Travel Advice for Pediatric Travelers

Developmental Aspects and Travel

A journey with a child presents many opportunities and challenges. Travel with children opens many doors for cultural experiences that would not be readily available otherwise. Newborns can be easily transported; their schedules are easily adjusted to time zone changes; and they can be protected from many environmental and dietary risks of travel. Children thrive on routine. Toddlers are often the most challenging age. Their mobility presents safety and infectious exposure issues. They are more vulnerable to diarrhea due to hygiene and oral-fecal contact. Toddlers should be carefully labeled with identification that is carried in a waistpack or affixed to their clothing. The child's name, birth date, citizenship, and passport number should be included, along with the telephone number and address of the appropriate consulate or embassy in the destination country. An active, curious toddler can easily wander off in a crowded airport, train station, or market. The use of a chest harness on the child with a tether to an accompanying parent or adult is strongly recommended. Toilet training may be interrupted when a change in routine occurs. Lowering adult expectations of traveling toddlers is wise. Older children may be reluctant to use unfamiliar toilets, so carrying an extra change of clothing and toddler pants is recommended. Using the toilet on the airplane just before de-planing avoids the problem of unavailability or phobia of facilities in overseas terminals. Diaper availability may be limited in some developing countries. Diaper liners can be helpful for disposal of stool when in remote locations. Advise families traveling to Africa about the tumbu fly. Cloth diapers dried in the sun can have fly eggs deposited on them and later result in larval myiasis when used. Although work intensive, ironing cloth diapers and other articles of clothing dried in the sun will kill the eggs and ensure safety.

School-aged children need education about safety and traffic concerns. They should be aware of dangers of animal encounters such as bites, licks, or scratches and instructed to report any contact to a parent. The unfamiliar environment may be particularly challenging to certain youngsters. Bringing along familiar toys, blankets, or books from home may be comforting.

Traveling high school and college students are addressed in Chapter 13 .

Airline Travel

Occupying children with activities during long airplane flights is intuitive for most parents. Pens, paper, playing cards, and books are essential elements of the carry-on bag. Water and snacks are helpful to have during long waits in hot airline terminals and can salvage difficult delays in customs terminals. Special meals can be ordered ahead of time for children when planning an airplane flight.

Airline regulations vary regarding children traveling alone on planes. Generally, children <5 years old are not permitted to travel unaccompanied by an adult. The child's age and maturity level should be taken into account when considering whether to send him or her alone. Nonstop flights are preferable, and contingency plans should be set up in case delays or cancellations occur. Special passes may be obtained at airline ticket counters for parents to accompany their minor child to the departure gate through security. The child should be comfortable with requesting help from the flight attendants and be told what to expect during a normal flight. Education on personal and stranger safety issues is best reinforced at this time.

Children under 40 pounds are safest in airplanes if riding in an approved child restraint system. Though not required, the Federal Aviation Administration (FAA) strongly recommends their use. Holding young children on the lap or buckling them in the same seat belt as the adult carrying them is hazardous during severe turbulence, rough landings, and crash situations. Federal safety standards have found that all child restraint seats manufactured after January 1, 1981 adequately protect children under 40 pounds on an airplane. A sticker stating that all applicable FAA standards have been met for airplane travel identifies appropriate seats. Child restraint systems without this sticker are not allowed on the plane. The airline's infant-seat policy should be checked at the time reservations are made. Some airlines offer discounted seats for children using restraint systems. Choosing off-peak flights may improve the chances of getting a free individual seat for the child or infant, but purchasing a full seat is the only guarantee.

Otitis media is not a contraindication to air travel. Tympanic membrane rupture is not a reported complication of flying in aircraft. Barotrauma is a theoretical concern when middle-ear equilibration fails. Have the child or infant swallow during ascent and, particularly, descent to help the eustachian tube equilibrate the middle ear. A pacifier may help the infant with equilibration. Older children can be taught pressure equalization techniques such as the Valsalva maneuver to relieve the discomfort of middle-ear pressure. Administering an antihistamine before the flight may help some children, but its benefit has not been conclusively reported.

Advice on sedating children with a weight-appropriate dose of over-the-counter antihistamine may be requested by the parent(s) and can be done as close to actual take-off time as possible. Paradoxical reactions to antihistamines occur in a small percentage of children and are best discovered at home, before the plane trip. Prescription sedatives should be avoided. An unanticipated side effect, such as respiratory depression, can be much more serious in-flight, where medical care is unavailable.

Past recommendations have suggested that infants <6 weeks old should not travel by air. No data exist to support the restriction of healthy infants flying on airplanes. The avoidance of infectious diseases between birth and 2 months old is of prime concern to parents and healthcare providers, as fever in a neonate <2 months old requires urgent medical evaluation at home or while traveling.

There is an expanding market of travel-related gear for children and their parents, from child-sized neck pillows to inflatable potties to breast pump backpacks. Convertible airplane-ready strollers that roll down aisles easily, then convert to car seats and, later, feeding booster seats make travel more convenient than in the past. Most vendors are easily located on the Internet. While electronic devices (DVD and MP3 players and handheld games) are useful entertainers at times, the battery requirements and electrical incompatibility may limit their overall usefulness during prolonged trips abroad.

Motion Sickness

Children suffering from motion sickness present particular challenges to mobile families. Nonpharmacologic treatment includes sitting susceptible children beside a window, facing forward, and avoiding heavy meals before travel. Wearing dark glasses and traveling at night may also reduce symptoms. Ginger preparations have not been tested in children.

Acceptable and safe medications for motion sickness in children are listed in Table 12.1 . Over-the-counter preparations will usually suffice for mild to moderate symptoms. The use of promethazine should be reserved for children over 2 years with severe symptoms. Any of these medications are best given 1 hour before the anticipated symptoms occur.