The Travel Clinic at Children’s Hospital provides consultation to persons traveling internationally who need evaluation for potential travel related illnesses. Services include pre-travel consultation which provides an extensive evaluation of the planned itinerary as well as any existing medical problems. Vaccine records are reviewed and routine immunizations are updated and travel related immunizations are provided as needed. Other non-vaccine preventable diseases are also discussed and medications are prescribed as indicated.
June is traditionally the beginning of the summer vacation season in the United States. As international transportation has become more and more convenient, more children are able to enjoy seeing different countries around the world. While international trips are a time for great excitement, they also present potential dangers.
According to the Centers for Disease Control and Prevention (CDC), an estimated 1.9 million children travel internationally each year. Although data about the incidence of pediatric illnesses associated with international travel are limited, the risks that children face while traveling are likely similar to the risks that their parents face. The most commonly reported health problems among children are:
• Diarrheal illnesses
• Dermatologic conditions
• Systemic febrile illnesses, especially malaria
• Respiratory disorders
The Travel Clinic at Children’s Hospital provides consultation to persons traveling internationally who need evaluation for potential travel-related illnesses. The physicians providing care – Rodolfo E. Bégué, M.D., Chief Infectious Diseases, and Lorna M. Seybolt, M.D. – are board certified in pediatric infectious diseases. In addition, Dr. Seybolt holds the Certificate in Travel Health from the International Society of Travel Medicine.
Travel Clinic services include pre-travel consultation which provides an extensive evaluation of the planned itinerary as well as any existing medical problems. Vaccine records are reviewed and routine immunizations are updated and travel related immunizations are provided as needed. Other non-vaccine preventable diseases are also discussed and medications are prescribed as indicated. The Travel Clinic at Children’s Hospital is an Official Yellow Fever Vaccine Center. In the event of illness, post-travel consultation is available.
CDC guidelines for traveling safely with infants and children
Food & Water
Water served to young children, including water used to prepare infant formula, should be disinfected. In some parts of the world, bottled water may also harbor germs and should be disinfected before consumption. Similarly, food precautions should be followed diligently. Foods served to children should be thoroughly cooked and eaten while still hot; fruits eaten raw should be peeled immediately before consumption. Additionally, caution should be used with fresh dairy products, which may not be pasteurized and may be diluted with untreated water. For short trips, parents may want to bring a supply of safe snacks from home for times when the children are hungry and the available food may not be appealing or safe.
Scrupulous attention should be paid to hand washing and cleaning bottles, pacifiers, teething rings, and toys that fall to the floor or are handled by others; water used to clean these items should be potable.
Parents should be particularly careful to wash hands well after diaper changes, especially for infants with diarrhea, to avoid spreading infection to themselves and other family members. When proper hand washing facilities are not available, an alcohol-based hand cleaner can be used as a disinfecting agent.
Malaria is among the most serious and life-threatening diseases that can be acquired by pediatric international travelers.
Children who are visiting friends and relatives are at particularly high risk for acquiring malaria if they do not receive chemoprophylaxis.
Children with malaria can rapidly develop a high level of parasitemia. Clinicians should counsel adults traveling with children in malarious areas to use the appropriate preventive measures, be aware of the signs and symptoms of malaria, and seek prompt medical attention if they develop.
Children should sleep in rooms with air conditioning and screened windows, or under bed nets, when available. Mosquito netting should be used over infant carriers.
The CDC recommends the use of DEET, picaridin, OLE or PMD, and IR3535, which are repellents containing active ingredients registered with the US Environmental Protection Agency, according to the product labels. Most repellents can be used on children aged >2 months.
Infection and infestation from soil contact
Children are more likely than adults to have contact with soil or sand, and therefore, they may be exposed to diseases caused by infectious stages of parasites present in soil. Children and infants should wear protective footwear and play on a sheet or towel rather than directly on the ground. Clothing should not be dried on the ground. When traveling in countries with a tropical climate, clothing or diapers dried in the open air should be ironed before use to prevent infestation with fly larvae.
Although air travel is safe for healthy newborns, infants, and children, a few issues should be considered in preparation for travel.
Children with chronic heart or lung problems may be at risk for hypoxia during flight, and a physician should be consulted before travel. Making sure that children can be safely restrained during a flight is a safety consideration. Severe turbulence or crash can create enough momentum that a parent cannot hold onto a child:
• Children should be placed in a rear-facing Federal Aviation Authority-approved child-safety seat until they are aged ≥1 year and weigh ≥20 lb.
• Children aged ≥1 year and 20–40 lb should use a forward facing Federal Aviation Authority-approved child-safety seat.
• Children who weigh >40 lb can be secured in the aircraft seat belt.
• Ear pain can be troublesome for infants and children during descent. Pressure in the middle ear can be equalized by swallowing or chewing:
Infants should nurse or suck on a bottle.
Older children can try chewing gum.
Antihistamines and decongestants have not been shown to be of benefit.
There is no evidence that air travel exacerbates the symptoms or complications associated with otitis media. Travel to different time zones, "jet lag,” and schedule disruptions can disturb sleep patterns in infants and children, as well as adults.
Changes in schedule, activities, and environment can be stressful for children. Including children in planning for the trip and bringing along familiar toys or other objects can decrease these stresses. For children with chronic illnesses, decisions regarding timing and itinerary should be made in consultation with the child’s healthcare providers.