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Dr. Christina Johns
Senior Medical Advisor, PM Pediatrics

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Winter Bundling Do’s & Don’ts and Snow Safety

Some of my favorite pictures of my children are when they were toddlers playing outside in the snow. Dressed in a snowsuit and fluffy mittens with a hat with a giant pom pom on top, they could barely bend their elbows or knees they were bundled up so securely! I laugh about it now but know that I was fully intentional at the time of making them look like little linebackers. Whether you’re bundling kids to play in the freshly fallen snow or for a fun winter sporting activity like skiing or outdoor ice skating, or you just need to take a stroll for some fresh air with your infant, it’s important to understand a few do’s and don’ts of proper bundling for kids.

Generally, children need more cold weather protection than adults, and the smaller the child the more layers they require to keep their body temperatures at a safe level in cold temperatures. Effective layering is one method for safe outdoor winter play, however, there are other factors to be aware of when deciding when and if it’s safe for a child to enjoy the great wintery outdoors.

Keep an eye on the temp and don’t ignore the wind chill

There is definitely a threshold for unsafe outdoor temperatures when it comes to children (and adults, honestly). In order to effectively determine if playing outside should be avoided, look at both the temperature and the wind-chill.
If the wind-chill drops the temperature below 32 degrees Fahrenheit, I’d recommend limiting time spent outdoors until temps climb a bit. Additionally, general guidelines state that any temperature under around 13 degrees Fahrenheit, with or without the wind-chill factored in, is considered dangerously cold. Temperatures that drop this low could lead to hypothermia. It is recommended to avoid being outside, if possible, in that scenario.

Do: layer effectively. Do not: over-bundle (especially infants).

Yes, infants need to be kept warm in cold temps, but over-bundling could be problematic because of the chance for overheating, which the research shows could potentially lead to certain risk factors such as SIDS. I have seen babies in the emergency department come in with fever, only to realize that they had too many snowsuits and blankets on and were overheated by these external factors, not having true fever at all. That being said, other risk factors come along with not being bundled enough. So where do we land on this?

A good rule of thumb is to give children and babies one more layer than you, as an adult, are wearing. The order of the layers matters, too, as each layer of clothing has a different “job.”

The first layer for babies can be a “onesie” and for children should be a thin and fitted long-sleeved shirt, ideally made of a moisture-wicking material. Thermal athletic apparel can be a good choice here. Keep in mind that cotton can be tricky because if it gets wet it will remain so and will not keep in body heat effectively. Some people choose merino wool (if it’s not itchy) as a base layer as it’s thin, wicks moisture, and is hypo-allergenic for sensitive skin.

The purpose of the middle layer is to retain heat, so think about: thick sweater or sweatshirt. Wool or fleece are good materials for layer number two. The outer layer’s job is to keep the child dry so waterproof and windproof jackets will do the trick.

For toddlers and young kids playing in the snow, waterproof pants and mittens/gloves are necessary to keep wetness away from the skin at all times. For footwear, I recommend socks that are a blend of wool and synthetic fibers for the most warmth and dryness, and rubber sole boots that fit properly so snow and water can’t sneak in.

Cold-Weather Myths

I hear from parents all the time that they fear their child will “catch a cold” if they’re outside in the cold weather for too long or without proper bundling. Not exactly. You don’t get sick from being outside for any given amount of time, but – there is some data to suggest that lower body temperatures render a person less effective at fighting off any germ they may encounter. A good reason to pay attention to appropriate layering!

Related to this, parents ask me about pneumonia all the time.

Pneumonia is an infection in the lungs, acquired after contact with droplets containing germs from an infected person’s throat, nose or mouth and breathing them in. Pneumonia spreads most commonly in the winter because these germs thrive in cold weather and because we all spend more time indoors so germ particles can travel more easily. (I’ll say it again- this does not have anything to do with a child being outside in the cold for a specific length of time.)

Finally, one of the most common parent concerns: their child getting very red cheeks that stay red for a long time after coming inside and warming up. If this happens and the cheeks are extremely red it can be what we call “cold panniculitis” and while it may look dramatic, it is harmless and will go away on its own without any intervention. One way to avoid it is by applying an ointment like Vaseline on the cheeks prior to going outside to add that protective layer between the skin and the elements.

Have fun, stay safe outside, and don’t forget to bring your camera!
Dr. C

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