Last reviewed by Faculty of Harvard Medical School on February 1, 2012 
Henry H. Bernstein, D.O.
Senior Lecturer, Harvard Medical School
Winter means colder weather and, in some parts of the country, playing different outdoor sports than in the spring and summer. Although these activities can be fun as well as good exercise, being outside in the cold weather can cause injuries and death, if not done safely.
Children have larger body surfaces for their weights than adults do. Therefore, in cold conditions, children will lose heat more quickly than adults, making their body temperatures drop below normal (hypothermia) more easily. It is never healthy for body temperature to get too low.
Follow these tips, some adapted from the American Academy of Pediatrics, to prevent cold- and sports-related injuries in the winter.
General Tips for Playing Outdoors
- Dress in several layers. For example, have your child wear thermal underwear (wool, silk or polypropylene hold heat best) under pants and a sweater. The outermost layer should be tightly woven and waterproof to keep out wind and water. Even children who are carried can become chilled if not dressed warmly enough.
- Wear a hat since most body heat is lost through the head.
- Have their ears covered at all times with a hat, headband, scarf or earmuffs.
- Keep gloves and shoes dry. If either becomes wet, change your child into a dry pair. Hands and feet are most easily injured by the cold. Mittens are warmer than gloves since the fingers stay close together. Boots should be warm and waterproof, with plenty of room for the toes to wiggle around.
- Don't be outdoors for too long without taking breaks inside. Always check children regularly to make sure they are warm and dry. Younger and smaller children will tend to get colder faster.
- Drink plenty of fluids. Kids can get dehydrated in the winter, too, especially if they are playing hard and not drinking enough.
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Sledding
- Look for smaller, gently sloped hills without trees, fences or other things in the way of the path down.
- Avoid areas around parked cars and paths that run into a roadway.
- Be sure the sled, tube or toboggan is in good condition.
- Always go down the hill sitting up (feet first), or kneeling. Lying down increases the risk of head, back (spine) and belly (abdominal) injuries.
- Children under 6 years old should never ride alone; an adult must ride with them.
- Wear a ski or hockey helmet (never a bicycle helmet) to protect the head from injury.
- Avoid using long, dangling scarves or hats, which can get caught under the sled.
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Ice skating
- Be sure the ice is at least 6 inches deep before going on it.
- Never skate near open water.
- Never skate alone.
- Wear skates that are comfortable, with good ankle support to keep the ankles from getting injured.
- Wear ski or hockey helmets. Hockey helmets with face cages will protect the face in case of a forward fall.
- Wear other protective equipment, including mouth and shin guards, along with a helmet, when playing hockey.
- Be sure your children know NEVER to skate (or walk) on a frozen pond, lake or pool unless an adult has checked the surface to make sure it is safe. Ice rinks and shallow ponds are the safest outdoor surfaces.
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Skiing and Snowboarding
- Take lessons, since many injuries can be avoided by knowing the right way to do things.
- Always wear a warm, lightweight helmet with side vents that allow hearing. The helmet should be approved for use with skiing or snowboarding. One of every five injuries in children under age 15 is a head injury. Although all children and teen-agers should use them, helmets are especially important for young skiers and snowboarders, who have a higher incidence of head injuries. Helmets usually can be rented at ski shops or bought at sporting goods stores. Choose one with an outer layer that matches the speed and ability at which your child skis.
- Never ski or snowboard alone.
- Always wear wrist guards when snowboarding.
- Stay on marked trails, and only on those that match the child's ability level.
- Use caution when going over moguls, jumps and bumps, which is when many children are injured.
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Snowmobiling
- No one younger than 16 years should ever be driving a snowmobile. To learn to operate a snowmobile safely, people must take a snowmobile safety course, offered in most northern states.
- Children younger than 6 years should not even be riding on a snowmobile because they are not strong enough to handle the speed and movements.
- Wear well-insulated protective clothing, including goggles and waterproof snowmobile suits, gloves and rubber-bottomed boots.
- Wear helmets approved for use with motorized vehicles such as motorcycles and snowmobiles. Head injuries are the leading cause of snowmobile-related deaths.
- Never carry more than one passenger.
- Keep the headlights and taillights on at all times so that others can see the snowmobile better.
- Pulling someone behind a snowmobile on a saucer, tube, tire, sled or skis is not recommended.
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Henry H. Bernstein, D.O., is a senior lecturer in pediatrics at Harvard Medical School. In addition, he is chief of general academic pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of general pediatrics and director of primary care at Children's Hospital Boston.
