Heat or Ice – What’s the Best Application for Pain or Injury?

boy-with-ice-pack-on-back-of-headWhen it comes to the application of cool or warm compresses, there are guidelines, rules of thumb, exceptions to the rules and sometimes even the need to “try a little of both and see what helps.” Since using the wrong application can cause further damage, it’s a good idea to occasionally review when to use heat or ice to ease discomfort.

If your doctor provides specific treatment instructions, you should always follow them, but, in general, remember this:

Ice eases inflammation and numbs pain.

Heat helps to relieve stiffness after inflammation resolves.

Now, we realize this still leaves some gray areas, so listed below are the most common injuries and pain that children experience along with the correct application of heat or ice.

Strains (pulled muscles, injured tendons) – Apply ice immediately or soon after the injury to reduce swelling, redness/”hotness” and tenderness, and to numb pain. After 24-48 hours, heat can be applied to ease any lingering stiffness. If an injury involves the neck or back (even if pain is mild), call for emergency assistance.

Sprains (stretching or tearing of ligaments in the foot, ankle, knee, wrist, etc.) – Treatment is identical to strains (above).

Head Injuries or Headaches – If your child is an infant, loses consciousness at all, or is not alert and acting normally after injury, seek immediate medical attention. Otherwise, you can apply ice to the injured area. For headaches related to a fever, an ice pack can be applied to relieve throbbing pain. For headaches that are related to sinus pain, applying heat across the nose and cheekbones may ease discomfort.

Fever – DO NOT use an ice bath to reduce a child’s temperature. This just causes unnecessary shock. A cool washcloth can relieve discomfort.

Application Tips and Cautions:

  • Never apply ice or an ice pack directly to skin (wrap in a towel or t-shirt).
  • Apply ice for no longer than 20 minutes and wait at least 40 minutes to re-apply (for children).
  • Heat should not be directly applied to the skin (keep a layer of clothing, a towel or a t-shirt between heat source and skin).
  • Infant skin is very sensitive. Apply ice or heat only under your doctor’s instructions for infants.
  • When applying heat, “warm,” not “hot,” is the correct temperature.
  • Heat applications can range from 15 minutes to an hour, depending on pain.
  • Ice or heat should not be applied to open wounds or acute injuries (fractures, dislocations).
  • Ice should not be applied before activity. Pain is a message that activity should be reduced. Ice numbs pain so children may not be mindful of an existing injury and their activity may cause further injury or damage.
  • Applying ice when your child is chilled or heat when your child is feverish should be avoided because it will add to existing discomfort.
  • In a pinch, bags of frozen vegetables make excellent flexible ice packs, and one bag can be refrozen for repeated use over the course of 24 hours. Bags of vegetables used as ice packs should not be cooked or eaten.

As always, if you have any questions, the doctors and staff at Association of Childcare Physicians are here to help. Please contact our office and we will be happy to provide you with guidance.