An informal survey of several dozen parents planning major family trips showed that about half of them did not know whether their children (or themselves) are fully covered for all medical expenses incurred away from home. Many confessed that they have never read their insurance policies, not even the large print. Many were not familiar with penalties charged when trips had to be cancelled.
Here is what you should know:
1. The mildly bad news: Young kids get sick often. With preschool children, count on having about half a dozen illnesses a year, with some of the illnesses requiring a visit to a doctor. So if your family is away from home two or three weeks a year, there is a fairly good chance that illness and travel will one day coincide.
2. The mostly good news. Surveys by the International Society of Travel Medicine show that travel is surprisingly safe and healthy for children and that children very rarely come down with serious travel-related illnesses. This is true even for mildly adventurous travel, and holds for infants as well. When illness does occur it is usually minor, the types of illness that may occur at home. But there are exceptions. And away from home, even minor illnesses tend to be worrisome.
3. Problems may arise before you leave home.Many family trips are planned – and paid for – months in advance. The more children, the greater the chances of one becoming ill and the more money down the drain if you must cancel. Increasingly, documentation of illness (doctors’ notes, for example) may not help in obtaining refunds from airlines, cruise lines, resorts, and amusement parks. Check cancellation policies and consider purchasing cancellation insurance.
4. Don’t expect that all urgent-care centers, ERs and doctors’ offices will accept your insurance. Ask your insurance company about their policies before leaving home. Chances are there will be no charge if the facility you visit is in your company’s network. But if it is not, expect to pay all costs on the spot. Hopefully, they will accept your credit card. Make sure that you are in good standing with your credit card company. Generally, in such cases your insurance company will reimburse you for medical expenses, but not until you submit the bills, which may be weeks later.
5. Some companies want pre-authorization for extensive ER visits and hospitalizations (except for emergencies). Such visits can cost megabucks. (And good luck reaching your insurance company at 3AM to obtain pre-authorization.) In addition, your company may decide what constitutes an emergency. For example, in a typical case, reimbursement was denied for a late night ER visit for a 10-month-old, cranky child with a fever of 101 degrees F (38.5 C).
6. Find out whether your insurance covers your family outside the country. Travel arrangements to Canada, Mexico and most Caribbean islands are so easily made that many people forget that these destinations are foreign countries and that American insurance is not automatically accepted. Check before you go.
7. Consider getting travelers assistance insurance for travel outside the US. Such policies provide a 24-hour telephone “hotline” staffed by persons who can direct you to English-speaking physicians; pay the costs of treatments and hospitalizations at the time of the incident; if necessary arrange and pay for evacuation to a medical facility that can provide necessary treatment; and many other benefits. See “travel assistance insurance” on the web. Note that the company, not you, will decide if evacuation is necessary. Do not expect an evacuation home unless the condition is life-threatening.
8. Travel assistance insurance is expensive. But you may find that you are already covered by your insurance company and/or credit card provider; some have added such benefits. Note that many cruise lines and package tour operators insist clients buy travel assistance insurance and include it in the price of the trip. However, on cruises, for example, you may be covered only for ship-related incidents, not for air travel or land excursions you take on your own. Often, when parents are insured by travel assistance companies, there is no additional charge for children.
9. Other considerations. Ask if preexisting medical conditions (asthma and diabetes, for example) are covered away from home; there may be additional charges. And some hazardous travel-related activities popular with older children (parasailing and scuba diving, for example) may NOT be covered by insurance.
10. Request summaries of medical treatments and receipts for medical expenses. Data regarding medical diagnosis and treatments may be especially helpful for on-going medical conditions. Both the medical records and the receipts are necessary to present to your insurance company for reimbursement.
1. Can newborns travel safely by air? Commercial jets are safe for healthy newborns. However, infants with a history of serious medical issues – (significant premature birth or heart and lung problems around the time of birth), for the first year, even if the infant shows no symptoms, may have difficulty compensating for lower oxygen concentrations at cruising altitudes. Such infants should be medically cleared for air travel.
2. Do airlines have lower age restrictions for newborns? Some do: American Airlines allows infants two days of age to travel. United, Delta and Air Canada, require a letter from a physician for infants less than 7 days of age. Southwest requires a letter for infants less than 14 days of age. Most airlines have their newborn policy stated on their web site. Go to web site and the to “travel with infants.” Or call the airline.
3. Are infants likely to catch infectious diseases in flight? Unlikely. Infants are partially protected by immunity obtained from their mothers, but this immunity varies an wanes over the first few months of life. Cabin air is replaced every few minutes with sterile air from outside or recycled through sophisticated filters. And air circulates from ceiling to floor, not through the entire aircraft, making passengers susceptible only to illnesses from those sitting nearby. There are no known cases of infants catching serious infectious diseases during flight, but it is often difficult to determine when/where an illness is caught. (Rarely, adults have caught serious diseases in flight.)
