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Recommendations from The National Athletic Trainers' Association

Tips For Keeping Your Kids Safe in Cold Weather

Prevention and treatment of hypothermia, frostbite and other cold-related injuries

Cold-related Ailments: Identification and Treatment

The following is a summary of the cold-related ailments, as well as their prevention and preferred treatment, as outlined in the Journal of Athletic Training article:


Signs and Symptoms

The signs and symptoms of mild hypothermia include:

  • vigorous shivering
  • increased blood pressure 
  • core body temperature less than 98.6F(37.6C) but greater than 95.6F (35.6C) 
  • fine motor skill impairment 
  • lethargy 
  • apathy, and 
  • mild amnesia.

Signs of moderate and severe hypothermia include:

  • very cold skin
  • depressed vital signs 
  • core body temperature between 90.6F (32.6C) and 95.6F (35.6C) for moderate hypothermia or below 90.6F (32.6C) for severe hypothermia 
  • impaired mental function 
  • slurred speech 
  • unconsciousness, and 
  • gross motor skill impairment.


  • Remove wet or damp clothing;
  • Insulate the subject with warm, dry clothing or blankets (including covering the head); 
  • Move him or her to a warm environment with shelter from the wind and rain. 
  • When re-warming, apply heat only to the trunk and other areas of heat transfer, including the armpit, chest wall and groin. Re-warming the extremities can send cold blood from the body's periphery to its core, which leads to a drop in core temperature, and may result in cardiac arrhythmia and death. 
  • Provide warm, nonalcoholic fluids and foods to help sustain shivering and maintain metabolic heat production. 
  • Avoid applying friction massage to tissues, which may increase damage if frostbite is present.


Signs and Symptoms

Signs and symptoms of superficial frostbite include

  • swelling, redness or mottled gray skin appearance
  • stiffness and transient tingling or burning.

Signs and symptoms of deep frostbite include:

  • edema, mottled or gray skin appearance,
  • tissue that feels hard and does not rebound
  • blisters, and 
  • numbness or loss of sensation.


The decision to re-warm a subject is contingent upon resources available and likelihood of re-freezing. Re-warming can occur at room temperature or by placing the affected tissue against another person's warm skin. Re-warming should be performed slowly, and water temperatures greater than 98.6F to 104.6F (36.6C-40.6C) should be avoided.

  • To re-warm, immerse the affected tissue in a warm (98.6F-104.6F [36.6C-40.6C]) water bath for 15 to 30 minutes.
  • Gently circulate the water.
  • Thawing is complete when the tissue is pliable and color and sensation have returned.
  • In addition, re-warming can result in significant pain, so a physician may prescribe pain medication.


Signs and symptoms

Chilblain occurs with exposure to cold, wet conditions for more than 60 minutes at temperatures less than 50.6F (16.6C). It can be identified by the presence of small red bumps, swelling, tenderness, itching and pain.


  • Remove wet or constrictive clothing
  • wash and dry the area gently
  • elevate the area
  • cover with warm, loose, dry clothing or blankets.
  • Do not disturb blisters, and refrain from applying friction massage, creams or lotions or high levels of heat.
  • Do not allow any weight bearing on the affected area.

Immersion (Trench) Foot

Signs and Symptoms

Occurs with exposure to cold, wet environments for 12 hours to three or four days. Symptoms include:
  • burning
  • tingling or itching
  • loss of sensation
  • bluish or blotchy skin
  • swelling, pain or sensitivity
  • blisters and skin fissures or maceration.
  • thoroughly clean and dry the feet
  • apply warm packs to affected area or soaking in warm water (102.6F-110.6F [38.8C- 43.3C]) for approximately five minutes.
  • Replace wet socks with a clean, dry pair, and rotate footwear or allow footwear to dry before reusing.

Special considerations for children and adults over 50

Children should take similar preventive measures as those suggested for adults, but they should also be encouraged to take more frequent breaks from a cold environment, especially water immersion.

Similarly, as adults reach the age of 50, the ability to tolerate cold decreases and risk of hypothermia increases. Older athletes are also more likely to have chronic health concerns, such as diabetes, hypothyroidism, hypopituitarism or hypertension, which can increase the likelihood of cold injury; therefore, older athletes should carefully and conservatively follow all prevention and recognition recommendations.

"We are not invincible when it comes to exercise in the cold," Cappaert, said. "In extreme cases, if medical care is not provided in a timely manner, serious long-term damage can occur."

Source: National Athletic Trainers' Association.

Revised December 13, 2011