Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Will your children be wearing face masks any time soon?
1. The US Centers for Disease Control CDC) recommends that children (and adults) NOT wear face masks at this time. Facemasks are the hallmark of coronavirus disease. Pictures from China show that even the very young are bedecked with them. However, wearing facemasks makes sense only where and when person to person spread is prevalent and ongoing, as in China, not where spread is minimal, as is presently the case in the US and most other countries.. The reasons for not wearing facemasks are discussed below. Also discussed are the rare exceptions to this rule.
2. The CDC is also advising parents against stocking up on face masks for “just in case.” Parents are buying masks helter-skelter with little understanding regarding which kind to buy and how and when to use them. Retailers are running out of masks, even ones that offer no protection. Some American children are already wearing masks.
3. The US government says it has huge stockpiles of face masks for children and adults. The government has storage facilities holding drugs and supplies in the case of bioterrorism, nuclear attack or outbreaks of serious infectious diseases.
4. The optimal masks for preventing coronavirus-type diseases are not suitable for young children. These are N95 respirator masks and are intended for healthcare professionals only. However, they can be bought by the public. Health care workers who wear them must undergo periodic “fit’ tests to assure the masks fit tightly around the mouth and nose to prevent air from the outside entering. They block out more than 95% of the small airborne particles that spread viruses from person to person. These masks are somewhat uncomfortable to wear and may make breathing slightly labored.
5. Most masks commonly worn by children (and adults) are surgical masks. These were specifically designed to protect surgeons from being contaminated by splatter from the surgical field, not to provide protection from infectious diseases. The masks fit loosely around the edges, allowing some unfiltered air – and any viruses that may be present in that air – to enter the mouth and nose of the wearer. However, the masks are fairly comfortable to wear, even for prolonged periods of time. Surgical masks are available online for young children.
6. Surgical-type face masks provide very limited protection against coronavirus-type illnesses, says WHO (World Health Organization). Protectiveness depends on how masks fit, how much of the time they are worn, whether children are cooperative with wearing them, the concentration of viruses in the air and numerous other factors.7. The time and effort parents spend in teaching and enforcing proper mask wearing could be better used in teaching children simpler and more effective protective measures. (See #8 ) Few children are compliant with mask-wearing and become less so as the novelty of wearing them wears off. They remove them, pull them away from their faces or place their fingers under them. The younger the child the more difficult it is to have them wear masks.
8. Presently, the CDC recommends wearing face masks for only a small number of children. This includes (1) children sick with the virus, (2) children believed to have been exposed to someone sick with the virus (3) and children living in such households. For other children in countries where coronavirus disease activity is only minimal children should be taught the following: proper handwashing techniques, how to cough and sneeze into disposable tissues and how to dispose of those tissues, to stay away from sick individuals, and to stay home when sick. And, of course, parents must keep up with the news.
9. Check that the face masks you purchase are designed to protect against coronavirus-type illnesses. Many other types of masks are on the market. For information, contact your local health department or health care professionals. Also check with the manufacturers of masks on the internet. There are masks for protection against “pollution”, cold weather, and allergies, to mention just a few. There are masks which are just for fun and play and kits for children to make their own masks. Some masks should be used only once, others claim to be reusable. There are cotton masks said to be rewashable.
10. Assist children in removing their masks lest they contaminate themselves in the process. Remove masks as gently as possible so as not to disturb minute liquid and solid particles on the mask. Place masks in a plastic bag, preferably in a zip lock bag. Secure bag tightly, Place bag in a waste disposal unit. Wash hands thoroughly immediately.
Coronavirus disease and children: PART II
January 28, 2020. When reading this and similar articles, mentally jot down the date they were written. Very likely, some of today’s recommendations will be updated tomorrow.
(PART I, written on January 24 (four days ago) is available at: http://kidstraveldoc.com/are-your-children-at-risk-for-coronavirus-disease/)
1. The latest advice from the CDC. Unless you have been in China in the past few weeks or are presently in contact with someone who recently visited China, the risk of anyone in your family becoming infected with coronavirus illness is at the moment extremely remote, says the US Centers for Disease Control. Watchful waiting is the only reasonable action to take.
