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Cold Temperature Exposure
It's easy to get cold quickly if you are outside in wet, windy, or cold weather. Cold temperature exposure can also happen if you spend time in a dwelling or other building that is not well heated during cold weather.
Injuries from cold exposure
- "Frostnip" usually affects skin on the face, ears, or fingertips. Frostnip may cause numbness or blue-white skin color for a short time, but normal feeling and color return quickly when you get warm. No permanent tissue damage occurs.
- Frostbite is freezing of the skin and the tissues under the skin because of temperatures below freezing. Frostbitten skin looks pale or blue and feels cold, numb, and stiff or rubbery to the touch.
- Cold injuries, such as trench foot or chilblains, may cause pale and blistered skin like frostbite after the skin has warmed. These injuries occur from spending too much time in cold, but not freezing, temperatures. The skin does not actually freeze.
- Eye pain or vision changes caused by cold exposure most often occur in individuals who try to force their eyes open in high winds, cold weather, or during activities such as snowmobiling or cross-country skiing. Snow blindness is not directly caused by cold temperatures but does occur in snow conditions. Sunlight reflecting off the snow can cause a corneal injury or burn. Eyelids may become red and swollen. Eyes may feel dry and as though they have sand in them.
- An abnormally low body temperature (hypothermia) occurs when the body loses heat faster than it can make heat. (There may be other reasons a person has a low body temperature. For more information, see the topic Body Temperature.) Early symptoms of hypothermia include shivering in adults and older children; clumsy movements; apathy (lack of concern); poor judgment; and cold, pale, or blue-gray skin. Hypothermia is an emergency condition—it can quickly lead to unconsciousness and death if the heat loss is not stopped.
Risk factors for cold exposure injury
There are many factors that increase your risk of injury from exposure to cold temperatures.
- Being a baby
- Being an older adult
- Drinking alcohol
- Being in outdoor conditions, such as high altitudes or windy, wet weather, or being immersed in cold water
- Not being dressed properly, having wet skin, or wearing wet clothing
- Being tired or dehydrated
- Being exposed to cold temperatures in your workplace, such as working in cold-storage units
- Having certain health risks
Many people get cold hands or feet, which often are bothersome but not a serious health problem. You are more likely to feel cold easily if you:
- Do not have much body fat. Fat under the skin helps keep you warm. People who have low body fat may be more likely to get hypothermia. Babies, older or ill adults, or malnourished people have low body fat.
- Smoke cigarettes or drink caffeine. Nicotine (from tobacco) and caffeine cause narrowing of the blood vessels in the hands and feet. When blood vessels are narrowed, less blood flows to these areas, causing the hands and feet to feel cold.
- Are under a lot of stress or feel tired. Chronic stress or anxiety can cause your nervous system to release adrenaline, which acts to narrow the blood vessels that supply blood to the hands and feet.
- Have a medical condition, such as hypothyroidism or Raynaud's phenomenon, that makes you feel or react more strongly to cold temperatures.
If you have already been exposed to the cold, first aid measures can warm you up and may even save your life.
Check your symptoms to decide if and when you should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Pain in adults and older children
- Severe pain (8 to 10): The pain is so bad that you can't stand it for more than a few hours, can't sleep, and can't do anything else except focus on the pain.
- Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it's severe when it's there.
- Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.
Pain in children under 3 years
It can be hard to tell how much pain a baby or toddler is in.
- Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
- Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
- Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.
Early symptoms of hypothermia may include:
- Cold, pale, or blue-gray skin.
- Clumsy movements.
- Poor judgment and a lack of interest in or concern about what's going on.
- Not speaking clearly.
Cold injury to the skin may cause:
- Severe pain.
- Numbness, tingling, or a prickly feeling.
- Hard, stiff, shiny, or rubbery skin.
- Cold, pale, white, pink-purple, or blue-gray skin.
- Blisters or sores.
Low body temperature means:
- In an adult or older child, 95°F (35°C) or lower.
- In a baby, 97°F (36.1°C) or lower. Rectal temperatures are the most accurate.
Some people's skin is very sensitive to cold temperatures and reacts abnormally. For example:
- The fingers, toes, nose, or ears may turn pale or white. Later they may turn blue.
- These areas may feel numb and tingly and feel very cold to the touch.
- As the areas warm, they may turn red and start to throb.
Symptoms of severe hypothermia may include:
- Stumbling and having trouble walking.
- Weakness, confusion, or extreme sleepiness.
- Slow, shallow breathing.
- Slow or uneven pulse.
- Passing out.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Most minor cold injuries will heal on their own, and home treatment is usually all that is needed to relieve your symptoms and promote healing. But if you think you may have a more severe cold injury, use first aid measures while you arrange for an evaluation by your doctor. These first aid measures can also be used for children. Be sure to warm the child's whole body with blankets as well as the cold injured parts.
- If you have hypothermia, try immediate first aid measures. Stay calm, find shelter, change to dry clothes, keep moving, and drink warm fluids to prevent further heat loss and slowly rewarm yourself.
