Day: January 3, 2011

What Parental Guidance Should I Offer to Parents About Winter Safety?

Patient Presentation
In the late fall, a 3-year-old male came to clinic for a health supervision visit. During staffing with her continuity clinic attending, the resident noted that both the family and she herself were both from warm places and that this was going to be their first winter in a cold environment. She said that she knew what to tell the family for a warm environment but not for a cold one. Her attending reviewed choosing appropriate clothing, keeping well hydrated, car and travel safety and sledding specifically. The attending also showed the resident the American Academy of Pediatrics parent education website (HealthyChildren.org) where the resident found winter safety tips for parents. She printed two copies – one for the family and one for herself. Several days later, she told the attending that she herself had gotten her car ready for the winter, and was planning on going shopping for an appropriate winter coat and boots with another resident.

Information about summer safety can be found here

Discussion
With the winter comes new challenges for children and parents to keep healthy and prevent problems while still getting outside and remaining active. Even those who don’t usually live in northern climates may still have seasonal storms that can bring ice and cold. People may visit family, friends or take a trip to a winter environment and need to learn or remind themselves how to stay healthy.

Learning Point
Below are some of the anticipatory guidance that can be offered to parents about winter safety.

  • Prevention
    • Taking breaks
      • Children and adults may tire more quickly after playing or doing other outdoor activities in the winter. Take frequent breaks. Have something to drink and change wet clothing. These simple steps can prevent many problems.
    • Clothing
      • Layering of clothing makes it easier for children to have enough clothing to be warm but not sweating. Layers that wick moisture away from the skin can also keep children from becoming chilled or even hypothermic if they do sweat. Wet clothing should be removed if possible and replaced.
      • Clothing should be properly sized so children don’t injure themselves. Stay away from clothing that could cause accidents such as long scarves or mitten cords. Clothing that blocks vision should also be avoided.
      • Older infants and children generally need one more clothing layer than an adult. Keep blankets, pillows, and other soft/loose bedding away from infants. A one-piece sleeper is recommended. If a blanket is used, the American Academy of Pediatrics recommends that it be tucked around the crib mattress and reach only as far as the infants chest.
    • Hypothermia and Frostbite
      • Hypothermia is when the body temperature falls below normal. This occurs easier in children than adults. Lethargy, somnolence, difficulty talking and shivering are some of the signs.
      • Frostbite occurs when the body tissues freeze with extremities, nose and ears being the most common parts affected. Numbness, pale, grey or blistered tissues are seen.
    • Fluids and food
      • Children need to maintain their hydration especially when they are playing outside.
      • Eating to provide calories to stay warm is also important.
  • Traveling
    • Leave a message with someone about your route, time left and expected time of arrival.
    • Take a cell phone with you if possible, but realize it may not work in all locations.
    • Be prepared to stay with your car, snowmobile, etc. by packing appropriate emergency supplies.
    • Check the local road conditions and warnings. Follow local laws regarding safety such as the use of tire chains.
  • New Surroundings
    • If you are traveling to an unfamiliar location, ask about other possible hazards. For example, what should you do while traveling in an avalanche zone?
  • Car
    • Keep the car in good repair and fill-up the gas tank when no less than 1/4 full.
    • Check that normal safety equipment such as first aid kit, flares, safety triangles, and jumper cables are in good repair, and water is stored in the car. Some people also have a towrope stored.
    • Add some extra clothing such as hats and socks (they also work as mittens) and a warm blanket.
    • Salt or ice melt and a small shovel can help if the car is stuck in snow or ice.
  • Safety
    • Fire and Carbon Monoxide
      • Fires and carbon monoxide poisoning often occur during the winter months.
      • Properly cleaning and testing of fireplaces and other heating equipment should occur at regular intervals.
      • Fire and carbon monoxide detectors should be on each floor of a house. Batteries should be changed at least twice/year and the detectors should be tested monthly.
      • Fire safety drills should also be practiced.
    • Sports
      • Check all equipment and have it fitted for the year. Also check again each time it is used making sure it is not broken or damaged.
      • Make sure all the equipment properly fits the child.
      • The child should have proper safety equipment such as helmets (ice hockey, skiing), goggles, wrist guards (snowboarding), mouth guards, etc.
      • Warm up and cool down with each session.
      • Appropriate adult supervision is recommended for the number of participants and their ages. Activities should not be done alone.
      • Use of alcohol by participants and/or supervisors is never recommended.
        • Sledding
          • Sled in a safe place that is away from moving vehicles, trees, fences, and other hazards.
          • Hills should not be too steep (< 30 degrees) and have a flat runoff.
          • Sledding while seated, bottoms down, and feet first may prevent head injuries.
          • Try to keep younger and older children separated to avoid accidents.
        • Snowmobiling
          • Children under 16 years are not recommended to operate a snowmobile by the American Academy of Pediatrics.
          • Travel at safe speeds on marked trails away from roads, water, and pedestrians is recommended.
        • Skiing/Snowboarding
          • Children under 7 years are not recommended to snowboard by the American Academy of Pediatrics.
          • Avoid skiing where there are obstacles including crowded slopes.
          • Slopes should fit the ability of the individual.
        • Ice Skating
          • Skate in approved places only.
          • Skate in the same direction as the crowd.
  • Health
    • Preventing Illness
      • Frequent handwashing and hand hygiene can help to prevent common colds and influenza. All children more than 6 months and adults should be encouraged to be vaccinated again influenza yearly.
    • Sun
      • Sun exposure occurs all year round, particularly at higher elevations. Sun reflects off ice and snow increasing exposure. Remember to wear sunscreen.
    • Nosebleeds
      • Humidification of the air around the child may help. Properly clean the humidifier at regular intervals. A small amount of petroleum jelly to the nares may also help.
    • Skin
      • Keeping orally hydrated and frequent use of moisturizers can help.

