Travel in Good Health

Traveling with children, no matter their age, can be a joyful, tiring, exciting and exhausting endeavor. Traveling with children who get sick on the trip is just plain exhausting and, sometimes, exciting in a way that we don’t want to experience.

Prevention is key, and no one does that better than the CDC. This article captures some tips for traveling families from CDC’s website, and a few other places.

If anyone in your travel group has an existing condition that may affect his or her health, it’s important to discuss travel health safety with a healthcare provider.

If you’re traveling outside the United States and you love detail, download a copy of CDC’s Yellow Book . It’s written for healthcare providers, but many people find it useful. Wherever you’re traveling, these suggestions may help you and yours avoid infectious diseases on the road.

There are steps you can take prior to departure that will protect you and your kids, and many things you can do while traveling. First, the pre-departure list:

Time Zones and Rest

If you’re changing time zones, spend a few days just before travel adjusting your sleep/wake periods to match the destination’s time zones. When you arrive, get out during the sunny periods so that you body realizes it’s time to be awake. Good sleep is critical to good health. Make sure everyone gets lots of rest a few days before and then during the trip.

Vaccinations

You and your kids should be up-to-date on currently recommended vaccines in the U.S.

If you’re traveling outside the United States, you need to check the destination country for recommended vaccines for you and your children, and if you have special health concerns , you need to determine which vaccines to get and which you should not have. Not all vaccines recommended for international travel are licensed for children.

If you’re traveling outside the U.S., read the CDC’s Health Notices first to get the latest updates on infectious diseases in various areas of the world. What you learn may affect your travel plans.

First Aid Kits

Prepare a first aid kit for the trip or purchase one from a commercial vendor. This is a sample list, as not all destinations require the same things.

• 1% hydrocortisone cream

• Ace wrap

• Acetaminophen, aspirin, ibuprofen, or other medication for pain or fever

• Address and phone numbers of area hospitals or clinics

• Adhesive bandages

• Aloe gel for sunburns

• Antacid

• Anti-anxiety medication

• Antibacterial hand wipes (including child-safe) or alcohol-based hand sanitizer containing at least 60% alcohol

• Antibacterial soap

• Antibiotic for general use or travelers’ diarrhea (azithromycin, cefixime)

• Antidiarrheal medication (e.g., bismuth subsalicylate, loperamide)

• Antifungal and antibacterial ointments or creams

• Antihistamine (such as Benadryl)

• Antimalarial medications, if applicable

• Anti-motion sickness medication

• Commercial suture/syringe kits (to be used by local health-care provider with a letter from your prescribing physician on letterhead stationery)

• Cotton-tipped applicators (such as Q-tips)

• Cough suppressant/expectorant

• Decongestant, alone or in combination with antihistamine

• Diaper rash ointment

• Digital thermometer

• Epinephrine auto-injector (e.g., EpiPen), especially if anyone has a history of severe allergic reaction. Also available in smaller-dose package for children.

• First aid quick reference card

• Gauze

• Ground sheet (water- and insect-proof)

• High-altitude preventive medication

• Insect repellent containing DEET (up to 50%)

• Latex condoms

• Laxative (mild)

• Lice treatment (topical)

• Lubricating eye drops

• Malaria prophylaxis and standby treatment, as required by itinerary

• Medications that the child has used in the past year

• Moleskin for blisters

• Mosquito netting, if applicable

• Oral rehydration solution (ORS) packets

• Personal prescription medications in their original containers (carry copies of all prescriptions, including the generic names for medications, and a note from the prescribing physician on letterhead stationery for controlled substances and injectable medications)

• Safe water

• Scabies topical ointment

• Sedative (mild) or other sleep aid

• Snacks

• Sunscreen (preferably SPF 15 or greater)

• Throat lozenges

• Tweezers

• Water purification tablets

Discuss with your family’s pediatrician any special needs your children might have that require you to prepare beyond this basic list. Also, your pediatrician may be able to give you sample sizes of antibiotics and other meds that may be useful for your kit.

Check travel regulations and carry what you can onboard the plane, particularly prescription medication. Put the rest in your checked baggage. Put your first aid kit in a fanny pack or backpack that you take with you everywhere you go. There’s no sense bringing the kit if you don’t have it when you need it.

Bugs—potential disease carriers

Some bugs carry certain diseases, such as West Nile virus, malaria, dengue and others. Whether you’re in Napa Valley, the Sahara or the Alps, there are steps you can take to avoid infection.

• Use an insect repellent on exposed skin to repel mosquitoes, ticks, fleas and other arthropods. EPA-registered repellents include products containing DEET (N,N-diethylmetatoluamide) and picaridin (KBR 3023). DEET concentrations of 30% to 50% are effective for several hours. Picaridin, available at 7% and 15 % concentrations, needs more frequent application.

• DEET formulations as high as 50% are recommended for both adults and children over 2 months of age. Protect infants less than 2 months of age by using a carrier draped with mosquito netting with an elastic edge for a tight fit. There are DEET-free solutions available, but check with the pediatrician for a final recommendation. Protection against mosquito bites is the goal.