2. How do the coronavirus and other viruses spread from person to person? Infected individuals exhale, cough, and sneeze viruses into the air. Generally, viruses can “‘fly” about six feet (two meters), enabling individuals within that area to inhale them. Viruses also land on nearby surfaces. Touching those surfaces transfers viruses to one’s hands. Subsequent touching of one’s mouth and nose allow them to enter the body.
3. Are young children especially at risk? This is a new virus and definite answers are not yet available. However, during previous outbreaks of somewhat similar coronavirus diseases, fewer children than adults were infected and the disease was considerably milder in children. More information on this aspect of the disease will become available as more cases occur.
4. What other information is needed to formulate meaningful control measures? The incubation period is believed to be two to five days, but may be longer. Still unclear are the following: can individuals be infected, show no signs of illness yet spread the virus? Does the virus start spreading in the days before symptoms appear? Does it spread only while symptoms are present or is spread possible after symptoms disappear? Answers should become available within the next week or two.
5. How can I tell whether my child has a cold or the coronavirus disease? Unfortunately, you can’t with certainty. At the onset of these diseases, the symptoms (runny nose, cough, sore throat, muscle pain, fatigue, and fever) are identical. There is no specific treatment for either illness. Cough and cold remedies, mostly antihistamines and dextromethorphan (for coughs), are no longer recommended for children due to occasional side effects. Use appropriate doses of acetaminophen or ibuprofen to reduce fever and relieve aches. However, these medications do not shorten the duration of viral infections.
6. Should parents take children with cold-like illnesses to medical facilities to rule out coronavirus disease? No, says the CDC. As yet, in the US, there has been no reported person-to-person spread. Healthy young children who attend daycare or school average three to five cold-like illnesses per year, mostly in winter months. Moreover, unnecessary visits overburden medical facilities at the very time maintaining efficiency is especially important. Also, medical facilities at this time of year especially are common places to catch colds. If you strongly suspect that your child may have coronavirus disease, call your facility before arrival, allowing them to prepare to isolate you upon arrival.
7. Does wearing a facemask reduce the risk of becoming infected? While such masks have become the hallmark of the coronavirus outbreak, masks offer limited protection. Presently, the CDC does not recommend wearing masks. To be effective, the right type of mask must be worn; many types are available. And masks must fit tightly and be removed correctly, with a fresh mask applied each time. Children especially object to wearing masks. They frequently subvert the efficacy of the mask, by placing their fingers under the mask, for example. Wearing masks is important for individuals dealing with an infected person. The US government has stockpiled facemasks and other supplies necessary to contain epidemics. See below.
8. How can doctors diagnose coronavirus disease? There are no rapid diagnostic tests. Presently, diagnostic testing can be performed only at the CDC laboratory. Tests are not routinely performed. They are done only in cases where there is strong suspicion that the disease is present, generally due to a history of recent travel to China or close contact with someone who has been diagnosed with the disease.
9. When will a vaccine be available? Scientists at three different institutions are already working on coronavirus vaccines, says the National Institute of Health (NIH). Vaccine development technology has greatly improved in recent years with rapid response platforms ready and able to speed up the process. However, there are no guarantees of success; each virus is unique and unforeseen problems are common. The most optimistic estimates say a vaccine could become available before the end of the year.
10. Is the government prepared for major epidemics? According to the Washington Post, the U.S. government has several secret storage facilities holding drugs and supplies that are part of a $7 billion Strategic National Stockpile ready to be used in the case of bioterrorism, nuclear attack or an outbreak of an infectious disease. The medical contents of the repository held nationwide would cover more than 31 football fields if laid out.
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Coronavirus disease and children: PART II
January 28, 2020. When reading this and similar articles, mentally jot down the date they were written. Very likely, some of today’s recommendations will be updated tomorrow.
(PART I, written on January 24 (four days ago) is available at: http://kidstraveldoc.com/are-your-children-at-risk-for-coronavirus-disease/)
1. The latest advice from the CDC. Unless you have been in China in the past few weeks or are presently in contact with someone who recently visited China, the risk of anyone in your family becoming infected with coronavirus illness is at the moment extremely remote, says the US Centers for Disease Control. Watchful waiting is the only reasonable action to take.