    Questions for Further Discussion
    1. What anticipatory guidance should be offered to parents regarding summer safety?
    2. Where on the Internet can trusted resources for anticipatory guidance be found?

    Related Cases

    To Learn More
    To view pediatric review articles on this topic from the past year check PubMed.

    Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

    Information prescriptions for patients can be found at MedlinePlus for these topics: Winter Weather Emergencies and Safety.

    To view current news articles on this topic check Google News.

    To view images related to this topic check Google Images.

    American Academy of Pediatrics. Winter Safety Tips. HealthyChildren.org.
    Available from the Internet at http://www.healthychildren.org/English/news/pages/Winter-Safety.aspx (rev. 12/1/2009, cited m/d/yy).

    American Academy of Pediatrics. Winter Storm Disaster Fact Sheet. HealthyChildren.org
    Available from the Internet at http://www.healthychildren.org/English/safety-prevention/at-home/pages/Winter-Storm-Disaster-Fact-Sheet.aspx (rev. 6/10/10, cited 11/15/10).

    Harris E. Chillin’ With Winter Safety. HealthyChildren.org.
    Available from the Internet at http://www.healthychildren.org/English/safety-prevention/at-play/pages/Chillin-With-Winter-Safety.aspx?nfstatus=402&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+Local+token+is+not+valid (rev. 8/3/2010, cited 11/15/10).

    ACGME Competencies Highlighted by Case

  • Patient Care
    1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
    2. Essential and accurate information about the patients’ is gathered.
    4. Patient management plans are developed and carried out.
    5. Patients and their families are counseled and educated.
    6. Information technology to support patient care decisions and patient education is used.
    8. Health care services aimed at preventing health problems or maintaining health are provided.

  • Medical Knowledge
    10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
    11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.

  • Practice Based Learning and Improvement
    13. Information about other populations of patients, especially the larger population from which this patient is drawn, is obtained and used.
    15. Information technology to manage information, access on-line medical information and support the healthcare professional’s own education is used.

  • Professionalism
    22. Sensitivity and responsiveness to patients’ culture, age, gender, and disabilities are demonstrated.

    Author

    Donna M. D’Alessandro, MD
    Professor of Pediatrics, University of Iowa Children’s Hospital