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Travel Risks: How to Help Parents Protect Infants and Young Children

Travel Risks: How to Help Parents Protect Infants and Young Children

Although infants and children make up only 4% of all international travelers, they account for 25% of travel- related hospitalizations.1,2 With appropriate preparation, however, travel can be safer and more enjoyable for the entire family. You have an important role in helping families prevent travel-related illnesses and injury.

Here we provide practical tips you can offer parents who plan to travel with infants and children. The key advice to give these families can be summed up as "precaution and prevention."

PRETRAVEL COUNSELING

Travel insurance coverage. Accidents are the leading cause of mortality in young travelers.3 Advise parents to check the coverage provided by their regular health plans for international travel. If their health plans lack this coverage, parents should purchase travel and evacuation insurance, since the cost of evacuation can range from $25,000 to $100,000 per person.

Child identification. Long travel times, layovers between flights, and unfamiliarity with new areas can result in the separation of children from their parents. Therefore, children must have identification on them at all times during travel.

International travel with one parent. The accompanying parent must have a notarized letter of permission from the nonaccompanying parent. If the accompanying parent has custody or is a widow/widower, a notarized copy of the custodial document or death certificate may also be required. Immigration and Naturalization Services, as well as the State Department, have been known to request such notarized documents before they will allow a child to travel with only one parent internationally.4

PREPARING THE CHILD

Anxiety about travel to unfamiliar areas is very common among children. Here are some ways to reduce this stress:

Inclusion in the planning process. Parents can prepare their children for travel with videos, books, pictures, foods, and Internet resources. Planning for the areas they will visit, people they will meet, and foods they will eat during their journey gives children a sense of control and ownership of the travel process.

Items of security or familiarity. It may be helpful for the child to bring a special toy, blanket, or picture to establish a sense of security and familiarity.

Anticipation of disrupted routines. Parents should explain to children that problems associated with travel--such as long delays, irregular meals, and alterations in schedules and nap times--may disrupt their normal routines. Parents also should be prepared for unexpected frustrations and for entertaining children during long periods in confined spaces.

AIR TRAVEL

Contraindications. Air travel is not recommended for infants younger than 2 weeks because of the possibility of surfactant deficiency, with its associated risks of perfusion-ventilation mismatch, alveolar collapse, and pneumothorax.5,6 The CDC does not recommend air travelfor infants younger than 6 weeks.7

Otolaryngologists generally recommend that air travel be avoided for 2 weeks after ear surgery (eg, after tympanomastoidectomy, stapedectomy, labyrinthectomy, or acoustic neurectomy), since blockage of the eustachian tubes is known to cause pain and can lead to perforation of the tympanic membrane during air travel. Similarly, middle ear infections and effusions also are contraindications to air travel.5

Barotitis and barotrauma--resulting from compression of the eustachian tubes--cause ear pain in 15% of children during descent.8 The eustachian tubes can be decompressed by swallowing motions. These can be induced by breast-feeding or bottle-feeding infants and by having older children chew gum, blow up a balloon, or plug their nose and blow.

Because barotitis can also be caused by acute otitis media (AOM) with effusion,5 it is recommended that children with AOM wait 2 weeks after treatment is initiated before flying.9 In contrast, complete effusions and pneumonostomy tubes are not contraindications to flying, since they protect against middle ear barotraumas by minimizing pressure changes. Although pseudoephedrine has been used to prevent barotraumas in adults, its effectiveness has not been proved in children.10

Restraining devices. Althoughthe Federal Aviation Administration (FAA) recommends that children younger than 2 years be restrained during air travel, it prohibits the use of lap belts (belly belts), booster seats, and vests for this age group.11 However, FAA-approved car seats are permitted if the parent purchases a ticket for a child younger than 2 years and if the car seat carries an original intact FAA-approval manufacturer's sticker. Some international airlines provide special child-restraining devices that anchor the child to the parent's seat belt.

Jet lag. Because of their adherence to natural circadian rhythms, children and infants are less prone to jet lag.12 The following advice can be offered to parents in the event of jet lag or difficulties in adjusting to new sleeping routines.

Adjustment of sleeping and eating patterns during and immediately after air travel can help ameliorate jet lag. Exposure to the sun or other bright light in the morning for eastward travel, and in the afternoon for westward travel, also helps combat jet lag.12

Use antianxiety agents, such as benzodiazepines, with extreme caution in children, because of the lack of clinical experience as well as the potentially devastating effects of accidental overdose. Experience with melatonin in children is extremely limited, and there are no controlled studies of the use of melatonin in this population. In addition, melatonin may affect sexual maturation.13 Therefore, this agent should not be prescribed for children.

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