Cold packThis question keeps cropping up – especially from those working in schools with younger pupils: Ice pack vs cool pack – what’s the difference?


Key facts to consider:

Younger children have a faster metabolic rate (increased heart and breathing rate) than older children/adults and this means that they cool down much more quickly due to the blood getting to the skin’s surface more frequently. Additionally, their temperature regulation mechanisms in the body are not well developed -they do not know if they are hot or cold (think of watching a child shivering in the playground and having to tell them to put on jumpers/coats!). Therefore if an adult tells a younger child to sit with an ice pack on e.g. an injured knee, they will do so… it will numb the injury site so they may not realise it’s too cold… and they risk an ice-burn which means that tissue damage has been caused.


Regarding heads – if the skull has actually been broken or if the ice-pack is too cold/applied for too long then the brain will be rapidly cooled – this can lead to seizure-like episodes. (Brains are fussy – they like to operate at a core body temperature of approximately 36.5-37.5°).  In my opinion never use ice on heads – not worth the risk – stick with cool compress/pack (see below). Caution with babies/younger toddlers as the fontanelle may not yet have closed over – cool compress only.


For younger children, gel packs from fridges (not freezer compartments) or a wadge of wet paper towels cooled under the cold tap are generally sufficient to cause constriction of blood vessels, reduce leaking of blood from capillaries and lessen internal bleeding/bruising (a clean wet tea towel works well at home!). These are ‘cool-packs’ or ‘cool compresses’ not ‘ice-packs’, so ensure that you document accordingly on first aid forms.

Note: Cool packs can be sterilised by washing in hot soapy water (same us washing up a mug), then left to dry before returning to the fridge. Ideally use a paper towel wrapped around them for additional hygiene measures when using on casualty.


For older children/adults IF using instant ice-packs then it is important that the casualty is told ‘if it’s too cold and you want it removed let me know’ and it’s not applied for more than a maximum of 10 minutes (most people will remove it by 5 minutes) AND that they have hot/cold sensation AND that they have appropriate language to understand this. If non-verbal, English language/understanding is poor, there are any issues with sensation (includes elderly, previous surgical scars, some diabetics…) then it is safer to stick with the cool-compress/pack rather than an ice-pack.

Also it’s cheaper in the long-run too!


Top tip with paper towels: have a dry one to hand to stop any dribbling of water away from the injury site.



Written by Helen Underwood





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