Traveling with Children
I know a lot of people that think they cannot take that dream vacation because they “have kids”. I also know a lot of adults that are wonderfully diverse in interests and experiences because they traveled with their parents, since early childhood. Having a child on your trip can help the adults view things in a different light and open them up to new experiences they might not normally have. Plus, this is your chance to infect your kids with the travel bug. This is especially helpful in helping them understand why you want to spend their college fund on a retirement cruise for you!
Before you pack that diaper bag and head off for the world, there are a few things to know about. Showing them a great time is the first goal, getting them back home healthy should be your second goal.
Children less than two weeks of age should not travel by air, unless there is an extreme need. Changes in air pressure can play havoc with their lungs, that may have not fully expanded yet. The infant’s lungs and heart are still getting used to using air and the changes in the circulatory system that occur after birth. Placing the baby in a lower oxygen environment may cause hypoxemia or low levels of oxygen.
For kids that are of age to fly, there are a few tricks to helping them have a pleasant and quiet journey on a plane. Breast of bottle feeding may help alleviate the “ear pain” associated with changes in cabin pressure experienced during take-off and landing.
The FAA (Federal Aviation Administration) has also released some guidelines for flying with children and using safety seats. The use of a rear-facing child safety seat is advised for children under 20 lbs (9kg) and a forward facing seat for kids in the 20-40 lb (9-18 kg) range. Children larger than 40 lbs (18kg) can use an adult seat and belt. Most automobile safety seats are certified for use on an airplane, but check the label to make sure. It is also a good idea to pre-measure your safety seat and confirm with your airline that it will fit their seats. Lastly, it never hurts to ask about a discount on a seat for a child, when they are traveling with a paying adult.
Most parents know that diarrhea is a common problem with children at home, let alone on a trip. Strange food, problems with hand washing, new people and new things to touch and play with are some things that can cause a bout of diarrhea.
The biggest problem with diarrhea, not only on the road but also home, is dehydration. Kiddos loose a lot of water when they are having diarrhea and/or vomiting. Make sure they stay hydrated and keep them drinking. A good way to monitor their hydration status is the number of diapers they are using. A decrease in number of diapers can mean they are getting more dehydrated. Crying without producing tears and lack of urination are other signs of dehydration.
A sports or electrolyte drink is vital and should be used every day there is diarrhea, and a few days after it stops! The loss of fluid in the diarrhea or vomiting loses electrolytes in addition to water. The glucose (sugar) in the sports/electrolyte drinks helps water get from the gut to the bloodstream, where it is needed most, faster. The World Health Organization advises a ORS (oral rehydration solution) that is available commercially, in a packet designed to be mixed with one liter of water for correct dosage. The WHO ORS contains 1.5 grams potassium chloride, 3.5 grams sodium, 2.5 grams bicarbonate and 20 grams glucose. If you get into a bind, you can make your own with 2 pinches of salt, a squirt of lemon juice and 2 spoons of sugar put into a liter of water. More on Electrolytes and Hydration here: Fluids and Rehydrate
A blander diet may benefit those kids suffering with diarrhea, at least for a few days. The name to remember is the BRAT diet. This is not named because they act like sick little brats. Bananas, Rice, Apples and Toast is where the name comes from. These foods are easy to digest and help a sick stomach “cool off”. Avoidance of dairy products may be of benefit, as well. Diarrhea causes the thin inner lining of the intestines to basically fall off and leave the body with the diarrhea. This thin lining is where lactose and dairy products are digested. When the lining is gone, the bits of lactose stay in the intestine and cannot be digested. This causes more diarrhea! Only withhold dairy and milk products if there are other sources of nourishment that are know to be free of disease. Generally, after a few days without diarrhea, the thin layer re-grows and they can eat all the milk and cheese they want.
The approach to preventing traveler’s diarrhea in adults is the same as children. Only drink from known, pure sources. The mantra is “if its not cooked, boiled or can be peeled, don’t eat it”. Hand washing works to prevent infectious diseases. Washing with plain soap and water, prior to eating especially, is the best and first line of defense. A common trick to ensure proper length of hand washing is to have the child sing the “happy birthday song” which is about fifteen seconds. Studies have shown this is the most effective length of time to wash with soap and water. Hand sanitizer is an acceptable alternative, when clean water for washing is not available.
The use of antibiotics in treating traveler’s diarrhea is controversial. It becomes even more controversial when children are involved. One agreement the relevant literature shares is that using antibiotics and/or bismuth-subsalicylate (Pepto-Bismol) is not advised to prevent diarrhea. Treatment of diarrhea, once it has occurred, is another matter.
