While it's not new, the "salt and ice challenge" appears to spreading among kids and teens via social media once again. As you'll find on YouTube, the challenge dares kids to place water, salt, and ice on their skin for as long as possible. The serious problem with this? In some cases, it results in skin damage similar to frost bite and leaves permanent scars.

As with other challenges this blog has covered through the years—such as the  duct tape challenge, Neknomination, and cinnamon challenge— kids are lured in by the risk taking, curiosity, and social media aspect of these potentially dangerous trends.

What can parents and caregivers do? We checked in with Stephen L. Soffer, PhD, a psychologist and director of outpatient services in the Department of Child and Adolescent Psychiatry and Behavioral Sciences at Children's Hospital of Philadelphia, and James M. Callahan, MD, interim chief of the Division of Emergency Medicine at Children's Hospital of Philadelphia to find out more about the salt and ice challenge, and how we can talk to kids about the risks of these challenges.

What's happening during the salt and ice challenge?
When water, salt, and ice are mixed together in the presence of normal heat from our body, the melting point of the ice is greatly decreased. It can now be much colder than it would normally be. These very cold temperatures (close to -20 degrees F) when applied directly to the skin cause serious damage within two to three minutes.

One of the first things that happens is the nerve endings in the skin are killed so the person no longer feels pain, and pain helps us avoid injuries. The longer the ice is held against the skin, the more damage is done and the deeper the damage goes into the skin. A partial thickness injury, very similar to what we used to call a second degree burn, develops within a couple of minutes causing blistering and damage to the skin. A full thickness injury through the tissue underneath the skin can happen if the ice and salt is kept on even longer. Injuries like this often lead to permanent scarring and may even require skin grafts, a surgery to transplant skin from other parts of the body, to heal.

Have you treated a child for something like this before?
Although I have not treated anyone with one of these injuries acutely, I have seen several adolescents with permanent scars, usually on their forearms, but some on the back of their hands from having done this. There are several case reports and case series in the medical literature—many from physicians who work at centers where severe burns are treated—describing this and showing the injuries that have occurred as well as the lasting scars and permanent damage.

Why are kids and teens taking on these challenges?
It is important for parents to monitor and be aware of what their teens are viewing on the internet, and to keep up to date with trends such as the "salt and ice challenge." Teens may feel compelled to copy or imitate behavior that they view on videos for several reasons, including the need to see for themselves if what they view will really occur, to get first-hand experience when it does, and to share their experience within their social networks to positively impact their social status. In addition, labeling these actions as "challenges" naturally appeals to a teenager, as it communicates something to overcome and accomplish, which only heightens their interest.

Finally, thinking about and appreciating long-term consequences such as risk prior to engaging in behavior can be very challenging for adolescents. This is understandable and consistent with what we know about the adolescent brain and social development. However, it can result in increased risk of negative outcomes if the social media influence is dangerous or inappropriate.

How can you talk to your child about these challenges?
If a parent discovers a trending video or challenge that is potentially harmful, they should ask their teen if they are aware of the video in a non-confrontational and emotionally neutral manner. Parents are encouraged to explore with their teen the appeal of the challenge, and help their teen understand the potential consequences of the challenge beyond the immediate, yet temporary, gratification of receiving "likes" and reactions from peers and social media followers.

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