No single answer fits all infants nor all situations. Moreover, the answer changes based on new findings – like the one that just came to light: apparently, very rarely, parents may accidently suffocate infants sitting on the parent’s lap.
Here is what is known:
No government agency regulates the age at which newborns may fly. Each airline has its own policy. Lower age restriction on major US and international airlines vary from no restrictions to 2 days, 7 days and 14 days. Some airlines allow infants younger than the airline’s stated cutoff age to fly if parents carry a letter from a doctor. Airlines’ policies are posted on each airline’s website. No reasons are given for rulings. Recommendations are not based on flight lengths.
Overall, air travel for infants is extremely safe. Millions travel each year; only an infinitesimal percentage experience recognizable health issues. Some restrictions date from the early days of aviation when aircraft were poorly pressurized, oxygen was sometimes required, and little was known about newborn physiology.
Some infants should have medical clearance before flying. Infants born with significant medical issues (prematurity or heart and lung problems, for example), even if they appear totally healthy at home, may have difficulty compensating for lower cabin oxygen concentrations at cruising altitudes. Clearance is essential until age 12 months.
Infants may suffocate when held on a parent’s lap. (Journal of Pediatric Critical Care Medicine, September 2014.) A small number of infants with no known medical issues have died during flights, with deaths more common among infants held on laps than those in their own safety seats. Possibly, the adult holding the infant fell asleep and their bodies rested on the infant’s face, blocking the infant’s airways. Some of the deaths showed similarities with SIDS (Sudden Infant Death Syndrome), infants suffocating while sleeping on their stomachs. Infants should sleep on their backs and on firm surfaces.
Infants may contract infectious diseases in flight. Air circulates in aircraft cabins from ceiling to floor, not through the entire cabin. Air is replaced every few minutes. Therefore, infants’ (and other passengers’) exposure to disease-causing organisms exhaled by passengers is limited to those sitting in nearby seats, not from the entire aircraft.
An infant’s immunity to contagious disease varies. Infants inherit some immunity from their mothers but its effectiveness depends on innumerable factors and this immunity wanes over the first few months of life. Infants begin receiving immunizations at two months, but optimum immunity requires several doses of a vaccine over many months. Immunizations against other diseases (measles, for example) begin at twelve months. This leaves “windows” during the first year in which infants are vulnerable to infections. Moreover, there are no immunizations against cold-like contagious diseases. Yet very few infants are known to have become infected in-flight.
Is Ebola a threat to infants traveling by air? Probably not. In Africa, the virus shows no predilection for infecting children. Moreover, Ebola spreads by skin contact with body fluids from infected individuals, not through the air, and spreads only after the victim shows signs of illness. People ill with most other infectious diseases spread the disease-causing organisms before they themselves are ill, greatly abetting the spread of the disease.
Be safety conscious. Avoid aisle seats when holding an infant on your lap. Aisle seat-related accidents include: infants’ dangling arms and legs into the aisle and being struck by food carts; burns from hot beverages spilled by flight attendants or other passengers; and luggage falling from overhead bins. Also, walk carefully in aisles while holding an infant. He or she blocks your view, sometimes resulting in you stumbling over feet protruding into the aisle.
Miscellaneous. There is no evidence that air travel damages infants’ ears – though it may cause ear pain… Use disinfectant cloths to clean seat trays and other objects that infants may touch. Some disease-causing organisms survive for days on inanimate objects. Wash infants’ hands often. Aircraft toilets (door handles and sink surfaces, for example) are likely sources of organisms… Opt for the first flight of the day, when possible. Aircraft are thoroughly cleaned during the night. During the day only trash is removed.
Are you, the mother, fit to fly? Many obstetricians recommend delaying air travel for one to two weeks after routine vaginal deliveries and three weeks after caesarian sections. Post-delivery issues that may arise include blood clotting, bleeding and infection. For both mothers and infants, check if there are competent medical facilities at your destination.
If you are planning to travel with your children, in this country or abroad, there is presently no reason to change your plans due to the Ebola outbreak – even though this is a deadly illness with travel playing an important role in in its spread, says the Centers for Disease Control (CDC). The CDC does advise against visiting the countries in West Africa where the disease is currently endemic. These countries are among the poorest in the world and are rarely visited by travelers.
Here is what you should know:
Ebola is one of the deadliest infectious diseases known to man. It generally causes severe pain, internal bleeding, kidney and liver failure, shock, coma, and other life-threatening conditions.
A travel history should be part of every medical examination. If medical personnel fail to ask you where your family has traveled recently, tell them. Numerous illnesses have strong geographical links. Flu-like symptoms, for example, can be Ebola, malaria – or, most of the time, the flu. Even within the United States, there are illnesses found in the Southwest that are rarely seen in the Northeast.