2. How do the coronavirus and other viruses spread from person to person? Infected individuals exhale, cough, and sneeze viruses into the air. Generally, viruses can “‘fly” about six feet (two meters), enabling individuals within that area to inhale them. Viruses also land on nearby surfaces. Touching those surfaces transfers viruses to one’s hands. Subsequent touching of one’s mouth and nose allow them to enter the body.
3. Are young children especially at risk? This is a new virus and definite answers are not yet available. However, during previous outbreaks of somewhat similar coronavirus diseases, fewer children than adults were infected and the disease was considerably milder in children. More information on this aspect of the disease will become available as more cases occur.
4. What other information is needed to formulate meaningful control measures? The incubation period is believed to be two to five days, but may be longer. Still unclear are the following: can individuals be infected, show no signs of illness yet spread the virus? Does the virus start spreading in the days before symptoms appear? Does it spread only while symptoms are present or is spread possible after symptoms disappear? Answers should become available within the next week or two.
5. How can I tell whether my child has a cold or the coronavirus disease? Unfortunately, you can’t with certainty. At the onset of these diseases, the symptoms (runny nose, cough, sore throat, muscle pain, fatigue, and fever) are identical. There is no specific treatment for either illness. Cough and cold remedies, mostly antihistamines and dextromethorphan (for coughs), are no longer recommended for children due to occasional side effects. Use appropriate doses of acetaminophen or ibuprofen to reduce fever and relieve aches. However, these medications do not shorten the duration of viral infections.
6. Should parents take children with cold-like illnesses to medical facilities to rule out coronavirus disease? No, says the CDC. As yet, in the US, there has been no reported person-to-person spread. Healthy young children who attend daycare or school average three to five cold-like illnesses per year, mostly in winter months. Moreover, unnecessary visits overburden medical facilities at the very time maintaining efficiency is especially important. Also, medical facilities at this time of year especially are common places to catch colds. If you strongly suspect that your child may have coronavirus disease, call your facility before arrival, allowing them to prepare to isolate you upon arrival.
7. Does wearing a facemask reduce the risk of becoming infected? While such masks have become the hallmark of the coronavirus outbreak, masks offer limited protection. Presently, the CDC does not recommend wearing masks. To be effective, the right type of mask must be worn; many types are available. And masks must fit tightly and be removed correctly, with a fresh mask applied each time. Children especially object to wearing masks. They frequently subvert the efficacy of the mask, by placing their fingers under the mask, for example. Wearing masks is important for individuals dealing with an infected person. The US government has stockpiled facemasks and other supplies necessary to contain epidemics. See below.
8. How can doctors diagnose coronavirus disease? There are no rapid diagnostic tests. Presently, diagnostic testing can be performed only at the CDC laboratory. Tests are not routinely performed. They are done only in cases where there is strong suspicion that the disease is present, generally due to a history of recent travel to China or close contact with someone who has been diagnosed with the disease.
9. When will a vaccine be available? Scientists at three different institutions are already working on coronavirus vaccines, says the National Institute of Health (NIH). Vaccine development technology has greatly improved in recent years with rapid response platforms ready and able to speed up the process. However, there are no guarantees of success; each virus is unique and unforeseen problems are common. The most optimistic estimates say a vaccine could become available before the end of the year.
10. Is the government prepared for major epidemics? According to the Washington Post, the U.S. government has several secret storage facilities holding drugs and supplies that are part of a $7 billion Strategic National Stockpile ready to be used in the case of bioterrorism, nuclear attack or an outbreak of an infectious disease. The medical contents of the repository held nationwide would cover more than 31 football fields if laid out.
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Are your children at risk for coronavirus disease?
January 24, 2020. Unless you have been in China in the past few weeks or are presently in contact with someone who recently visited China, the risk of your family becoming infected with coronavirus illness are presently extremely remote, says the US Centers for Disease Control (CDC).
However, stay tuned. This current outbreak is a rapidly evolving situation and must be taken very seriously. Previous similar outbreaks of this disease spread rapidly and widely around the world resulting in numerous cases and many deaths. The present outbreak has already reached the US. A case was diagnosed on January 21 in an adult living in Washington State. He had recently returned from Wuhan, China, the epicenter of this outbreak.