- If small areas of your body (ears, face, nose, fingers, toes) are really cold or frozen, try home treatment first aid to warm these areas and prevent further injury to skin. Warm small areas by blowing warm air on them, tucking them inside your clothing, or putting them in warm water.
Frostbitten skin may be more sensitive after the cold injury. The injured skin area should be protected with sunscreen and protective clothing to prevent further skin damage. The color of the injured skin may also change over time.
Apply aloe vera or another moisturizer, such as Lubriderm or Keri lotion, to windburned skin. Reapply often. There is little you can do to stop skin from peeling after a windburn—it is part of the healing process—but home treatment may make your skin feel better.
Use nonprescription artificial tears warmed to body temperature to moisturize and soothe eyes that are cold, sore, or dry from exposure to cold or wind.
Try a nonprescription medicine to help treat your fever or pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your doctor if any of the following occur during home treatment:
- Symptoms of a skin infection develop, such as redness, swelling, or pus.
- Blisters develop after you begin home treatment.
- Symptoms have not gotten better or have gotten worse after 1 hour of rewarming treatment.
- Symptoms become more severe or frequent.
Many cold injuries can be prevented by protecting yourself when you are outdoors in cold weather.
- Bring an emergency kit if you are going into the backcountry so you are prepared for cold, wet, or windy weather conditions that might arise.
- Head for shelter that will protect you from wind and rain if you get wet or cold.
- Avoid doing too much activity and sweating. Sweating increases heat loss through evaporation, so you will feel cold.
- Avoid touching metal, especially with wet hands, because it will make you feel colder and may cause frostbite.
- Eat plenty of food to help maintain your body heat. Carry high-calorie foods, such as candy bars and trail mix, when going out in cold weather.
- Drink plenty of water. Carry extra water with you and drink it hourly. If you are not urinating every 2 to 3 hours, you probably are not drinking enough fluids.
- Do not drink alcoholic beverages. Alcohol:
- Interferes with your body's ability to regulate body temperature.
- Affects judgment. For example, a person may not put on more clothing when it is needed if his or her judgment is changed by alcohol.
- Can cause blood vessels in your skin to dilate. This increases heat loss.
- Reduces your ability to sense cold because it depresses the nervous system.
- Do not use caffeine and do not smoke while in the cold. Nicotine (from tobacco) and caffeine cause narrowing of the blood vessels in the hands and feet. When blood vessels are narrowed, less blood flows to these areas, causing the hands and feet to feel cold.
- Wear proper clothing and shoes. Keep extra protective clothing and blankets in your car in case of a breakdown in an isolated area.
- Keep your hands and feet dry. Wear mittens instead of gloves. Wear socks that retain warmth and keep moisture away from your skin.
- Protect your eyes from cold and wind by wearing glasses or goggles if you are planning outdoor activities.
Prevention measures for children
Children may not be aware of cold temperatures. Parents need to understand the ways in which the body loses heat and:
- Limit the amount of time a child is out in cold, wet, or windy weather.
- Dress children appropriately for the weather conditions. Remember C-O-L-D:
- Cover your child's head, neck, and face as much as possible since a lot of heat loss can occur in these areas. These areas are also at risk for frostnip or frostbite. Apply lip protection.
- Overexertion (being too active) can cause your child to sweat and chill more quickly. Sweating causes clothing to become damp and increases heat loss.
- Layers of clothing will keep your child warm and protect your child best against wind and cold conditions.
- Dry is key in preventing cold injury. Keeping your child dry with waterproof clothing reduces heat loss.
- Keep close watch on your children's body heat even in the summer when they are swimming in a lake or pool for a long time.
- Teach children to avoid touching cold metal with bare hands or licking extremely cold metal objects. Cold is transmitted more easily through metal and increases the risk of a cold injury, such as frostbite. Also, your child's tongue might stick to the cold metal and be difficult to remove.
Older or less active people can prevent indoor hypothermia by dressing warmly while indoors and keeping room temperatures above 65°F (18°C).
Be aware that some states fund programs to help low-income families add insulation or "weatherize" their homes to keep the family warm. Also, some low-income families may qualify for help in paying their heating bills. Contact your state or local energy agency or the local power or gas company for more information.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:
- What are your main symptoms?
- How long have you had your symptoms?
- What was the weather when you were outdoors and your symptoms began?
- How long were you exposed to cold temperatures?
- Have you had cold injuries before? Do you have any continuing problems because of them?
- What first aid home treatment measures have you tried? Did they help?
- If your skin was frozen, how long was it frozen? Did it rewarm? Did it get frozen again?
- Were you using any illegal drugs, alcohol, or tobacco at the time of your cold exposure?
- Are you currently taking any medicine? If so, are you following the prescribed dosage and schedule? Has there been any recent change in your dosage or schedule?
- Do you have any health risks?
Current as of: October 19, 2020
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
Adam Husney MD - Family Medicine
Kathleen Romito MD - Family Medicine
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