Treating diarrhea in the pediatric traveler centers on rehydration of lost fluid. Using antibiotics and/or anti-motility agents may be required in moderate or severe cases. Bismuth-subsalicylate (Pepto-Bismol) is contraindicated in those with aspirin allergy. However, it can help reduce loose stools. Each tablespoon (15mL) contains a total of 262 mg of BSS. Studies indicate that effective relief of loose stools occur with a dose of 100-150mg/kg of BSS. Thus, a 22 lb (10 kg) child should get relief with 3-4 tablespoons of BSS, per day. The use of anti-motility agents (Imodium, Loperamide) are not advised.
Antibiotics are, generally, only advised if the diarrhea is invasive. Some things that may indicate the diarrhea is invasive include presence of blood in the stool or diarrhea, fevers or abdominal pain. Trimethoprim/Sulfamethoxazole (TMP/SMX), Amoxicillin and Erythromycin are commonly used antibiotics to treat pediatric diarrhea. Depending on where you are traveling, there could be antibiotic resistance. A good option is to discuss, with the child’s regular physician, about carrying a course of antibiotics in the event of illness. For more info on traveler’s diarrhea
Travel to a known malaria zone requires medication to protect everybody from getting sick. Children are no exception, but there are a few special things to know.
Most antimalarial drugs are secreted in breast milk, but not at high enough levels to protect the nursing infant. Mefloquine (lariam) is the drug used to protect infants and children in chloroquine resistant areas. This is dosed based on the child’s weight and comes in easy to use pediatric tablets. Mefloquine is taken once per week, making its use with fussy children easier. For areas of the world known to have chloroquine sensitive malaria, a chloroquine suspension may be available in your country of destination, but is not available in America or Canada at present. Tablets of Chloroquine are readily available in the USA and Canada. Chloroquine is dosed based on the child’s weight. The tablets of either mefloquine or chloroquine may be crushed and dissolved into a soft food such as applesauce, puddings or chocolate syrup.
Standard malaria precautions apply to adults as well as children. Anopheles mosquitoes, which carry malaria, bite at dawn and dusk. Avoidance of outdoor activities at this time helps reduce chances of bites. Bug suits and mosquito nets are also advised for prevention of mosquito bites. DEET is a chemical that is know to repel mosquitoes and other insects. Many different commercial preparations are available, but no more than 10% DEET solution should be used for children under 12 years old. DEET should not be applied to the face of a child. Aveeno, the skin cream, has also been used in prevention of insect bites on the face, but is unproven in medical literature. Sunscreen should be applied before insect repellent. The use of sunscreen and DEET bug spray, together, may lower the effectiveness of the sunscreen. There should be no problem with the efficacy of DEET. Lastly, covering exposed skin should be a primary prevention tool. Use caution to make sure the child is not overheating and staying hydrated in the long sleeve/pants outfit. Mosquito Bite Prevention and Malaria
Children are naturally friendly and curious. This is sometimes a bad thing, in a strange land. Lots of new and potentially wild animals could pose a problem. The idea of staying away from animals may be new and foreign, but it must be stressed. That urge to pet a doggie may lead to a bite from an unfriendly dog and possible exposure to rabies.
Hopefully, your children arrived to their new destination in a safety seat, either by plane, car or train. Keep using them when you are at your destination! A child that should be in a car seat is not safe riding on a lap of the adults. Unfortunately, traumatic accidents are still the number one health threat to travelers of all ages. A safety seat can prevent this.
I love to bike and really enjoy seeing young kids taking up the sport. If you are doing any kind of biking, with a guide/outfitter or just renting on your own, you have to make sure you have a proper fitting helmet. A simple phone call or e-mail to your biking source can reserve a child’s helmet and ensure good protection for their melon.
Always carry a copy of your child’s immunization records with you, when you travel. Further, if your child takes any medications, at all, bring a copy of the prescription with you, in addition to the medicine in the original packages.
Children from the UK, USA, EU, Australia and most other developed nations routinely vaccinate children. It is important to make sure your child is fully vaccinated with the “basics”, before any trip. This should include vaccines against Hepatitis A and B, Tetanus and Diptheria, Pertussis, Polio, Measles, Mumps and Rubella, Heaemophilus (HiB) and Pneumococcus.
Most vaccine schedules are based on age of the child. Some vaccines cause more severe reactions I children and are not given below a certain age. One good example of this is the Yellow Fever vaccine only being given after 9 months of age. Some of the vaccines are spread out over several injections, given months apart. Should you need to vaccinate your child prior to travel, ask your doctor about accelerated schedules provide the most protection before your trip. Vaccines
Looking for Help:
If you decide that your child’s condition needs a health care professional, the next step is to find one. For those staying in resorts, the concierge is a good place to start. They often have physicians that make “house calls” to the hotel. This is usually a cash only transaction and the doctors often have to give a “finder’s fee” to the hotel.
I always advise to contact your local embassy if you are having a medical problem or emergency. They will speak your language and have a list of doctors in the area who also speak your language. Often, these are the doctors that look after the embassy staff, as well.
Lastly, there is the International Society of Travel Medicine. They maintain a list of certified, English language speaking, doctors, worldwide.