Coronaviruses typically cause cold-like illnesses that at onset are indistinguishable from other colds. In fact, most adults and children have already had a coronavirus illness. However, occasionally a new and virulent strain emerges that can trigger pneumonia and other life- threatening respiratory conditions. Such outbreaks have occurred at least twice in recent decades. Young children, the elderly, and immunocompromised individuals were especially at risk. The current outbreak seems to be due to such a strain.
Coronaviruses are common in animals, and only rarely and for unknown reasons spread to humans, possibly through very close contact. The spread from human to human is similar to the spread of other viral illnesses: via respiratory droplets produced when an infected person coughs or sneezes and touching objects contaminated by coughs and sneezes. The severity of outbreaks is difficult to predict. It depends on the characteristics of the virus, how contagious it is, the severity of the resulting illness and other factors.
Much is being done to try to contain the illness. In China, Wuhan has been quarantined with travel out of the city and surrounding areas severely restricted. In the US, travelers arriving from Wuhan are being examined at US airports. However only their temperatures are taken. Both quarantines and measuring temperatures are of limited help.
There is currently no vaccine or medication to prevent infection. The chances of acquiring the infection can be reduced by having your children and yourself doing the following:
● wash hands frequently with soap and water for at least 20 seconds. For information about optimum hand washing, see CDC’s Clean Hands Save Lives!
● avoid touching your eyes, nose, or mouth with unwashed hands
● avoid close contact with people who are sick. The early symptoms are indistinguishable from those of a cold.
● Wearing face masks is of questionable efficacy. Moreover, it is difficult to keep masks on small children.
● Consider limiting travel to affected areas.
If you have cold-like symptoms, you can help protect others by doing the following:● stay home while you are sick
● avoid close contact with others
● cover your mouth and nose with a tissue when you cough or sneeze, then throw the tissue in the trash and wash your hands
● clean and disinfect objects and surfaces
● stay home and rest
If you are concerned about your symptoms, check with your healthcare provider.For more information about the current outbreak in China, visit: https://www.cdc.gov/coronavirus/novel-coronavirus-2019.html
For more information about Coronaviruses: https://www.cdc.gov/coronavirus/index.html
For travel health information: https://wwwnc.cdc.gov/travel/notices/watch/pneumonia-china
Help! Will somebody hush that crying baby on this plane?!
(This is an update of an article I wrote some years ago. It also appeared in the New York Times.)
When traveling by air, a lasting nightmare is sitting near a cuddly little baby that suddenly morphs into a nonstop noise machine, emitting high decibel, ear-piercing, headache-producing, sleep-preventing discomfort. An even worse nightmare: it’s your baby.
1. “Crying infants” is one of the more objectionable features of air travel. Surveys show it rivals foul language, being seated next to an obese passenger, body odor, boisterous behavior and inappropriate displays of affection.
[An Australian airline settled a lawsuit by a passenger who said a screaming child caused her to lose some of her hearing. The incident occurred before the aircraft left the ground.]
2. In fact, the vast majority of infants do NOT cry while traveling by air. I base this on (1) my personal observations during hundreds of flights, (2) fifty years of questions from parents in my pediatric and travel medicine office, and (3) a questionnaire regarding crying that I distributed years ago to parents who recently had traveled by air with infants less than three years of age. (True, not a scientific study.) The consensus: most infants sleep like the proverbial baby, sometimes better than they do at home. The droning of the aircraft may lull them to sleep.
3. Yes, some infants do cry during flight. Surprisingly few, though, considering that air travel disrupts their eating and sleeping schedules and places them in new surroundings, away from their own cribs, in new and often uncomfortable sleeping positions and among strange noises and unfamiliar faces. If they are resting on an adult’s lap, they are disturbed every time the adult moves. However, the rare infant who does cry is so disturbing to us, say psychologists, that the event is ingrained into our psyches and remembered for years, the result of mixed feelings of anger at the helpless baby, anger at the hapless parent(s), and guilt for feeling such anger.
