Dr Lindsay Clukies: Hi, I'm Dr. Lindsay Clukies, a Washington University Emergency Medicine physician at St. Louis Children's Hospital, and I'm a mom doc.

Melanie Cole, MS (Host): The coldest months bring along their own unique set of potential winter injuries. And during winter, it's important for everyone to be extra cautious both indoors and out. But not only do winter storms pose health hazards and dangers, they can certainly make it challenging to reach an emergency room due to icy roads. I know that is every parent's big fear. And since most kids aren't used to dealing with winter throughout the year, their risk of getting injuries may rise.

Welcome to Mom Docs, the podcast from St. Louis Children's Hospital. I'm Melanie Cole, Dr. Clukies, always a pleasure to have you with us. What are the top winter injuries that you see in the emergency room for kids?

Dr Lindsay Clukies: Thanks for having me, Melanie, and great question. I want to start off by saying that I'm a huge proponent of letting kids play outside. It is so good for them. And getting outside, even when it's cold, is a great way for kids to exercise, to burn off steam. And winter weather offers families the chance to enjoy great cold weather activities.

But it's really important to remember that children are at risk from the cold more than adults are. And this is physiologically and anatomically. Their bodies are smaller and they lose heat quicker. And plus, we all know when they're having fun, they're less likely to come inside to take breaks. And so, I think it's really important that we're talking about this today so we can be prepared for the winter activities.

We see all types of injuries throughout the winter in the emergency room. By far, the number one mechanism is falls. And honestly, it's the number one mechanism all year round. But what's different in the winter is that they commonly occur, like you mentioned, on icy or snow covered surfaces. And so with the sleet and the snow and the ice, the terrain can be rough, making the chance of falling a bit higher than other months.

We also see things like sledding injuries, and ice skating injuries, and skiing injuries. And of course, you mentioned motor vehicle injuries because of the challenging road situations. Now when we look at the types of injuries, by and large we see significant head injuries and broken bones. I would say those are the most common things we see this time of year.

Melanie Cole, MS: So as we're talking about head injuries, broken bones, we think of like the ice storms that much of the country has been seeing recently and slips and falls and certainly for adults, but kids slip and fall on the ice. As parents, we think of the bruising and whatever. When do we take our kids to the emergency room?

Dr Lindsay Clukies: I think it's really important for parents to stay calm. So, I always say, "Before you check on your kid, make sure you check your own pulse." Oftentimes, the calmer the adult is, the calmer whoever's watching the child, then the calmer the child will stay. So, it's important to follow the child's lead after a fall.

You know, if they get back up and they start running again, that's obviously quite reassuring, and it's appropriate at that point to just continue to monitor your child if they're acting normally and not complaining of anything. However, if your child is sobbing or they won't get back up or they're complaining of pain, it could be time for an assessment.

Some of the red flag symptoms that I typically mention are things like painful or difficulty breathing, multiple episodes of vomiting, or other neurological changes. And what I mean by neurological changes is things like weakness, slurred speech, or the inability to walk. If your child can't walk, they definitely need an evaluation. And if you see any type of significant deformity, right? So if the bone does not look like it's supposed to, if it does not look straight, they definitely need to be seen. Now, you can have broken bones without a deformity. And so, I typically mentioned that it's important to try something like Tylenol or ibuprofen. And if they're still in significant pain in their arm or their legs after that, then they should be evaluated.

Melanie Cole, MS: What about things like frostbite and hypothermia? We've seen temperatures just running the gamut. So, tell us a little bit about the symptoms, what the difference is. And as our kids want to go outside or have to go outside to go to school or to play sports or do something, you know, we have to be concerned with these things.

Dr Lindsay Clukies: Absolutely, and the biggest difference is that hypothermia is a medical emergency, and I want to start by saying that. Now, both frostbite and hypothermia are pretty uncommon, especially in our area. But like you mentioned, especially the last few years, it has been cold. And so, we're starting to see it more often.