Children are no more susceptible to Ebola than adults. In fact, in previous outbreaks in Africa, children were less affected (CDC: Journal of Emerging Diseases, October 2014). This may be because children had less contact with infected adults or for unknown reasons. It is not unusual for diseases to have a predilection for individuals of certain ages. (In Africa, one very sad consequence of the Ebola outbreak is the large number of children left orphaned.)
Ebola does not spread through the air. People become infected with Ebola from direct contact with virus-containing blood, sputum or other body fluids of infected individuals, or by touching objects such as needles that have been contaminated with infected fluids. The virus then enters uninfected individuals through broken skin or membranes in the mouth or eyes. Family members and healthcare workers caring for the ill individual are at greatest risk. Frequent and thorough hand washing may help prevent infection.
Infected individuals do not spread the virus until they show symptoms of being ill. This is contrary to most childhood infections, which start spreading several days before symptoms surface – while children are still attending daycare and school, greatly abetting the spread of the disease.
Animals appear to be the reservoir of the virus. People in Africa become ill from close contact with animals harboring the virus. Suspect animals include chimpanzees, gorillas, monkeys, forest antelope, pigs, porcupines and fruit bats. In the poor countries where Ebola exists, people live in close contact with the animals.
Early symptoms are vague. Symptoms include fever, headache, joint and muscle aches, weakness, tiredness, sore throat and chills. As the disease progresses, other symptoms begin appearing: bleeding inside and outside of the body, nausea and vomiting, diarrhea (often bloody), bruising and other skin rashes, and difficulty breathing and swallowing.
Prompt diagnosis and isolation are vital to help prevent spread. Often, only a good travel history will raise the suspicion of the presence of a serious disease. Medical personnel must wear proper protective gear. Various blood tests and viral studies help make the diagnosis. Ebola can appear from 2 to 21 days after someone has been exposed to the virus. Most people’s symptoms begin 8-10 days after exposure.
There is as yet no specific treatment for Ebola. Experimental drugs and vaccines have been used recently but it is too early to evaluate the results. Presently, treatment consists of replacing blood lost by bleeding, maintaining vital signs, supplying oxygen, and treating complications as they appear. Currently about 50% of victims die.
Backpacks here. Backpacks there. Backpacks practically everywhere. Toddlers wear them for the sake of wearing them, often empty and in the shape of cartoon characters. Elementary school-age kids pile everything they have into them. High school kids use them as fashion statements; it doesn’t matter what’s in them.
But for parents, there are health and safety issues to consider.
1. Loads on backs should not exceed 20% of the child’s body weight. Lesser loads, 10 to 15%, are recommended for backpack beginners, long trips, going uphill, climbing stairs, walking on tough terrain, and in hot weather.
2. Backpacks that are too heavy or worn incorrectly may cause back problems. (However, there is no evidence that these problems cause permanent deformities.) In the US, more than 7,000 backpack-related injuries are seen in emergency rooms each year, with many more seen in doctors’ offices. Approximately half of the cases are in children. Upper and lower back pain and shoulder pain, sometimes severe, are the most common symptoms.
3. Choose function before fashion. Opt for backpacks with shoulder straps that are wide, contoured, and padded to prevent straps from digging into the shoulders. Straps should be adjustable so that the backpack rests snuggly against the back, can be put on and taken off easily, and doesn’t interfere with arm movement.
4. Waist straps help keep backpacks in place. When straps are too loose, backpacks dangle uncomfortably. Ideally, the backpack should rest two inches above the waist. Padding in the backpack protects wearers from objects inside. The lighter the backpack, the more weight can safely be placed in it.
5. Discourage children from wearing backpacks on one shoulder. This fad is now in vogue – and even young children are surprisingly fashion-conscious. Weight should be distributed equally. Numerous compartments simplify weight distribution. Place heavier objects at the bottom, near the center, and up against the back.
6. Tuck in straps. Some backpacks, especially ones designed for small children, have long straps to fit children of various sizes. Long straps may cause tripping, become entangled in branches or get caught in doors.
7. Watch your child for backpack “dysfunction.” The aches and pains resulting from wearing new backpacks is not a necessary adjustment period. Discomforts ought to be investigated before they become worse. Investigate red marks on kids’ shoulders or complaints of tingling or numbness in their arms. Backpacks are too heavy when children have difficulty putting them on, lean to one side while wearing them, or bend forward with their heads down to balance them. This can cause children to topple over, especially on stairs.
