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Clinical manifestations of hypothermia in children

Howard M Corneli, MD
Robert G Bolte, MD
Section Editor
Daniel F Danzl, MD
Deputy Editor
James F Wiley, II, MD, MPH


The clinical manifestations of unintentional hypothermia in children will be reviewed here. Treatment of hypothermia in children, neonatal hypothermia, and frostbite are discussed separately. (See "Hypothermia in children: Management" and "Short-term complications of the premature infant", section on 'Hypothermia' and "Frostbite".)


Hypothermia is defined as a core body temperature below 35ºC (95ºF). The stage of hypothermia, defined by core temperature, has a large impact on both recognition and treatment. The most commonly used definitions found in the literature are as follows [1,2]:

Mild - Core temperature 32 to 35ºC (90 to 95ºF)

Moderate - Core temperature 28 to 32ºC (82 to 90ºF)

Severe - Core temperature below 28ºC (82ºF)


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Literature review current through: Jun 2015. | This topic last updated: May 12, 2015.
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  1. Giesbrecht GG. Cold stress, near drowning and accidental hypothermia: a review. Aviat Space Environ Med 2000; 71:733.
  2. Jolly BT, Ghezzi KT. Accidental hypothermia. Emerg Med Clin North Am 1992; 10:311.
  3. Brown DJ, Brugger H, Boyd J, Paal P. Accidental hypothermia. N Engl J Med 2012; 367:1930.
  4. 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 10.4: Hypothermia. Circulation 2005; 112:IV.
  5. Durrer B, Brugger H, Syme D, International Commission for Mountain Emergency Medicine. The medical on-site treatment of hypothermia: ICAR-MEDCOM recommendation. High Alt Med Biol 2003; 4:99.
  6. From the Centers for Disease Control and Prevention. Hypothermia-related deaths--Utah, 2000, and United States, 1979-1998. JAMA 2002; 287:981.
  7. Corneli HM. Accidental hypothermia. J Pediatr 1992; 120:671.
  8. English MJ, Farmer C, Scott WA. Heat loss in exposed volunteers. J Trauma 1990; 30:422.
  9. Bierens JJ, van der Velde EA, van Berkel M, van Zanten JJ. Submersion in The Netherlands: prognostic indicators and results of resuscitation. Ann Emerg Med 1990; 19:1390.
  10. Wagner HR, Subramanian S. Deep hypothermia in infant cardiac surgery. Pediatrics 1978; 61:479.
  11. Golden FS, Hervey GR, Tipton MJ. Circum-rescue collapse: collapse, sometimes fatal, associated with rescue of immersion victims. J R Nav Med Serv 1991; 77:139.
  12. Corneli HM. Ventricular fibrillation from hypothermia. In: Ventricular Fibrillation: A Pediatric Problem, Quan L, Franklin WH. (Eds), Futura, Armonk 2000. p.69.
  13. Solomon A, Barish RA, Browne B, Tso E. The electrocardiographic features of hypothermia. J Emerg Med 1989; 7:169.
  14. Bolte RG, Black PG, Bowers RS, et al. The use of extracorporeal rewarming in a child submerged for 66 minutes. JAMA 1988; 260:377.
  15. Gilbert M, Busund R, Skagseth A, et al. Resuscitation from accidental hypothermia of 13.7 degrees C with circulatory arrest. Lancet 2000; 355:375.
  16. Mattu A, Brady WJ, Perron AD. Electrocardiographic manifestations of hypothermia. Am J Emerg Med 2002; 20:314.
  17. Aslam AF, Aslam AK, Vasavada BC, Khan IA. Hypothermia: evaluation, electrocardiographic manifestations, and management. Am J Med 2006; 119:297.
  18. Beilman GJ, Blondet JJ, Nelson TR, et al. Early hypothermia in severely injured trauma patients is a significant risk factor for multiple organ dysfunction syndrome but not mortality. Ann Surg 2009; 249:845.
  19. Walpoth BH, Walpoth-Aslan BN, Mattle HP, et al. Outcome of survivors of accidental deep hypothermia and circulatory arrest treated with extracorporeal blood warming. N Engl J Med 1997; 337:1500.
  20. Maxton FJ, Justin L, Gillies D. Estimating core temperature in infants and children after cardiac surgery: a comparison of six methods. J Adv Nurs 2004; 45:214.
  21. Harasawa K, Kemmotsu O, Mayumi T, Kawano Y. Comparison of tympanic, esophageal and blood temperatures during mild hypothermic cardiopulmonary bypass: a study using an infrared emission detection tympanic thermometer. J Clin Monit 1997; 13:19.
  22. Rogers IR, Brannigan D, Montgomery A, et al. Tympanic thermometry is unsuitable as a screening tool for hypothermia after open water swimming. Wilderness Environ Med 2007; 18:218.
  23. Tunnessen WW, Roberts KB. Hypothermia. In: Signs and Symptoms in Pediatrics, 3rd edition, Lippincott, Williams & Wilkins, Philadelphia 1999. p.8.
  24. Taylor AJ, McGwin G Jr. Temperature-related deaths in Alabama. South Med J 2000; 93:787.
  25. Aitken LM, Hendrikz JK, Dulhunty JM, Rudd MJ. Hypothermia and associated outcomes in seriously injured trauma patients in a predominantly sub-tropical climate. Resuscitation 2009; 80:217.
  26. Hickey RW, Kochanek PM, Ferimer H, et al. Hypothermia and hyperthermia in children after resuscitation from cardiac arrest. Pediatrics 2000; 106:118.
  27. Gillenwater JM, Quan L, Feldman KW. Inflicted submersion in childhood. Arch Pediatr Adolesc Med 1996; 150:298.
  28. Lavelle JM, Shaw KN, Seidl T, Ludwig S. Ten-year review of pediatric bathtub near-drownings: evaluation for child abuse and neglect. Ann Emerg Med 1995; 25:344.
  29. Medani CR. Seizures and hypothermia due to dietary water intoxication in infants. South Med J 1987; 80:421.