How to stay safe in cold weather, according to a doctor

CNN, CLEVELAND CLINIC

By Katia Hetter, CNN

(CNN) — Much of the United States is experiencing prolonged and extreme cold weather, with recent winter storms, dangerous windchills and record low temperatures affecting millions of people. As winter stretches on, many people still have to commute to work while figuring out how to keep active and safely let children play outside.

Cold weather brings real health risks and raises practical questions about everyday life, and they are not all solved by wearing a coat, hat and gloves. How does extreme cold affect the body? What precautions matter most when going outside? How can families balance safety with staying active, especially for kids? And what should people know about protecting themselves during extended cold spells?

To help answer these questions, I spoke with CNN wellness expert Dr. Leana Wen, an emergency physician and clinical associate professor at the George Washington University. She previously served as Baltimore’s health commissioner and is the mother of two young children she’s trying to keep warm as cold weather hits Maryland.

CNN: Why does extreme cold pose health risks, and who needs to be especially careful?

Dr. Leana Wen: Extreme cold stresses the body in multiple ways.
Cold temperatures cause blood vessels to constrict, which raises blood pressure and forces the heart to work harder. Breathing cold air can irritate the airways, and prolonged exposure increases the risk of frostbite and hypothermia, which can be extremely dangerous. Cold weather also reduces dexterity and balance, making falls more likely. There are also elevated risks of motor vehicle accidents with a lot of ice and snow.

Certain groups are at higher risk for cold-related illnesses. Older adults may have reduced ability to regulate body temperature. Young children lose heat faster than adults and may not recognize symptoms of hypothermia. People with heart or lung disease, diabetes, circulation problems, or mobility issues may be more vulnerable to complications. Medications that affect alertness (such as certain pain medicines and antidepressants) or circulation (such as some blood pressure pills) also can increase risk. That does not mean that people in these situations need to stay inside the entire time when it’s cold, but it does mean they should be especially cautious.

CNN: What should people do before heading outside in cold weather to reduce risk?

Wen: Preparation makes a big difference. Check the temperature and windchill before going out, not just the forecast’s high temperatures — because wind significantly increases heat loss. Plan how long you will be outside and know whether there are places to warm up if needed.

Try not to exercise outdoors alone. If you do, make sure to tell someone where you are going and consider sharing your live location with them. Always make sure your phone is charged. If you are driving, keep your gas tank at least half full and carry basic supplies including blankets and coats in case you are delayed.

CNN: What are the biggest concerns with injuries once you are outside?

Wen: Falls are one of the most common and serious winter injuries. Ice, especially black ice, is often invisible and can form on sidewalks, steps, parking lots and roadways even when conditions look clear. Slipping and falling can lead to fractures, head injuries and spinal injuries, with older adults at particularly high risk of serious harm because of lower bone density and higher likelihood of being on blood thinners.

Exposure to cold poses another major danger. In extreme temperatures, uncovered skin can develop frostbite in minutes, especially on fingers, toes, ears and the nose. Frostbite damages skin and underlying tissue, and the condition can lead to permanent injury if not treated promptly. People may not notice frostbite developing because numbness often comes before pain.

Hypothermia occurs when the body is losing heat faster than it can produce it. This condition is a medical emergency. Early symptoms include shivering, confusion, slurred speech and clumsiness. As body temperature drops further, shivering may stop and mental status can worsen. Eventually, the cardiac and respiratory systems could fail and lead to death.

What makes cold-related injuries especially dangerous is that they can creep up on people. Cold dulls sensation and judgment, so individuals may not realize how much trouble they are in until symptoms are already significant. That’s why anticipating outside conditions and limiting exposure time and responding quickly to warning signs are critical for staying safe in extreme cold.

CNN: What about shoveling snow? I’ve heard it can be dangerous.

Wen: Shoveling snow can place sudden strain on the heart and muscles, especially when the snow is heavy or wet. People with heart disease, high blood pressure or other cardiac risk factors should check with their clinician about whether shoveling is safe for them or consider asking for help. Everyone should pace themselves, take frequent breaks, push snow when possible instead of lifting it, and stop immediately if they feel chest pain, shortness of breath, dizziness or unusual fatigue.

CNN: How long is it safe to be outdoors in extremely cold temperatures?

Wen: There is no single safe time limit, because it depends on temperature, windchill, clothing, activity level and individual health. In extreme conditions, even short periods outdoors can be risky without proper protection. Pay attention to your local weather updates since temperatures can drop quickly.

A practical rule is to check in with your body frequently. If you feel numbness, intense shivering, clumsiness or confusion, it is time to go inside and warm up. Short, purposeful trips outside are safer than one extended exposure.

CNN: Is it safe for children to play outside in the snow? If so, what should parents and guardians watch for?

Wen: Children can safely play outside in the snow when conditions are reasonable and they are dressed appropriately. The key is supervision and time limits.

Parents should make sure children wear insulated, waterproof clothing, as well as dry gloves and socks. Set clear time limits and bring children inside for warm-up breaks. Watch for warning signs such as pale or reddened skin, shivering, irritability or tiredness. If a child resists going back outside after warming up, that is also a sign they have had enough exposure.

CNN: What should people do when they come back indoors after being out in the cold?

Wen: Warming up should be gradual. It’s crucial to first remove wet clothing promptly and change into dry layers. If there is concern for frostbite, use blankets or warm clothing rather than hot showers or heating pads directly on cold skin, which can cause injury.

Warm drinks can help raise body temperature, but alcohol should be avoided because it increases heat loss. Pay attention to hands and feet, and check for any areas that feel numb, hard or painful, which could signal frostbite. If symptoms do not resolve with gentle warming, seek medical care.

CNN: How can people stay physically active when it is too cold or unsafe to exercise outdoors?

Wen: Staying active is important during prolonged cold spells. Consider working out indoors while the weather is especially bad. You do not need special equipment. Body-weight exercises, stretching routines, stair climbing or following guided workout videos can all be effective.

Remember, too, that short bouts of activity, or “exercise snacks,” throughout the day add up. Standing up regularly, doing chores or just walking around the home can help maintain circulation and flexibility.

CNN: In your experience as an emergency physician, what is the most common mistake people make during prolonged periods of extreme cold?

Wen: The most common mistake is underestimating risk. People may assume that they know how to handle cold weather and then go outside without proper clothing, stay out longer than planned, and ignore early warning signs from their body.

Another frequent issue is trying to push through discomfort. Cold-related injuries often develop gradually. Paying attention to conditions, planning properly and being willing to cut activities short can help to keep you and your family safe during extreme cold.

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