8. Consider rolling backpacks. Wheels allow children to roll backpacks where feasible. Handles on wheeled backpacks should be sufficiently long so that children can stand fully upright when pulling them. Some schools have banned wheeled backpacks as being dangerous on stairs and not fitting into lockers.
9. Put backpacks on correctly. Children should bend at the knees, not at the waist, while keeping the trunk of the body straight and stable. They should push up using their leg muscles and keep the backpack close to the body. Excessive twisting and turning may indicate that the backpack is too heavy or the wrong model. Some children find it advantageous to place backpacks on a chair or table (depending on the child’s height), before placing them on their backs.
10. Avoid backpack-related injuries to others. Fully loaded backpacks protrude more than a foot. Bystanders, in the aisles of school buses or on airplanes, for example, have been knocked over when a backpack wearer suddenly turns around. People at airports trip over backpacks carelessly left on the floor.
There are more than a million known species of insects and, according to experts, millions more waiting to be identified. And it seems as if there are almost as many insect repellents, with new ones popping up frequently, some containing new ingredients and safety warnings aimed at young children.
Here is the latest:
1. The US Centers for Disease Control (CDC) recommends repellents containing one of the following active ingredients:
No repellent bears the name of the active ingredient. You must search for the name of the ingredient on the label.
2. These repellents have been scientifically tested. They are safe for young children when used correctly and are effective against a wide variety of biting insects including mosquitoes, ticks, fleas, and chiggers, but they are not effective against bees, wasps and hornets.
Little is known about the safety and effectiveness of the hundreds of products on the market not containing CDC-approved ingredients; insect repellents are not government-regulated.
3. Check lower age limitations and recommended concentrations of repellents with CDC-approved ingredients. DEET, for example, should not be used on infants less than two months of age; oil of lemon eucalyptus, not on infants under 3 years. The skin of infants and young children is especially permeable to substances applied to it. DEET is the only CDC-approved repellent that comes in various concentrations; for children, use ones that contain between 20 and 30% DEET.
4. The terms “natural” and “chemical free” have little meaning. Oil of lemon eucalyptus, for example, is “natural.” However, this doesn’t make it safer/better than repellents formulated in laboratories. (Poison ivy and deadly mushrooms are 100% natural. Vitamin C taken from oranges is identical to that synthesized by chemists.)
5. Apply repellants correctly. Place the substance on your hands and then rub it on your child’s skin. No need to place it under clothing; long pants and sleeves reduce the amount of repellent needed. Wash off when no longer needed. A thin coating is sufficient; thicker coats do not increase protection. Avoid eyes, mouth, wounds or rashes. If accidentally applied to such areas, rinse with soap and water. Apply outdoors or in well-ventilated indoor areas.
6. Use permethrin on clothing. Permethrin helps prevent insects from crawling under or biting through clothing. Once correctly applied, permethrin remains effective on clothing through many washings. Permethrin can also be sprayed on camping gear such as tents.
7. Avoid products that combine insect repellents and sunscreens. While many situations call for both, the intervals of applications and other considerations make combination products impractical. Generally, apply the sunscreen at least twenty minutes before sun exposure. Repellents can be applied just before going outside. Repellents may reduce the effectiveness of sunscreens. If both are needed, consider using a stronger sunscreen.
8. Avoid items that claim to protect against insects. Wristbands are ineffective. Taking vitamin B merely reduces itching from bites, causing you to think you are being bitten less. Sound and light devices attract insects to the devices, but then attack people near the devices, possibly increasing risk of being bitten. Products that emit vapors may be harmful if inhaled indoors over prolonged periods of time, especially by children. Outdoors, vapor effectiveness varies depending on wind direction and other factors.
9. Consider other methods to avoid getting bitten. Don’t use scented soaps, perfumes, and hair spray as they may attract insects. Place nets over strollers and playpens. Check window and door screens. Avoid areas near standing water – birdbaths and flowerpots, for example – where insects breed. Air conditioning and fans help; most biting insects prefer warmth and avoid turbulent air.
10. Familiarize yourself with one or two repellents. Products come in the form of lotions, creams, gels, aerosols, sticks and towelettes. Read instructions. Contact manufacturers, if necessary; most have websites. Know how long protection lasts; hot weather, perspiration, swimming and other factors tend to shorten duration of effectiveness. Read storage advice. Most products have expiration dates. Using extremely old repellent can cause skin irritation and rashes.
(Hi Readers: Here is the first of what will be a regular feature on KidsTravelDoc, a short item to help keep you and your children healthy and safe for travel and outdoor activities.)
