Keeping Warm and Having Fun

“If you are going to be outside, dress appropriately,” said Sharon Evans, injury prevention manager at Cook Children’s Health Care System.

Experts advise caregivers to dress little ones in several thin layers to keep warm and dry. Children are at more risk from the cold because their bodies lose heat more quickly. Insulated boots, mittens or gloves, and a hat are recommended.

Make sure children change out of any wet clothes as soon as they come indoors.

“While playing in the snow or “sledding” be aware of your surroundings, be careful to not run into trees or out into the street and mailboxes can be real dangers,” said Evans.

Know the Signs of Hypothermia 

According to the American Academy of Pediatrics, hypothermia, or abnormally low body temperature, "is a dangerous condition that can occur when a person is exposed to extremely cold temperatures." This is a medical emergency, and treatment should be sought immediately. 

 Symptoms of hypothermia include: 

• Blue skin
• Shivering
• A cool chest and stomach are signs that children may be dangerously cold.
• If you see these symptoms, take action immediately to get kids out of the cold. Seek immediate medical attention if you are not able to warm the body.
• Victims of hypothermia can include babies sleeping in cold rooms. 

 Warning signs for infants include: 

• Bright red, cold skin
• Very low energy 

 Warning signs for adults include: 

• Shivering, exhaustion
• Confusion, fumbling hands
• Memory loss, slurred speech, drowsiness 

Coats & Car Seats

While keeping kids warm is a priority during the winter, it should never come at the expense of car seat safety.

“Stay home and inside if possible. If you must be on the roads make sure everyone is buckled up correctly,” said Evans.

Bulky coats, such as puffy jackets, can create extra space between the child and harness straps or seat belt, which can increase the risk of injury in a car crash.  It is recommended to dress in thin layers and use a blanket or put the coat on backwards after the child is buckled in. 

If caregivers decide to start the car to allow it to warm up prior to entering the vehicle, it is important to make sure the car is in a ventilated area, such as an open garage, and that they lock the vehicle when they are not inside.  This will make sure that a child does not enter the vehicle unsupervised and become trapped in the vehicle.

Evans adds families should have snacks, water, and extra blankets in their car in case you get stranded. 

“If you are stranded and waiting for help on the side of the road, please make sure everyone stays buckled up,” said Evans, “often cars may slide/spin near you and hit your car.”

In addition, just as local officials advise people to stay off the roadways, if possible, ice can make dangerous driving conditions for ATV’s, Golf Carts and Go Karts.

 Safe Sleep

With winter weather, keeping infants warm is a priority for caregivers, and it is essential to do so safely.

“Caregivers often use extra blankets and hats for warmth, but these soft items can easily become a suffocation or entanglement hazard,” said Samantha St. John, program coordinator at Cook Children’s Center for Community Health.

A safer alternative is a sleep sack, also called a wearable blanket. A sleep sack provides warmth and comfort without risk because it fits securely around the baby's upper body and is sized so the fabric cannot cover their face, while still allowing plenty of room at the bottom for comfort and movement.

St. John suggests a general rule to follow dress a baby in one more layer of clothing than an adult would find comfortable in the same environment.  In winter months this could mean baby is in a long sleep fleece onesie with a wearable blanket/sleep sack. When dressing baby for bedtime or nap time during the extremely cold temperatures, it may be necessary to add socks, mittens, or hats to baby. Caregivers want to make sure that these items cannot come off during sleep and become a loose item in the crib.  It is also important to make sure baby is not going to overheat.  Signs of overheating can include sweating, a hot chest, or flushed skin.  

 Remember the ABCs of Zzzs:

• Alone: The sleep space should be clear of any soft items, such as blankets, stuffed animals, pillows, and bumper pads, leaving only a mattress with a tight-fitted sheet.
• Back: Babies should always be placed flat on their back for every nap and every night.
• Crib: A crib, bassinet, or portable play yard with a firm, flat mattress and a fitted sheet is the safest sleep surface. 

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"One of the triggers of asthma symptoms are respiratory viruses and we are seeing a large number of those driving people to access Emergency Care," said Corwin Warmink, M.D., medical director of Emergency Services at Cook Children's.

Karen Schultz, M.D., medical director of Pulmonary Services, advises parents of children who have asthma to make sure they have an asthma action plan. An asthma action plan should be provided by the outpatient physician who cares for the child's asthma or, if admitted to the medical center, will be provided by the discharging nurse at Cook Children's.

