Ask the Expert

In the winter months kids enjoy many types of cold-weather activities. From building snowmen to playing ice hockey to sledding down the neighborhood hill, winter is an exciting time for children. However these activities also bring dangers and opportunities for your child to suffer an injury.

What are some things you should watch out for to keep your children safe? Do you know when to seek medical assistance for your child? Dr. David Reitman, Suburban Hospital’s Chairman of Pediatrics, offers these tips to ensure a safe winter experience for your child.

What types of injuries do you see in emergency rooms during the winter months?
Most outdoor winter injuries that come through our Pediatric Center can be divided into two major categories: sports-related injuries and weather-related conditions. Both of these types of injuries vary in severity and can be prevented entirely if appropriate precautions are taken ahead of time.

What types of sports injuries occur during the winter months?
Injuries that occur most frequently in the winter result from such activities as ice hockey, ice skating, skiing, sledding, and snowboarding. With these sports, we often see head injuries, broken bones, lacerations, and bruises.

Another area of concern that often gets overlooked in the winter months is the potential for drowning. Frozen ponds can be very dangerous because of weak spots in the ice. A child can easily fall through and drown. Ice skating should only be allowed on ponds that have been properly inspected. Parents should be aware of where their children are skating and check the ice carefully for weak spots.

Does my child need to wear a helmet when participating in winter sports?
For any sport or outdoor activity where a collision could occur, a helmet must be worn. This includes ice hockey, ice skating, skiing, sledding, and snowboarding. Parents frequently don’t think about making their children wear helmets for these types of activities, but often kids don’t have the stability that is needed to avoid falls and collisions. Because they can’t maneuver or stop as quickly as adults can, they typically sustain more injuries.

My child bumped his head while sledding. How do I know if it’s serious?
When sledding or skiing, head injuries may commonly occur as a result of falling or colliding with other people or objects. The injuries can be as minor as a scrape or as serious as a concussion. If your child does not lose consciousness or have nausea or vomiting, you probably don’t have to worry. If, however, your child experiences a loss of consciousness, a headache, nausea, lethargy, disorientation or slurred speech, go to an emergency room as soon as possible. It’s always better to be safe than sorry, so don’t hesitate to seek medical attention if your child just doesn’t look or act right.

How should a laceration be treated?
With lacerations, especially facial lacerations, we close the wounds for cosmetic reasons as well as to prevent infection. Lacerations typically need to be closed within 12 hours to get the best cosmetic results. There are three basic options for addressing lacerations: Steri-Strips™, which are bandages; DERMABOND adhesive, which is essentially an epoxy; and stitches.

In what situation could you use DERMABOND instead of stitches?
DERMABOND adhesive is a liquid skin adhesive used to close wounds. Depending on the location, size, and shape of the laceration, the physician may choose to use DERMABOND instead of stitches. The advantage of DERMABOND is that it’s quicker to apply than stitches and doesn’t usually require any anesthesia. If the cut is deeper or has an irregular shape, the physician is more likely to use stitches to close the wound. In this situation, anesthesia will be injected into the wound to numb the area.

Do I need to worry about my child suffering from frostbite?
Any part of the body that is directly exposed to cold and wind can suffer from frostbite. Frostbite appears most often on the nose, ears, fingers, and toes. Signs of frostbite include skin that is hard, pale, cold, and numb. Skin that has turned white may indicate more severe frostbite. There may also be a tingling sensation or pain in the affected area.

If your child is going to be playing in the snow, be sure to dress him/her in layers and include a hat, gloves, warm socks, and waterproof boots. Check your child frequently for signs that he/she needs to come inside to warm up. Children often take their gloves off outside or their gloves get wet. It’s important to remove these wet items quickly and warm the area with warm water or warm washcloths. Severe frostbite can, in rare instances, lead to amputation, so this is a condition that should be taken seriously.