Choose foods that are too hot to eat immediately. When traveling, nearly all upset stomachs are due to microorganisms (and their toxins) found in food. Sufficient heat kills organisms and neutralizes toxins.
The fact that food is still piping hot indicates that it has just been heated and did not remain standing after preparation to be contaminated by flies or people’s hands. Ideal food items are soups and stews, ones that contain only small pieces of solids. (Large pieces of solids may remain insufficiently cooked in the center.) Thin omelets and items boiled in oil or water also tend to be safe. A rare exception is certain large reef fish in the tropics: snapper, grouper, amberjack, and others.These fish produce toxins that are not destroyed by heat. Well-prepared smaller fish are generally safe.
Choose foods carefully at buffets, especially outdoor ones in hot weather. Buffets require much handling to prepare and may remain on tables for hours, increasing the risk of lapses in sanitation plus exposure to insects and heat. Avoid foods that are warm, but not hot; “warm” allows organisms to multiply rapidly. Be cautious when selecting a dessert. Desserts are generally eaten last, but are often placed on the table at the same time as other items. Organisms also multiply rapidly in creamy products.
It’s all in the tone of your voice when you tell someone, “Go take a hike!” Are you telling them to “Get lost!” or are you recommending that they adopt a healthier lifestyle?
Hiking benefits both kids and adults, combining exercise, quality togetherness and exposure to the outdoors. Hiking requires little or no equipment, is a very safe activity, and can be performed almost anywhere, not only in the woods. The earlier kids get acquainted with nature, the more likely they will continue their interest when they grow up.
1. Start kids hiking before they can hike. Carry them on your back, so you can hike and get them used to the outdoors. Start when they are about six months of age, a time when they can hold their heads up. Check that you have an infant carrier appropriate for you and for the infant’s age and size. (Click infant carrier for details.) Be aware of branches and bushes as you walk. Protect their eyes from the sun, especially in snow country.
2. Don’t bother trying to predict how far, how fast or for how long toddlers will walk. (Toddlers are defined as being between one and three years of age. Then they become preschoolers.) Medically speaking, let them walk as long as they like; no need to limit them. Let them set the pace and direction – which may be slow and in circles. The first few times you go “hiking,” stay close to your house or car. You may hear the “carry me” at any time and, possibly, many times. Don’t go further than you can easily carry kids back.
3. Most four year olds will walk one mile. A rule of thumb: motivated kids will walk/hike one additional mile for each year over four, i.e. three miles for a six year old. Factor in physical fitness, difficulty of the terrain, and weather.
4. Keep them motivated. Let them help you pick out snacks for the walk/hike and tell them about what they will see on route. Call for rest stops when you see them dragging and losing interest. Do so before they complain. Let them lead the family. Alternate leaders if there is more than one child.
5. Choose interesting routes. Young children are rarely impressed by historical sites and scenic landscapes and prefer picking flowers to viewing them. They tend to like waterfalls, lakes (especially ones with ducks in them), lakes into which they can throw stones, and rocks on which they can climb (safely). Ideally, choose routes with attractions close together so you can entice them on with something interesting just ahead. Point out animal tracks and burrowing holes, anthills, and birds’ nests, for example.
6. Provide young kids with backpacks. Wearing backpacks makes them feel part of the group.For toddlers, it doesn’t matter what they carry – a light toy, a small water bottle, their favorite snack, or nothing. For older children on serious hikes, backpacks should weigh no more than fifteen percent of body weight, less for tough terrain, first time hikers, and extremes in temperatures. (This holds for school backpacks too.)
7. Keep kids well hydrated. Dehydration sets in before thirst does and decreases energy levels. Drinking is especially important in hot and humid environments. For children of all ages, even on fairly strenuous hikes, plain water is adequate. Energy drinks and electrolyte solutions are unnecessary.
8. Snacks are important. “Trail mixes” consisting of dried fruits, nuts, grains and chocolate are very popular, and available everywhere. These mixtures provide energy, taste good, are lightweight, and are easy to carry, store, and eat.
9. Teach young children to “Hug-a-Tree” if they lose sight of you. If children feel lost they start running in the direction they happen to be facing, greatly complicating reuniting. Supply preschoolers with whistles, when appropriate. Check the many electronic gadgets now available to keep track of children. See TenTip: Kids/Surveillance Systems.
10. Miscellaneous. Allow kids to bring a friend along. (Adults are boring, friends are cool.) Have lists of supplies to carry: insect repellent, sunglasses, sunscreens, extra clothing, a small first aid kit, and a cellular phone that works where you are hiking. Avoid becoming goal-oriented. The sole purpose of hiking with kids is to have fun.