The written plan helps patients develop with their doctor the methods to help control their asthma. The plan looks at the daily treatment of the patient, including medication to take and how to control asthma long term and how to handle worsening asthma, or attacks.

"General signs of initial worsening of asthma include some difficulty breathing, coughing and wheezing, problems working or playing, or waking up at night coughing," Dr. Schultz said. "At this point families should start using their rescue medications as instructed by their physician. Families should call their physician if their child has required three extra treatments in a 24 hour periods or they need them more frequently than every four hours."

Worsening signs of asthma include breathing that is hard and fast, trouble talking or walking, inability to work or play, constant coughing, or a color change in the lips and/or nail beds. At this point, rescue medications should be given and the family should seek immediate care.

To learn more about asthma, Dr. Schultz answered a few of our questions:

1.What is asthma?

Asthma is an inflammatory process that happens in the lungs that causes swelling and increased mucus down in your lungs so it makes it harder to breathe.

2.When do asthma flare ups occur?

An asthma flare up occurs when someone is exposed to a trigger of their asthma. The muscles around their airwaves actually squeeze down and make it even more difficult for people to breathe. They can also get more mucus and more swelling in their lungs, which also makes it harder.

3.What are the triggers?

People have different triggers for their asthma. The most common ones tend to be weather changes, viral infections and exposure to certain allergens. Cold, dry air can cause bad flare-ups and viral infections are the most common trigger this time of year. Parents should stress to their children the importance of handwashing, especially this time of year.

Allergens could include cats, pollen, grass and mold. Another big trigger is exposure to smoke. Exposure to second-hand smoke is a big issue with kids with asthma. Not only can it be a trigger for an asthma flare, but it can keep your child’s asthma from ever getting under control in the first place. Any parent who has a child with asthma, should not smoke. Even smoking outside exposes your child to some smoke particles and can still keep their asthma out of control.

4.Who gets asthma?

Asthma happens to people with a genetic predisposition who then have the right trigger to start their asthma flaring at the right time.

Depending on the age, asthma can be diagnosed in different ways. In very young children and toddlers, it’s diagnosed based on their symptoms and what their physician on examination. So kids that have recurrent wheezing are diagnosed with asthma.

In older kids, 5 years and up, lung function testing can be done to help determine asthma severity.

5.What are the symptoms?

Common starting symptoms of an asthma flare often are just cough. Sometimes families can start seeing the kiddos breathe harder and faster and sometimes they can actually hear them wheeze. But often the wheezing can only be heard by a physician.

If they start noticing their child is breathing very rapidly, if they are sucking their air in above their sternum or in between their ribs, then those are signs that they are really struggling to breathe and a doctor needs to take a look at them.

6.How is asthma treated?

Asthma is treated with inhaled medications generally. The most common medication we use is albuterol which helps relax the muscles that tighten down around the airwaves. However, this will not prevent asthma attacks. To prevent asthma attacks, patients are often placed on inhaled steroids to help control the swelling and mucus in their lungs so they can breathe easier.

Asthma is monitored mainly by symptoms. Your physician may ask how often you are using your rescue inhaler or your albuterol to help determine whether your asthma is under good control or not.

The best way to control your child’s asthma is for him or her to take the medication that your physician prescribes on a regular basis. Many people will think that their children’s asthma is under good control and they will stop their medications and that’s when they start having more flares of their asthma.

Everyone with asthma should have an action plan. It will list out your child’s medications and what to do when they start having symptoms. It will tell you what to do when they have mild symptoms or more severe symptoms and should direct you to the appropriate health care resource should they start having more difficulty.

When children use inhalers for their asthma, they are more effective if they use a spacer, which is generally a clear plastic tube with a mouthpiece that helps the medicine deposit into your lungs rather than stuck on your tongue if you just puff the inhaler in your mouth.

7.When should I see a pediatrician?

If your child is having an asthma attack that’s difficult to get under control, you can try doing extra albuterol treatments or extra puffs of your albuterol. If your child needs more than three extra treatments in a day, then you need to contact your physician.

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• Asthma Information from Cook Children's
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• Asthma and your child
• Can my child die from asthma? Yes.
• Why asthma shouldn't be an excuse for keeping your child off the field
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