Ask a Pediatrician: Can My Child Get Sick from Not Wearing a Coat?

I happen to have an incredibly stubborn toddler with a fierce independent streak, which means that getting her dressed and out the door in the morning is a constant battle. In a heatwave, she wants to wear her favorite thick bird print pants and matching sweater. And in colder temps, she refuses to put her jacket on (or shoes for that matter!). With winter just around the corner, I'm dreading what will happen when those temperatures drop to 40 degrees. On the one hand, I’m exhausted by the constant power struggles and tempted to just let her leave the house in a T-shirt and see what happens. But I obviously don’t want her to catch a cold (or worse). So I reached out to an expert to ask: How bad is it to let her leave the house without a jacket this winter?

Dr. Christina Johns, MD, MEd, FAAP is board certified in both pediatrics and pediatric emergency medicine. She has over two decades worth of experience in the medical field and is a Senior Medical Advisor at PM Pediatric Care, the largest pediatric urgent care group in the U.S.

“Something I’ve heard from parents for years is that they think their child 'caught a cold' because he or she went outside without a coat on. Or a hat. Or they insist on wearing shorts,” says Dr. Johns. “Kids will often vehemently assert their independence by refusing to or insisting on doing something—my two do it regularly!” (Yep, been there.) The expert notes that often, kids don’t want to wear big, bulky winter coats because they feel that they’re too restrictive and they claim they are 'not cold' even when temperatures are low.

“This, of course, can drive parents crazy (raising my hand)! We also remember what our mothers told us: that a child is at risk for getting sick, specifically a cold or pneumonia, if they go out in the cold without a jacket. This is, in fact, a myth. There is no specific, definitive scientific data to support the claim that sending a child outside in cold weather without a coat will increase their chances of “catching a cold.”

And the Mayo Clinic agrees, stating: “While it might be optimal to dress in warmer clothes when it's cold outside, research indicates that cold weather—just like going outside with wet hair—doesn't make you sick.”

The reason why, Dr. Johns tells us, is that these types of illnesses are caused by germs (usually viruses), and not exposure to cold. “While it is true that cold viruses (there are over 200 of them!) can travel more easily in cooler temperatures, being exposed to cold does not directly correlate with whether or not a child becomes infected. There is some lab evidence that indicates a lower body temperature may actually decrease proper immune response slightly, but it is unclear whether this particular data has any significant real world effect in this scenario. If a child happens to be exposed to germs while their body temperature is lowered, the body could be less likely to activate a fully effective immune response to fight off infection. But again, the direct correlation between a child not bundling up and a cold infection is simply not there.” (Permission to let your kid go outside without a jacket, granted.)

Here are some other cold weather questions and concerns the pediatrician tends to hear during this time of year.

If we learned anything from the pandemic, it’s that playing outdoors is safer than gathering indoors when it comes to many viral infections, the expert tells us. That's because viruses spread more easily indoors than outdoors.

Per Northwestern Medicine, you are more likely to pick up germs indoors than outdoors because viruses spread more easily in poorly ventilated areas, plus people spend more time indoors and in close contact (i.e., your kid sitting next to his bestie swapping Legos with his pal inside is likely going spread more germs than if they were playing hide-and-seek outside).

Not only that, but the healthcare experts also state that by being indoors, “you're also limiting your sun exposure, which can cause your vitamin D levels to plunge. Low levels of vitamin D have been linked to influenza A and a weakened immune system, plus a variety of health issues, including fatigue, general achiness and even cancer.”

In other words, when it comes to viruses, playing outside may be better than playing inside. Just make sure that it's not too cold for littles, however (more on that below).

Per Dr. Johns, there is a threshold for unsafe temperatures when outdoor play should no longer be an option. “Look at temperature and wind-chill to determine if the conditions are too cold for a child. If the wind-chill is at or above 32 degrees Fahrenheit, it is deemed safe for children to enjoy outdoor play for an unlimited amount of time. The younger the child, the more layers they need. If the wind-chill drops the temperature below 32 degrees Fahrenheit, I’d recommend limiting time spent outdoors until temps warm up. Any temperature under 13 degrees Fahrenheit, with or without the wind-chill factored in, could be considered dangerous due to the potential of hypothermia.” These are general guidelines, but good ones to keep in mind.

Temperature Guidelines:

• Safe: Wind-chill at or above 32°F.
• Limit Outdoor Time: Wind-chill below 32°F.
• Dangerous: Temperatures below 13°F, due to hypothermia risk.
• Younger Children: Need more layers to stay warm.

“Pneumonia is spread after contact with droplets containing germs from an infected person’s throat, nose or mouth and breathing them in,” explains Dr. Johns. “Community acquired pneumonia is fairly common and can affect anyone at any time. However, it should be noted that it occurs most often during the cold months, not because of the temperature or exposure to cold itself, but because many of these germs thrive in cold weather and also because we all spend more time indoors in close contact with others so they can travel more easily. This is a good time to mention the importance of coughing into the elbow instead of covering the mouth with the hand to help avoid spreading germs: teach kids this strategy early.”

You let your kid run outside in cold (but safe) temperatures and when they come home, their cheeks are bright red—way beyond the usual flushed cheeks! What's going on? Dr. Johns breaks it down: “Some kids will get really red cheeks that can look infected from being outside in the cold for prolonged periods. This is called “cold panniculitis” and while it may look dramatic, it is harmless and will go away on its own. One way to avoid it is by applying an ointment like Vaseline on the cheeks prior to going outside.”

• Cause: Cold Panniculitis—a harmless skin condition causing red cheeks in cold weather.
• Prevention: Apply ointment like Vaseline on cheeks before going outside.

Per Dr. Johns, it's not really worth worrying about older children refusing to layer up. Instead, parents should focus their attention on other tactics to mitigate viral spread like hand-washing, enforcing mouth covering when sneezing or coughing, and keeping their immune systems strong through proper nutrition, hydration and sleep. “What is most important is that kids should be comfortable when playing outdoors. When playing outside in cold weather, take frequent 'warming breaks' to protect their skin from the elements, make sure they stay hydrated (dehydration can still happen in the winter), and it certainly won’t hurt to have their coat, hat, and mittens available if they change their mind (in my experience, they often do!).”