'Will you put a jacket on that child': Health consequences of over and underdressing children

I have a child who does not feel the cold. Most nights she sleeps with blankets off and even with the first chill of winter on us will happily run around all day in just a t-shirt. I have never worried much about it, believing that she just 'runs hot' but all around me older people look fretfully at her and many a time I have left her to come back and find her with a jacket (or two) on.
So who's right in this scenario.

Children are more sensitive to heat and cold stress than adults. This is because children have a larger surface area and so gain and lose heat more quickly. Child gain heat more quickly from exercise but lose heat quicker in cool temperatures. The smaller the child, the greater the amount of heat lost.
Children also take about four days longer to acclimatize to weather temperatures, so they may be still feeling the temperature change long after you no longer feel cold 1.

The risks of being too cold
Hypothermia: Occurs at temperatures from 0 to 10 degree,s so if the temperature is warmer than that it should not be a consideration 1. Inside temperatures are generally 5 degrees warmer than outside 2. If we work off average temperatures for Perth and add 5 degrees, on average minimum temperatures will not make hypothermia a consideration however lowest minimums have inside temperatures at hypothermia range place from May through until October.
Supporting this, hypothermia does occur in New Zealand and Australia but is rare (6.9 per 100 000) and deaths are even rarer (0.537 per 100 000). The majority of cases that occur inside the home are newborns, as newborns are unable to regulate their own body temperate.  8% of cases are not newborns or elderly people and some of these cases are likely older babies and young children 3.

The risks of being too hot
SIDS: Overheating has been linked to SIDS for many years. For example, a study of babies who had died of 'cot death' found that 24 out of 34 were overdressed, 19 were unusually hot or sweating and 14 were in an excessively warm environment 5. Overdressing or a warm room alone does not causes SIDS, however it is considered that it may act in combination with other factors to increase the risk of SIDS 6.
Heat rash: Small pinkish or clear blisters that usually occur in the summer but can occur if your child has been overdressed 7.
Eczema: Eczema is worsened by overheating and children with eczema should be dressed in multiple layers that they can remove as they feel hotter rather than heavy jumpers 7. They should also not be covered in thick blankets overnight. One set of recommendations include that children with eczema wear summer weight clothing year round 8.

Considering how worked up people get about what children are wearing, it is interesting to discover that there are only two real health consequences of over or underdressing a child. Both of these cases are extremes and SIDS and kids in particular warn against getting too obsessed with blanket configurations and room temperatures. Using your common sense in dressing your child appropriately overnight would be the best precaution.
The other obvious issue is the child's comfort level. Being too hot or too cold is uncomfortable and distracting, impacting on a child's behaviour, learning and sleep overnight. Given that there appears to be no real health consequences from being over or underdressed, particularly when the child is awake and moving around, you should let your child decide how much they want to wear. Likewise, if your baby or toddler is upset and you think the weather might be an issue consider adding or removing clothing to see if that helps



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