4. There are many theories but few facts regarding crying during air travel. “My baby cries all the time” is a common complaint at routine pediatric checkups. Likely, there are many causes that can be lumped together as “general discomfort.” Serious illness as a cause for such crying is an extremely rare finding. Our surveys suggest in-flight criers generally cry excessively at home and often at about the same hour on the clock. (Theories to explain excessive crying come and go. Acid reflux is currently in vogue.)
5. Some parents unwittingly contribute to inflight crying. They give infants lots of fluids, to prevent dehydration. In fact, dehydration during air travel is a myth. Adults erroneously interpret their own parched mouths and throats as dehydration. In fact, this dryness is due to air conditioning removing moisture from the cabin air. Moreover, changes in atmospheric pressure at cruising altitudes increase air in the stomach and intestines by about 20%. (This gives many adults a bloated feeling.) In infants, excessive fluids may cause colic. Feed infants no more inflight than at home.
[From a website for nursing mothers: Carry a lightweight blanket. Nurse discreetly. When someone objects, offer them the blanket so they can cover their eyes.]
6. Ear pain may be a culprit in inflight crying. Again, blame atmospheric pressure. And blame an air sac in the inner ear. Normally, the Eustachian tubes connect that sac with the nose and the outside, equalizing pressure. However, if the tubes become clogged with mucus from colds or allergies, the air in the middle ear is trapped. Atmospheric pressure expands the air, causing it to impinge on surrounding tissue and cause pain. Moreover, infants’ tubes are narrower than those in adults and mucus accumulation is more common. Fortunately, as far as is known, crying does not damage the ears.
7. Can parents prevent inflight crying? Sometimes. Sedating infants for air travel, once commonly done, is no longer recommended. Infants were given antihistamines to make them drowsy. However, this rarely helped. Additionally, antihistamines have many side effects and are now rarely used for any purpose in young children. Also not very helpful is waking sleeping infants for takeoff and landing when crying may be somewhat more common; awake infants swallow more frequently than sleeping ones and swallowing may help open clogged Eustachian tubes. Also, awake infants can be given bottles or be breastfed which also increases the frequency of swallowing. However, more liquids may cause colic. And why wake sleeping infants to prevent crying (though, ironically, crying also increases swallowing)? An age-appropriate dose of acetaminophen or ibuprofen may relieve ear pain.
[To misquote Shakespeare: To sedate or not to sedate infants for air travel, that is an oft-raised question. Is it truly nobler to spurn sedatives, risk a crying child and bravely suffer the scorn of outraged fellow passengers? Or is it more virtuous to sedate infants, perchance they’ll sleep, but endure the thousand humiliations that parental guilt is capable of self-inflicting?]
8. Airlines claim they have no solutions for the “crying infant dilemma.” Proposals include banning infants from scheduled “quiet” flights, setting aside a section of planes for families, and partitioning the back of aircraft with soundproof curtains. Presently, some airlines ban infants from first class. However, in an article asking, “Will new airline seating proposals create ‘baby ghettos?’,’’ the Wall Street Journal says that, likely, segregation won’t “fly.” If family sections are full and seats are available elsewhere, would families be barred from that flight? Must families with well-behaved children sit in the family section? Will adults traveling alone accept seats near children?
[A flight attendant allegedly secretly added Xanax, an antidepressant, to juice and told the mother that it will make her screaming infant sleep. It is unclear if the infant drank the juice; no side effects occurred. Later, the mother noticed that the juice was foamy, contained blue specks, and tasted bitter. She submitted the juice to authorities. Analysis revealed Xanax. The FBI charged the flight attendant with assault, charges he denied. He was fired. The outcome of the charges is unknown.]
9. Try every trick you can think of, bribery included. Bring toys, familiar blankets, bottles, appropriate treats, a DVD player and a pacifier (even if you don’t use one at home). Nurse them. Sing and hum. Walk up and down the aisle – but watch your step. Holding your infant in your arms blocks your view of protruding feet and luggage.
10. Ignore the scorn of fellow passengers. Stay calm, if possible. Infants may feel adults’ stress and cry in response. While fellow passengers may become angry with you, most of them, at some level, realize that no parent is oblivious to a screaming infant in their arms. Attempt to make peace with your neighbors before they make an enemy of you. Apologize for the disturbance. Tell them that you are doing your best to quiet your baby. Likely, they will sympathize with you. Listen to their suggestions; you need not act on them. Politely suggest they ask the flight attendant for another seat, if possible, or for earplugs or earphones.