• When using sunscreen, apply sunscreen first and then repellent. Repellent should be washed off at the end of the day before going to bed. Put repellent only on exposed skin and/or clothing and don’t apply repellent to open or irritated skin. Don’t let children handle the repellent. Rather than spraying it directly on children, adults should apply it to their own hands then rub it on the children. Don’t get it near a child’s mouth, eyes or hands and don’t use much around a child’s ears.

• Wear long-sleeved shirts which should be tucked in, long pants, and hats to cover exposed skin. When you visit areas with ticks and fleas, wear boots, not sandals, and tuck your pants into your socks.

• Inspect your body and clothing for ticks during outdoor activity and at the end of the day. Wear light-colored or white clothing so ticks can be more easily seen. Removing ticks right away can prevent some infections.

• Apply permethrin-containing (e.g., Permanone) or other insect repellents to clothing, shoes, tents, mosquito nets, and other gear for greater protection. Permethrin is not labeled for use directly on skin. Check label for use around children. Most repellent is generally removed from clothing and gear by a single washing, but permethrin-treated clothing is effective for up to 5 washings.

• Be aware that mosquitoes that transmit malaria are most active during twilight periods (dawn and dusk or in the evening). Stay in air-conditioned or well-screened housing, and/ or sleep under an insecticide-treated bed net. Bed nets should be tucked under mattresses and can be sprayed with a repellent if not already treated with an insecticide.

• Keep baby carriers covered with a mosquito net.

• Daytime biters include mosquitoes that transmit dengue and chikungunya viruses, and sand flies that transmit leishmaniasis.

Diarrhea—a common health problem when traveling

Babies and small children have developing immune systems and are less able to fight off diarrhea and other foodborne and waterborne infections. Little ones who are crawling or walking around and putting things in their mouths increase their exposure risk.

Breastfeeding helps eliminate foodborne and waterborne transmission to infants.

Use purified water for drinking, ice cubes, formula, brushing teeth, washing food if eating food raw, or just anytime you’d use water. Purify the water, unless you know the water source is safe.

Wash hands with soap and water frequently each day and certainly before eating anything and before preparing foods, after changing diapers, after going to the restroom, after coming in from outdoor activities (this includes shopping!), when you get up in the morning and before going to bed at night. Use soap and water if available and always when you can see any grime on the hands. Alcohol-based hand sanitizer can be used to help disinfect your hands.

Pacifiers and other items made to go into a baby’s mouth that you bring or buy on the trip need frequent cleaning.

Don’t eat food from street vendors. Make sure all your food is either cooked thoroughly or washed with purified water and, if applicable, peeled.

Dehydration due to diarrhea and vomiting

Infants and young children can easily become dehydrated due to diarrhea and vomiting. They need plenty of liquids each time they have a watery stool or vomit. If you’re unaware of the signs of dehydration, you should read up on it prior to departure. Prevention is the best thing, but just in case, there are commercial oral rehydration solutions, or you can make your own. Here are some suggestions from rehydration.org:

Make sure the rehydration drink has in it starches and/or sugars, a little sodium and some potassium. Breastmilk is great for those nursing, or watery cooked cereal, carrot soup, or rice water is fine as long as they’re made with purified water.

You can make a simple solution yourself by using salt and sugar (molasses, raw sugar or white sugar) and something like orange juice or mashed banana for potassium. Add one teaspoon of salt to eight teaspoons of sugar and stir into a liter of boiled and cooled water, stirring until everything is dissolved.

Fresh fruit juice, weak tea or even simply boiled and cooled water will help, if nothing else is available.

For more information on what to do about diarrhea and dehydration, listen to Nurse Mary Beth’s podcast on gastroenteritis.

Parasites in the soil

There are parasites in sand and soil where children love to play. They should wear enclosed footwear and play on a tarp or covering. Don’t put clothing or towels on the ground to dry, and iron anything you hang out to dry before using. All of these precautions are dependent on your destination, of course.

Rabies

Children are more likely to be bitten by animals yet less likely to tell parents about the bite. Remind the children to stay away from animals and to report any wound immediately. If a child is bitten or wounded, wash the area with soap and water and take the child in for evaluation. If possible, bring the animal in as well.

Water and infectious agents

Children and adults can pick up illnesses or infections by swallowing or simply being in contact with contaminated water. If you don’t know the area, don’t swim in fresh, unchlorinated water and, depending on where you travel, be careful with washing in the bathtub.

Health insurance

Before traveling, check your health insurance policy to see what it pays for. It will probable reimburse you for most of the cost of emergency medical care abroad, excluding any deductible or co-payment. For non-emergency care overseas, you may be covered, but check with your health plan about this before you leave home. Failure to get authorization may mean denial of reimbursement.

HAVE FUN!

Now that you’re thoroughly grossed out at the thought of all those infectious diseases waiting for you on your trip, we should say that it’s really about taking practical precautions and the level and type of precautions will be determined by your destination.

Important disclaimer: The information on pkids.org is for educational purposes only and should not be considered to be medical advice. It is not meant to replace the advice of the physician who cares for your child. All medical advice and information should be considered to be incomplete without a physical exam, which is not possible without a visit to your doctor.