Travelling with children can be a daunting prospect – there are vaccinations to think about and the worry of how to respond in a medical emergency in a foreign country. But these issues can be handled easily with a little organisation, preparation and forethought. General Practitioner Dr Ailene Chan answers some frequently asked questions about the medical issues surrounding traveling with kids. If you are a parent this is the travel advisor not to miss.
Where is the best source of information for parents on travel vaccinations or medications needed for a holiday?
Always be prepared with vaccinations so that you are protected from the diseases that you may not see at home. In particular, get advice about your yearly influenza shot and make sure the kids have all their regular vaccines up to date.
Many regular General Practitioners are not specifically trained to give advice about travel so it is best to consult an accredited travel medicine doctor. It takes a minimum of 10 days for the full effect of a vaccination to kick in, so prepare early. Allow at least six months (or 4 weeks minimum) before departure to see your doctor to ensure you can have boosters before you go.
Keep your vaccination records with your passport so that you know when your last dose was and immigration officials can consult it at a moment’s notice.
The American CDC website gives information about vaccinations specific to each country but it is only useful as a guide. The length of time you stay and the types of areas you will spend most of your time (such as farms, forests or at altitude) can affect the types of medicines you will need to take beforehand or while you travel. The Australian government also has an easy-to-navigate website that's useful.
Anti-malarial medication is not always safe for children. Does this mean families should avoid malaria areas altogether, or are there safe ways to visit?
When children can start taking anti-malarials depends on which drugs are being used, where you are travelling to and for what length of time. Whether they are appropriate for your kids usually depends on their weight, not age. Also some malaria drugs cannot be used in certain medical conditions in infants and some are not safe in pregnancy. You should consult your doctor for the information relevant to you.
It is safe to travel to malaria zones if you are adequately prepared. Ensure you have a DEET repellant (but only for use on children older than 2 months). Make sure you have mosquito netting for sleeping areas. (You can purchase DEET-covered netting for extra protection.) Indoor repellant sprays can be used around sleeping areas ten minutes before your kids go to bed.
At dusk and dawn avoid being outdoors without adequate protection. Mosquitos breed and bite around stagnant water and in dark places. Avoid swimming pools and water tanks or open water storage.
Investigate which mosquitos are found in the area you are travelling to. For example, all malaria mosquitos are anopheles mosquitos that bite at night, dawn and dusk. But other mosquitos can also transmit disease. Aedes aegyptis mosquitos transmits dengue fever and, unlike malaria, these bites usually occur during the day.
To be completely sure, always cover up with long sleeves and pants – use lightweight cotton or linen fabrics for breathability. Some camping brands also have DEET-covered hiking pants.
[To read about avoiding dengue fever in kids when travelling, see the suitcases&strollers story here.]
What should you do if your child gets food poisoning or gastroenteritis?
It is important to ensure you always carry oral rehydration salts when you travel to high risk countries. To avoid gastro, ensure you boil and then cool all your water (even for brushing your teeth) because even bottled water can be tampered with.
Symptoms of gastroenteritis include diarrhoea, vomiting, fever and abdominal pain. The most important treatment for gastro is rehydration. Even if a child is vomiting, some of the fluid they drink will still be absorbed, so keep giving it. With every diarrhoea or vomit, it is essential that the fluid is replaced.
If oral rehydration salts are not available you can make your own version using half a small spoon of salt and six level small spoons of sugar dissolved in one litre of water. Do not confuse the sugar for salt. Often this will be easier than plain water for children to drink if they are nauseous.
How will you know if the gastro is getting worse?
If you are worried, it is best to get medical advice. Some signs of worsening illness are:
• smelly urine
• persistent fever (more than 24 hours)
• not drinking
• dry mouth and eyes
• saggy skin (pinch their stomachs to see if the skin easily separates from the muscles)
• severe stomach pain
How can you tell if your child is just sick (and should be left to recover) versus suffering a serious medical emergency (that might require evacuation or hospitalisation)?
It can be hard to work out how serious an illness is but it is always worthwhile getting medical advice if you are seeing something you haven’t seen before. Some symptoms that are worth double checking include:
• Fever with shakes: this is called rigor and can be a sign of a more severe infection
• Illness that is taking longer than expected to recover
• A rash can be a sign of an allergy or even meningococcal disease so is always worth having checked. In general, if the rash disappears when pressure is applied it is a good sign that it’s not serious.
• Difficult to rouse. This can be a sign of dehydration or even concussion after a fall and should be checked by a doctor.
• Uncontrolled bleeding.
• Urine infection. Smelly urine, pain with urination, stomach pain and going to the toilet frequently can be signs of urine infection. A urinary tract infection should always be treated with prescribed antibiotics.
• Severe pain. Whether this be headache or stomach pain, you should seek medical advice.
• Dehydration. This is a significant problem in children that can escalate into a serious situation extremely quickly and should not be ignored.
• Large burns. A burn greater than an Australian fifty cent coin may need skin grafting and can easily become infected.
• Swelling of the lips, face or tongue. These can be signs of severe allergy and need immediate medical attention.
• Difficulty breathing. If you hear loud chest or neck sounds when your child breathes or if they are working hard to breathe get immediate help. This could mean a bad chest infection or they may have inhaled something.
• Skin infections. If a large area is affected, or the skin becomes red and shiny, it is likely antibiotics are needed.
• Stings and bites may need antivenom or special treatment depending on where you are. Get local advice or go to the emergency department to find out.
[For travel tips on first aid to apply in a medical emergency when traveling with kids, see the suitcases&strollers story here.]
What are the most common travel-related medical complaints and how can they be avoided?
Injuries and burns (in particular from motorbike exhausts) and injuries from participating in activities you are not used to. It is easy to be complacent while on holidays because you are relaxed, but be aware of the unique hazards of your environment. When at the beach make sure you are informed about the swell and rips that you usually cannot see from the shore. [For some family beach safety tips, see the suitcases&strollers interview with the team from Bondi Rescue here.] If travelling at altitude make sure you understand how to manage acclimatisation. Also, don’t push your body beyond your fitness level; a back injury will ruin your holiday.
Many tropical countries have parasites that are not seen at home. Get advice before swimming in fresh water or oceans and when walking in forested areas or playing in soil.
Similarly, always be prepared for the sun as over-exposure is a common ailment. Have plenty of water with you, sunscreen and protective clothing.
Bed bugs can ruin a holiday and can occur even in the nicest of hotels. Don’t stay around if you find them, they will be hidden in places even after rooms are cleaned.
For the list of essentials you should carry in your travel medical emergency kit, see the suitcases&strollers story here.
If you are planning to travel during pregnancy, see the suitcases&strollers story here.
For travel tips about purchasing family travel insurance, see the suitcases&strollers story here.