Anticipatory Guidance

Winter Safety



Despite dropping temperatures and snow, the winter still offers plenty of opportunities for children to enjoy a variety of activities outdoors, from sledding to snowman building. Below are some points to consider helping keep children warm and safe during this time of year, both inside and outside of the home.

Heater & Radiator Safety

Older homes without a central air heating system may rely on radiators or heaters to keep the home warm.  These can be dangerous to not only children but adults as well, so proper care and safety must be taken to avoid accidental injuries.

The safest heaters are portable electric space heaters rather than those that use gas, kerosene or propane as the heating element as these can spills and cause burns not to mention the dangers of having the fuel around the home.  

The following are good heater safety guidelines for families to follow:

  • Place the heater on a level, flat surface where children and pets can't reach it--and never in a child's room.
  • Don't leave a heater unattended while it's plugged in. 
  • Use a heater on a tabletop only when specified by the manufacturer. If you place it on furniture, it could fall and be damaged.
  • Don't use a space heater in a damp or wet area unless it's designed for outdoor use or in bathrooms. Moisture could damage it.
  • Keep combustible materials such as furniture (especially cribs or children's beds), bedding, and curtains at least three feet from the front of the heater and away from its sides and rear.
  • Don't use a heater near paint, gas cans, or matches. Keep the air intake and outlet clear.
  • Don't plug another electrical device into the same outlet or extension cord as the heater could cause overheating.

Review with families the importance of keeping heaters and radiators out of reach of children.  One option is using a child (or pet) safety gate to prevent access to the heating element.  Another is purchasing a low-cost radiator cover at a local hardware or DIY store.  The cover should go around the entire radiator without having any contact with it. The design, if it has any holes or spaces, should not allow a child to put a hand or a finger through to touch the radiator.

If renting, you can inquire as to whether your landlord might be able to provide a radiator cover for you, however they are not required to do so by law.

It is very important to advise families NOT to use an open oven door or lit burners to heat the home.  Not only is it ineffective, but it can lead to serious burn as well as carbon monoxide risk (see the section on Smoke & Carbon Monoxide Detectors below).

Clothing & Infants

Caregivers may be tempted to use more blankets and bedding for their newborns and infants in colder weather.  It is important to education families to avoid loose bedding in cribs, because they can contribute to SIDS risk.  

Instead, infants should wear additional one-piece sleepers or wearable blankets to keep warm enough - in general this is usually one more layer than parents would wear themselves.  

Safe Sleep logo.svg

Smoke & Carbon Monoxide Detectors

Studies show that more than 60 percent of deadly U.S. fires occur in homes that do not have smoke alarms installed or have alarms that do not function because of missing batteries, dead batteries or some other problem that keeps them from working properly.

The National Safety Council reports that nearly 300 people die each year in the US as a result of carbon monoxide poisoning. Carbon monoxide is often referred to as the silent killer, and is an invisible, odorless gas that is created when fuels burn completely. In the home, heating and cooking equipment that burn fuel can be sources of carbon monoxide.

Fire & carbon monoxide safety isn't something specific to the winter, but with the use of heaters and radiators, it is something important to review with families before the weather starts getting cool.  Here are some important tips for families about their use:

  • Install a smoke alarm in every bedroom, outside each separate sleeping area and on every level of the home, including the basement.
  • Install a carbon monoxide detector on every level of of the home and in a central location near each sleeping area.
  • Test smoke & carbon monoxide detectors by pushing the test button regularly, at least once every month
  • Replace batteries at least once a year
  • Plan at least two escape routes from the homes and practice those escape routes with the entire family.

For famlies that rent, it is important to let them know that their landlord is required (under under the Chicago Municipal Code Ch. 13-64-120 and 13-196-140) to provide the following:

  • At least one smoke detector in each unit.
  • At least one carbon monoxide detector in each unit, except in the case of a central boiler system, one carbon monoxide detector by the boiler is required.

It is up to the tenant to provide and maintain a working battery in all smoke & carbon monoxide detectors within the unit.

Sun Protection

Sunburnt woman.jpeg

Children can still get sunburned in the winter, as the sun reflects off snow and ice. Children should use sunscreen of at least SPF 15, which should be applied 15-30 minutes before they go outdoors.  Lip balm with sun protection and protective eyewear are also recommended.