Frostbite is actually very similar to a burn. To simplify things, I call it an ice burn. So, it happens when the skin and sometimes the tissues below it freezes. You more commonly see it on hands or on feet, and then oftentimes, noses and ears. And typically, what happens is it's significant pain and burning. The digit or the nose or whatever area is affected can look red and swollen. And then eventually, it becomes numb and it looks gray. And even blisters can form. So, it truly can look like a burn injury. If you have any concern about frostbite, then immediately bring your child indoors. That goes without saying. If you see anything to the area, especially blisters, then just leave them alone. Don't place anything hot on the skin. Just try and make sure your child's in a warm area. Cover them with blankets. You can even give them something warm to drink. But if the pain and the numbness continues for more than a few minutes, then it's important to seek care.

Now, more significantly, hypothermia is when your actual internal body temperature drops below normal. And it's from exposure to the colds. Shivering is one of the first signs and that's the way that the body warms itself up. And then if it continues and you don't get warmer at that time, then eventually your child can become clumsy, sluggish, start slurring his or her words and it can actually lead to coma. So if you have any concern for hypothermia, it's really important to call 911 because it's a medical emergency.

Melanie Cole, MS: Well, this is great information. And as we're thinking of medical emergencies, and these are such important episodes, Dr. Clukies, we spend more time indoors in the wintertime, and carbon monoxide poisoning is more prevalent in the winter. Can you tell us some examples? Because we like our fireplaces and we're, you know, using heaters or if the power goes out and we're cooking more. Tell us a little bit about some tips to prevent carbon monoxide poisoning and what are we doing?

Dr Lindsay Clukies: Yeah, and you're exactly right. We see carbon monoxide exposure every year when the weather starts getting colder. And like you mentioned, it's because people are using things to warm up their house. So, the problem with carbon monoxide is that it's colorless and odorless. So, you can have no idea that you're being exposed to it until you start showing symptoms. And a child, because they breathe faster than adults do, they tend to get poisoned quicker than adults. So, it's really important to know about this.

The good news is that it's preventable, and that's by using carbon monoxide monitors. So, every home should have one on every level of the home and in sleeping areas. And they'll typically alarm prior to levels where symptoms will show. So, the things we use in the winter that sometimes people don't realize can emit carbon monoxide are things like snow blowers. So, anything that uses gas or kerosene or coal or fuel or wood as their major heat source can emit carbon monoxide. So, gasoline-fueled snowblowers, propane space heaters, those can emit it; hibachi barbecues, things like that, and even your car being warmed up in your garage. So, it's important never to use any of those things inside in an enclosed space.

Melanie Cole, MS: Yeah, that's really important. And I mean, I know people that have done that and you think to yourself, it might be common sense. But at the time, it doesn't always seem like it's going to be something that's so dangerous. What else do you see, Dr. Clukies, that you'd like parents to know about in the winter? And we think of winter sports and winter sports injuries. I just went skiing recently with my kids and I'm much more cautious. But it certainly is something that families think about, injuries. Is there anything else you'd like to mention as far as winter injuries that you want parents to know about?

Dr Lindsay Clukies: I think it's important to dress the part. Whether you're sledding, or skating, or skiing, or snowboarding, absolutely go out there and do these things and have fun, but dress the part. Make sure you're dressed appropriately with layered clothing., Always wear a fitted helmet for sports like you mentioned, like skiing or snowboarding. Make sure to protect your skin and your eyes. So, sun that reflects off the snow can be very, very strong. So, sunscreen, goggles, sunglasses, all of that stuff is really important. And of course, have fun while you're doing it.

Melanie Cole, MS: I think that's great advice, Dr. Clukies. You're such an excellent guest as always. You come on here and you really tell us from your perspective what you see and what we can do hopefully not to have to see you. I mean, that's really the goal of this and thank you again for joining us. And for more advice and articles, check out the MomDocs website at childrensmd.org. That wraps up another episode of MomDocs with St. Louis Children's Hospital. Remember to share this show with your friends and family on your social channels, because we are all learning together from the experts at St. Louis Children's Hospital. I'm Melanie Cole. Thanks so much for joining us today.