types, first degree being the mildest and fourth-degree being the most severe. Signs of first degree Frostbite also known as “Frost nip” include shivering, redness of the skin, swelling but no blistering. A child with second degree Frostbite experiences a partial or full thickness injury that results in the formation of blisters and pain after rewarming. A child with third degree Frostbite or deep Frostbite experiences death of the tissue layers of the skin, loss of sensation and pain when rewarmed. Fourth degree Frostbite is the most serious type. It can lead to gangrene, permanent disability, arthritis and the loss of a body part.(3)

Those children at risk for Frostbite include inadequately dressed toddlers, children with poorly heated homes, hikers, skiers, lost mountain climbers and near drowning victims.(3) Exposures to wind and water also increase the risk of Frostbite. (4,5)

If you suspect that your child has a cold related illness such as Hypothermia or Frostbite, the first step is to remove the child from the cold environment. All wet clothing should be taken off and the child should be dried and warmed with a blanket. It is a good idea to put a child’s hands under an adult’s armpits. Vigorous massaging and rubbing should never be done because this can cause more tissue damage. (3) Thawing should not be attempted if refreezing is a risk because this will only cause more tissue damage.(3) Any child experiencing a cold related injury should be evaluated by a Physician as soon as it is physically possible.

It is also important to mention that children with Asthma are affected by the cold air. The cold air as well as changes in temperature are potential triggers for an Asthma Attack. (6) All children with Asthma need to be closely monitored for worsening of their condition during situations of extreme temperature or temperature changes. It is recommended that children with Asthma wear a face mask or scarf over their mouth to prevent them from breathing in the cold air when they are outdoors. This will ensure that the air is warmed before it reaches their lungs and can help prevent a bronchospasm.

A common recommendation for children with Croup is to “go outside into the cold air”. Croup or Laryngotracheobronchitis is a common condition in childhood that involves the inflammation of the upper airway. It can be caused by bacteria, but in most cases a virus is the culprit.(7) Croup accounts for more than 15 % of the respiratory illness in children.(7) Children between 6 months to 6 years old are affected most often, boys more commonly than girls.

Because the most important goal in treating Croup is maintaining the airway, measures to keep the airway open are a priority.(7) Mist therapy, exposure to cold air, inhaled epinephrine and corticosteroids are all traditional treatments for Croup. These measures are typically recommended by health care professionals with the goal of maintaining the patency of the airway. (4,7) The assumption is that the cold air shrinks the swelling of the upper airway and relieves the symptoms. Even though mist therapy has been widely used successfully, recent studies have questioned its efficacy.(7)

I hope this infomation answers your questions about bringing children out into the cold night air. Be sure to keep warm this winter!

References:
(1)Cheung M, Lieberman J. Influenza. Update on strategies for management. Contemporary Pediatrics. 2002. 19(10):82-94.
(2)Bellack J, Bamford P. Nursing Assessment A multidimensional approach. Belmont, CA:Wadsworth Inc.1984:285.
(3)Nield L, Nanda S. Cold Injuries. Consultant for Pediatricians. 2005. Oct:427-434
(4)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:2096-2099, 1215.
(5)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990: 636.
(6)Rance K, Blaiss M. Optimal Clinical and Counseling Strategies for the Pediatric Asthma Patient. The Clinical Advisor. 2006. Aug:S3-15.
(7)Bradin S. Croup and Bronchiolitis: Classic Childhood Maladies Still Pack a Punch. Consultant for Pediatricians.2006.Jan:23-28.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Kids Safe

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