Higher levels of SPF protection may offer higher protection (SPF 15 blocks 94% of UVB radiation while SPF 30 blocks 97%), however the key to sunscreen is in it's proper application (a liberal amount) & reapplication at least every 2 hours.

Frostnip & Frostbite

Frostnip refers to cold-induced, localized paresthesias that resolve with rewarming. There is no permanent tissue damage with frostnip.  

Frostbite on the other hand is a severe, localized cold-induced injury that results from actual freezing of cells and tissue and can have lasting complications:

  • Short-term complications include: 
    • Infection & gangrene
    • Autoamputation of the affected area 
    • Pain, which normally begins two to three days after rewarming and may persist for weeks or months
  • Longer-term complications include:
    • Scarring & tissue atrophy
    • Arthritis, bony abnormalities, and peripheral neuropathy including hyper or hypoesthesia of digits with decreased proprioception and chronic pain.
      • Pediatric patients may develop necrosis of epiphyses, with devastating growth abnormalities. 

Frostnip & frostbite commonly affects the following areas of the body:

  • Nose
  • Fingers
  • Toes
  • Ears

Frost bite.jpg
Frostbitten toes two to three days after mountain climbing

Most schools schools follow very strict guidelines for outdoor recess during cold snaps to keep children safe from the cold and avoid these cold-related issues.  Encourage families to follow these same guidelines for home and recreational activities. So, if it’s too cold for outdoor recess, then it’s too cold to build a snowman!

If frostbite is suspected, there are steps families can take prior to arriving to the hospital:

  • Get the child into a warm environment as soon as possible and remove any wet clothing.
    • If a child has frostbitten feet, carry them as walking on their feet can cause further tissue damage.
  • Do not rewarm frostbitten tissue if there is a chance of refreezing before reaching the hospital - unfreezing and freezing results in worse tissue damage.
  • Seeking urgent medical care is best, but if warming is attempted use warm, not hot, water or body heat (i.e., putting frostbitten fingers in the axillae)
  • Avoid rubbing frostbitten areas as this can cause more tissue damange 


Children’s bodies have a more difficult time regulating their temperature in extreme cold and heat than adult bodies do. As a result, they are more susceptible to hypothermia when outside in very cold temperatures for prolonged periods of time, or when they are not dressed appropriately for the cold temperatures.  

It's also important to remember it doesn’t take extreme cold for hypothermia to develop – wet conditions in milder temperatures can cause hypothermia as well.  

Prevention is key!  When outdoors, children should dress in several layers, with boots, gloves, and hats. Generally, young children should wear one more layer than adults do in order to stay warm.

Signs of hypothermia include the following:

  • Intense shivering
  • Blue skin
  • Lethargy
  • Clumsiness
  • Difficulty speaking
  • Confusion

If hypothermia is suspected, families should call 911 immediately. Meanwhile, families should bring the child indoors, remove any wet clothing, and try to warm the child by wrapping them in dry blankets.

Winter Sports and Activities

Just as with summer sports and activities, winter activities can be the source of significant injury in children and adults alike.

Children should be supervised by a capable adult during all winter sports.  Certain precautions can be taken to avoid serious injury, including:

  • Wearing helmets during activities such as skiing, snowboarding, sledding, snow tubing, and ice hockey.
  • Ice skating only at approved locations.
  • Ensuring hills for sledding don't empty into unsafe areas, such as a nearby street or frozen pond.
  • Sledding feet first rather than head first can help prevent head injuries.
  • Not allowing children under 6 years of age to ride on snowmobiles.
  • Not allowing children under 16 years to operate snowmobiles.
  • Not using snowmobiles to pull children on sleds or skis.
  • Only using helmets and protective eye equipment authorized for use on motor vehicles for snowmobiles.


  1. AAP. Winter Safety Tips. Jan 17, 2013.
  2. HealthyChildren. Chillin’ With Winter Safety. Feb 28, 2013.
  3. Corneli HM. Accidental hypothermia. J Pediatr 1992; 120:671.
  4. Pediatrics Now website - 
  5. Mechem CC et al.  Frostbite.  Up to Date, Oct 18, 2012