Avoiding harm in pediatric heatstroke: Lessons from a case of ice-related frostbite

Heatstroke is a life-threatening medical emergency characterized by a core body temperature exceeding 40 °C (104°F). Prompt and effective cooling is critical to prevent multiorgan failure and death. However, aggressive cooling techniques, if improperly applied, may lead to iatrogenic complications. We present a pediatric case of severe frostbite injury resulting from direct ice pad application during emergency treatment for heatstroke.

A 22-month-old infant was found unconscious after being left unattended in a parked car and was diagnosed with severe heatstroke. During prehospital care, direct ice packs were applied per emergency protocol. On admission, erythematous skin lesions were noted on both anterior thighs, which progressed to full-thickness eschars. The plastic surgery team later confirmed these as frostbite injuries. The patient underwent surgical debridement and autologous skin grafting, followed by successful recovery without long-term sequelae.

This case underscores the potential risks associated with rapid cooling interventions, particularly in pediatric patients with more delicate skin. While immediate temperature reduction is vital in treating heatstroke, cooling methods must be carefully selected and monitored. This report highlights the need for pediatric-specific protocols that prioritize both efficacy and safety, and emphasizes the importance of thorough communication between prehospital and in-hospital providers.