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Should infants sit in safety seats for air travel?
1. The facts: Infants are the only items on an aircraft that need not be battened down (secured) for takeoff, turbulence and landing. In case of severe turbulence and survivable crashes, an unrestrained 20-pound (9 kilos) infant sitting on your lap instantaneously becomes a 300-pound weight (136 kilos) that you cannot restrain. Infants have hit the aircraft ceiling or been propelled several rows forward, resulting in serious injuries and deaths.
2. You, the parent, must decide whether or not to use a safety seat (child restraint system, CRS.) Few parents do, mainly because airline travel is so safe. US regulations – and those of most other countries – allow infants less than two years of age to be held on an adult’s lap. Millions of young children travel by air annually, though the precise number is unknown. Estimates done some years ago, suggest that, in survivable accidents, if every child sat in a CRS it would prevent one serious accident or death every four years or so. One passenger death, an adult in 2018, was the first fatality on a US airline in nine years.
3. Using CRSs can be expensive. CRSs generally require purchasing an extra airline seat. The cost of such a seat ranges from free (increasingly rare) to full fare, with most such seats costing about half the full fare. Costs vary with airlines, empty seats available, and class of travel. Special rates for an extra seat to accommodate a CRS are rarely advertised; ask to receive a reduced-rate ticket.
4. CRSs have practical limitations. Until recently, a financial limitation was the cost of buying a CRS appropriate for air travel; most car seats did not fit into airline seats. Now, with rare exceptions, car seats meet the requirements. Check your car seat model with your airline. Also check model and rules with airline(s) if you visit other countries; rules may differ markedly.
5. CRS are cumbersome. Carrying a seat, the infant, and items needed by infants is at best a difficult task, a task almost impossible if only one adult is traveling. Moreover, even if you bring a CRS, during the flight, you still spend time holding your infant on your lap or walking the aisles, reducing the effective time the seat is protective. Especially on long flights, infants need to be fed, changed and comforted, tasks difficult to perform in the CRS.
6. Forcing all parents to use CRSs may be counterproductive. According to some experts, the cost of purchasing a seat for a CRS convinces many families who are planning short flights, to drive rather than fly. Road travel is more dangerous than air travel and would increase the number of injuries/deaths. However, such reasoning may be flawed. Driving statistics include all drivers – impaired and reckless ones, for example. Likely, most parents driving children are safer drivers.
7. Partial alternatives to CRSs are available. U.S. authorities have approved Child Aviation Restraint Systems (CARES), but only for children weighing between 22 and 44 pounds (10 to 20 kilos), generally children between one and four years of age. CARES do require purchasing airline seats but eliminates the use of a CRS. CARES consists of a harness worn by the child. The harness attaches to the airplane seat belt and has a strap that goes around the back of the airplane seat. The harness is lightweight and fits easily into a diaper bag.
8. Another partial alternative to CRSs are infants restraining vests. Such vests have straps that attach to the adult’s seat belt, allowing infants to sit on an adult’s lap, making extra airline seats unnecessary. These vests are lightweight and fit into a small pouch. However, vests cannot be used during takeoff or landing. Moreover, the permissibility of both vests and CARES varies from country to country. Check with your airline; most have websites with detailed information regarding infant safety considerations. CARES and vests can be purchased online.
9. CRSs may protect infants from several extremely rare types of mishaps. Unsecured lap infants are injured when adults fall asleep and the infants slides off the lap. And infants are suffocated when an adult falls asleep with their chest atop the infant. Even rarer, several lap infants have died in what may have been cases of SIDS (Sudden infant death syndrome.) However, the incidence of the combined number of these events probably approaches the one in a million frequency.
10. Are CRSs really necessary? Only a government-approved CRS offers infants maximum protection. The use of CRSs is strongly recommended by the American Academy of Pediatric, Centers for Disease Control, National Transportation Safety Board and Federal Aviation Administration. Moreover, these groups are petitioning government regulatory agencies to make the use of CRSs mandatory.
What do you think?
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