Winter is coming, and it is especially important for our children with disabilities to stay warm. Unfortunately, wheelchairs are notoriously challenging to use with most outerwear. In addition, some children with spasticity or cerebral palsy may have difficulty with traditional outerwear, especially coverings for hands and feet. Many of these children also require medical technology to survive, and tubes and pumps may also become problematic on exceptionally cold days.
This article will provide some suggestions to help keep your child with a disability warm and comfortable during the winter months.
Keeping Warm in a Wheelchair
Children in wheelchairs often have difficulty with traditional winter coats. The bulkiness of the coat may interfere with the positioning equipment on the wheelchair, especially for children with complex positioning devices, such as laterals, harnesses, head supports, and other upper body supports. Many traditional winter coats require positioning devices and harnesses to be loosened considerably, which means that they will then need to be tightened once a child gets to school or another location and removes the coat. As we all know, many schools do not have the personnel available to repeatedly adjust wheelchair fittings, especially when children go outside several times a day.
What alternatives are available? There are many different adaptive jackets, capes, and buntings that can be used to keep warm without interfering with the fit of the wheelchair. In fact, many can even go over straps, laterals, and harnesses with no adjustments needed.
The first category of adaptive jackets is the back-opening jacket. These jackets, which zip or Velcro in the back instead of the front, are great for kids who may have difficulty getting a coat on or off in a wheelchair, but don’t have laterals or upper body positioning devices on the chair.
Next up is the wheelchair cape or poncho, which goes over the child, harness, laterals, and other upper body supports. It may also be tucked around the child. In general, these are cut long in the front to cover as much of the child as possible. The back, however, tends to be shorter, to prevent it from getting caught in the back mechanics of the wheelchair. These can be made out of a variety of materials, including light fleece or waterproof fabric. Capes may be layered for additional warmth. For those who sew, capes are relatively easy to make, and patterns are readily available on the internet.
Also available are buntings, which stay permanently in the seat, but can be opened when the child does not need extra warmth. These can be designed to cover the entire child from head to toe, and work much like a larger version of an infant stroller bunting. These are typically custom-made by individuals who sew.
Sources for Adaptive Jackets, Capes, and Buntings for Children
Keeping Hands and Feet Warm
Another difficulty during the winter is keeping those little hands and feet warm. Children who have poor circulation, wear braces or other orthoses, or who have spasticity or muscle tone issues are particularly prone to developing cold extremities.
In general, getting gloves onto hands with spasticity can be near impossible, and gloves often won’t fit over thumb and hand splints. Some mittens, especially the ones that have opening flaps, will work for these children. Another option is the thumbless mitten. These mittens simply cover the entire hand without separating out the fingers or thumb. They can even be purchased a size up or customized to accommodate braces. For those who sew, fingerless mitten patterns are available on the internet and are relatively easy to sew.
Most children are able to wear regular socks, and both regular and adaptive shoes are readily available to fit over braces. But some children have great difficulty keeping their feet warm in the winter months, despite socks and shoes. These children can use a lower extremity bunting, which covers the feet and legs to keep them warm. They may also be able to wear adaptive fleece slippers or soft boots to provide additional warmth.
Another option is a hand or foot warmer. The most readily available versions typically use packets that produce heat due to a chemical reaction inside the packet. They can often be reused again and again. Other simple hand and foot warmers include microwaveable stuffed animals or hot packs. Be careful to make sure they are not too hot, as children can easily be burned, especially if they have any neuropathy or reduced sensation.
Sources for Thumbless Mittens, Fleece Boots, or Lower Extremity Buntings for Children
Keeping Medical Equipment Working in the Cold
While many people worry about tubes and lines freezing during the winter, this is rarely an issue. Feeding tubes and lines are usually kept close enough to the body that they do not freeze. Longer extension tubing may freeze when the temperature is less than 10F or when extended exposure occurs. In general, to avoid freezing, keep the tubing coiled up as much as possible, and as close to the body as possible. Keeping tubing under clothing and coats can also help, and a fleecy blanket around tubing or bags of formula/nutrition can help keep those from freezing.
Most medical equipment, including feeding pumps, IV pumps, suction machines, and ventilators, is designed to be stored in cold temperatures, but devices may not operate optimally in cold weather. Feeding and IV pumps may not run accurately at the set rate in cold temperatures, and most manufacturers suggest keeping devices at 45F or higher for accuracy. Most ventilators, feeding pumps, and IV pumps should not be used in temperatures below 40F, and some suggest 50F and above. If it is exceptionally cold, limit trips outside as much as possible, and cover devices with warm blankets when allowable. The batteries for these devices also may not work as well on extremely cold days, so attempt to keep batteries warm, especially when they are not attached to the device.
Children with tracheostomies, especially those who use any type of humidified air/oxygen or a Heat Moisture Exchanger (HME or nose), need to be very careful in extreme cold, since the moisture in these devices may freeze. Suction tubing also may become rigid in extreme cold. Covering devices and tubing with breathable blankets and limiting exposure is recommended.
Use Your Common Sense
Common sense is the best strategy when it comes to keeping warm. Limiting outside exposure is always best when the temperature dips into dangerous ranges. Children who do not regulate their temperatures well or who have difficulty breathing cold air may need to be kept inside on very cold days.
Just like all children, children with disabilities should be bundled and layered in the wintertime. Hats and mittens are a must, and some children even wear them inside to keep extra warm, especially at night.
We hope these tips help you to keep warm and keep safe!