What is hypothermia and what are the signs of hypothermia?
Hypothermia occurs when the body’s temperature falls below 96° F. Shivering, lethargy, difficulty walking, slurred speech, chills, or dizziness may all be signs of hypothermia. If your child is just not acting like himself or herself, this would also be a sign of a problem.

If you take your child’s temperature and it’s less than 96° F, you should seek medical assistance right away. Remove any wet clothing as soon as possible. If you can’t get to an emergency room, place your child in a bath of medium temperature (not hot) water, wrap your child in warm blankets, or use your own body heat to warm up your child. If you have heat packs available, place them in “high blood flow” areas such as the armpits, abdomen, and groin. This warming should be done gently and gradually.

Infants in particular lose their body heat quickly (often through their relatively large, hairless heads), so avoid taking them outside in very cold weather if at all possible. If you must take an infant outside in extreme temperatures, it is especially important that he/she wear a hat.

Do I have to worry about dehydration in the winter?
This is a big area of misunderstanding for parents and children alike. People tend to think that if it’s cold outside, you aren’t sweating as much so you aren’t at risk of dehydration. Unfortunately, that is not the case. You can easily get dehydrated in the cold. If you can see your breath, it means that you are losing water from your body. When playing outside or participating in any type of cold-weather activity, it is especially important to stay hydrated by drinking plenty of water.

We like to use our gas fireplace during the winter. Does this pose a hazard for our children?
Any time you use gas in your home, whether it’s a furnace or a fireplace, you should be aware of the potential for carbon monoxide poisoning. Carbon monoxide is an odorless, tasteless gas that can kill before its victims even realize that something is wrong. Symptoms of carbon monoxide poisoning include fatigue, mental confusion, nausea or vomiting, and headaches.

It is critical to have a carbon monoxide detector in any home that has a source of gas coming into the house. Carbon monoxide detectors save lives. Check your detector regularly to ensure that it’s working. And while you’re at it, remember to check your smoke detector as well. Colder months mean there is a greater likelihood for indoor fires.

What can I expect if I have to take my child to Suburban Hospital’s Emergency Department?
Three years ago, Suburban Hospital demonstrated its commitment to its youngest patients with the opening of the Pediatric Center, an innovative model of pediatric care that integrated emergency and inpatient care in a seamless, age-appropriate, and family-centered environment. To ensure around-the-clock pediatric expertise and promote continuity of care, a team of board-certified pediatricians and specially trained pediatric nurses staff both the emergency and the inpatient units of the Pediatric Center. The pediatric team treats everything from bumps and bruises to head injuries and broken bones to critical pediatric cases.

Will my child have to wait in the main emergency room with everyone else?
No. Following an expedited triage and registration process in the main Emergency Department, all patients under 18 go to a separate, more age-appropriate environment for emergency and urgent care. As an extension of the hospital's emergency facility, the Pediatric Center maintains access to all of the hospital’s high-tech diagnostic capabilities, while limiting exposure to the unsettling realities and potential long wait times often associated with a busy adult emergency and trauma center.

The Pediatric Center offers a state-of-the-art facility designed to promote the highest quality care with maximum efficiency and privacy. Open 24 hours a day, every day, the Center features:

• three rooms for emergency patients;
• four inpatient beds (two private, two semi-private); and
• a separate family waiting/play area.

Everything about the Pediatric Center is designed to mitigate the fear that children may experience in a hospital setting. From the moment you first walk into the Pediatric Center, you realize you are not in your average hospital emergency department. We hope that your child will never need to use our emergency services. But if he/she does, we are here to provide the highest and most personalized level of pediatric care possible.

Dr. David Reitman, Suburban’s Chairman of Pediatrics, received his medical degree from Tufts University School of Medicine in 1997 and completed his pediatrics residency at Massachusetts General Hospital. He has been a member of Suburban’s Pediatric staff since 2001; his office phone is (301) 896-2749.

Dr. Reitman is a board-certified adolescent medicine specialist. He currently serves as Director of Pediatric and Adolescent Health at the John L. Gildner RICA program (residential treatment center for emotionally troubled teenagers) in Rockville.