Children and Travel

Air Travel

Be prepared for in-flight medical problems and bored children.

Bring activity books, toys and nutritious snacks.

Request bulkhead row for more floor space.

Sedatives such as diphenhydramine (1mg/kg/dose no more than q4h) may be useful.  Administer a test dose before travel to rule out a paradoxical reaction of excitability.

Earaches occur in 15% of children traveling by air, usually during descent.  Encourage children to yawn, chew or swallow to open the eustachian tubes and equalize middle ear pressure.

Pseudoephedrine is ineffective in children, and antihistamines and other decongestants have not been studied.

Diarrhea and Dehydration

Children are more careless with personal hygiene and food and water precautions, so they are more susceptible to GI diseases.

Children have a greater tendency to become dehydrated so parents must understand the principles of oral rehydration and carry oral rehydration salts (ORS) and antibiotics.

The ORS packet is added to boiled or treated water as per package instructions.

ORS solutions held at room temperature should be consumed or thrown away with in 12 hours.  If it is refrigerated, it must be discarded after 24 hours.

Immediate medical care is imperative for the infant with diarrhea and signs of moderate to severe dehydration, bloody diarrhea, fever >38.9C or persistent vomiting.

If commercial ORS is not available, a home made solution can be used:

Glass A: 8 oz fruit juice, ½ tsp corn syrup or honey or sugar, pinch of salt

Glass B: 8 oz boiled water, ¼ tsp baking soda.

Alternate glass A and B to rehydrate.

Azithromycin is highly effective against traveler’s diarrhea in all age groups including children.  (10 mg/kg/day X 3 days)

Quinolones (norfloxacin, ciprofloxacin, levofloxacin) are not officially recommended for children, but most pediatricians would not hesitate to use a single of 3-day course in a child with moderate to severe diarrhea.

Loperamide and other antiperistaltic agents are not advised for children younger than 2 because of rare risk of ileus.

Bismuth subsalicylate is not recommended for children because of risk of salicylate intoxication and Reye’s syndrome.

For documented protozoal illness (giardiasis), quinacrine hydrochloride is 85-95% effective.  Furazolidone is available in liquid form and is 80% effective.

Sun and Insect Protection

Children should avoid sun from 10 a.m. to 4 p.m.  They should wear light-coloured protective cotton clothing, and wear sunscreens

Use DEET on exposed skin and permethrin sprayed on or impregnated into clothing and bed nets

Adequate protection for 4 to 6 hours is provided by formulations with 20 to 30% DEET.

When sunscreen and DEET are used concomitantly, the former should be applied first.  The protective effect of sunscreens in this combination may be reduced as much as 50%.

Immunizations

Routine immunizations should be up to date.  Measles can be given as early as 6 months, but then a second dose should be given at 9 months, or as soon after as possible

Other vaccines should be considered depending upon risk starting at the ages listed below:

BCG: birth

Cholera:           Injectable > 6 months

                        Oral:  2 years

Hepatitis A:  In North America it is not licensed for children < 2 years.  However, the WHO recommends giving the vaccine anytime from birth on, and many travel medicine practitioners recommend it for traveling children >1 year old.

Hepatitis B: birth

Influenza: > 6 months

Japanese Encephalitis: > 1 year

Lyme Disease: > 15 years

Meningococcal Meningitis: >2 years

Rabies: >1 year

Typhoid:           oral: >6 years

                        Injectable: 2 years

Yellow fever: > 9 months (>4 months if going to very high risk area)

Note:  BCG can be recommended for young children expected to make an extended stay in an area of high tuberculosis endemicity.

Safety and Security

Bringing car seats for young children will only be as useful as the fastening system available in local vehicles. 

Children should carry ID and a home or embassy telephone number in case he/she becomes lost.

Personal ID should not be visible to prevent strangers from greeting children by name.

Parents should carry a photograph of their child in case the child becomes lost.

If a child is traveling with only 1 parent, the traveling parent should carry a letter from the other parent giving permission for the child to travel.

Adolescents should be cautioned about engaging in body piercing, tattooing, and casual sexual activity in foreign countries due to risk of infections.

Children should avoid walking barefoot in the tropics, and avoid fresh water exposure in developing countries.

Medications 

Carry a medical kit for management of medical problems.

Some prescription drugs, such as amphetamines used to treat ADD, may not be brought into some countries.

Malaria Prevention

Malaria prevention in children is the same as adults with respect to personal protection measures and chemoprophylaxis.

Doxycycline is the only antimalarial contraindicatied in children and should not be used in those under 8 years.

Note that chloroquine is very toxic to children and may be fatal when as few as 3 tablets are ingested.

Mefloquine can be hidden in food to mask the taste.  Some pharmacies will weigh out exact amounts and place it in a capsule for later use.  One can also approximate the dose to the nearest quarter of a tablet.

Submitted by Dr. Lisa White, Ottawa