4. Should I wait to travel until my child is fully vaccinated? This adds only slight protection. Routine immunizations are generally given at two, four and six months with full immunity not achieved until the six months dose. However, the diseases that these vaccines prevent are unlikely to be present in flight – because the vast majority of people are vaccinated against these diseases. When measles is a threat, a dose should be given at six months in addition to the dose given at a year. For overseas travel, additional vaccines may be indicated.
5. Is there anything I can do to reduce the chances of illness? Not much. Washing your and your infant’s hands and wiping surfaces (organisms can survive for days on seats and armrests) may reduce risk. If possible, change seats if a nearby passenger coughs and sneezes. Travel when planes are less crowded.
6. Do infants need extra drinks to prevent dehydration? No. In-flight dehydration is a myth. Feed infants no more in flight than at home. Adult air travelers erroneously interpret their parched mouths and throats as dehydration. This dry feeling results from air conditioning removing most of the moisture from the cabin air.
7. Does feeding infants too often cause problems? It can. At cruising altitudes the air in the stomach and intestine is already expanded by 20%, the result of lower atmospheric pressure. (This is what gives many adults a bloated feeling.) For infants, sucking adds more and unnecessary air and food to the stomach, which may cause fussiness. Feed infants no more often in flight than at home.
8. Is it OK to sedate infants for long flights? Not really. Our surveys show that “criers” will cry whether they are medicated or not. Surprisingly few infants cry considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and sometimes uncomfortable positions and, if they are on your lap, are disturbed every time you move. There are no studies as to which medications are effective and how much and when to give them. Some sedating medications (antihistamines, for example) make some infants more active.
9. Can infants with respiratory infections and nasal allergies travel by air? It appears to be safe. Surveys of experts (hundreds of pediatricians, pediatric ear nose and throat specialists and other physicians) has failed to find one who has seen an infant with ear damage as a result of flying with these symptoms. Decongestant and nose drops/sprays do not help infants. Air pressure regulating earplugs do not reduce ear discomfort in children.
10. Is air travel safe with ear infections? Yes. The same experts agree. Ear infections actually reduce the chances of ear pain. Pain is due pressure changes in the air in the middle ear as the plane ascends and descends. Most ear infections obliterate this space with fluid, eliminating the chances of pain. Aerating tubes also eliminate the chances of ear aches. These tubes connect the ear canal with the middle ear air space, equalizing pressure. Some infants may suffer from ear pain. Older children do but there is no evidence that the pain damages the ear. Acetaminophen and ibuprofen reduce pain.
Next posting: Infants/Air travel/safety.
When your kid(s) are invited to spend a weekend with friends or relatives, is it a fair question to ask if they keep firearms in their house? And, if yes, should you ask questions such as: are those firearms kept under lock and key, or kept in a nightstand in the bedroom in case an intruder appears? Perhaps you should also ask about BB and fake guns. These too lead to injuries and deaths of children.
Here is what you should know:
1. About 40% of accidental shootings of young children occur in the homes of friends and relatives. Chances are they will be grateful that you made them aware of the issue, especially if they do have guns but no young children at home. Likely, in their planning to give your kid(s) a good time they probably never considered their guns in view of young visitors. One way to ask: “My child is very curious. Do you have any dangerous objects like guns that he/she might get into?”
2. But even when children and guns co-exist in a home there is no guarantee that the guns are properly stored. Americans own almost 200 million guns. One in three families with children have at least one gun in the house. More than 22 million children live in homes with guns. Surveys show that more than half of the guns are not properly stored.
3. Storing guns properly is complicated. Guns should be locked in a secure location, unloaded, with the ammunition kept in a separate location. Safety devices, including gun locks, lock boxes and gun safes, should be used for every gun. Storage locations, keys and lock combinations should be hidden from children.
4. But don’t be naive. Even when you take proper precautions 8 in 10 first graders know where their parents hide their guns. And even three-year-olds are capable of firing most guns. Just recently a 3-year-old shot her father and mother in Arizona. The girl found the gun in her mother’s purse while the family was staying in a hotel.
5. Ideally, adults with young children should not keep guns. So says the American Academy of Pediatrics. With guns present, it is far more likely that a family member or visitor will be shot than an intruder. About 1,500 children younger than 18 years of age die each year from guns and many more are seriously injured.
6. Parents of teenagers are even less likely to properly store firearms than parents of young children. Suicide is a leading cause of death among teenagers, and occurs almost 10 times more commonly when guns are in the house. More than 90% of suicide attempts with a gun are deadly.
7. The National Rifle Association (NRA) opposes doctors counseling parents about guns. In Florida, the NRA lobbied to make it illegal for doctors to question patients regarding guns, citing gun owners’ rights to privacy and constitutional rights. In 2011, Florida passed the “gun-gag” law prohibiting doctors from discussing gun safety with patients. The law was upheld by a federal court. At least 10 other states have introduced similar bills. The NRA does have its own extensive program to teach gun safety to children.
8. Teaching children gun safety does not necessarily improve the outcome when children find a gun. Parents often believe their child would not touch a gun because “they have been taught better.” In fact, most children will handle a gun when they find one. While educating your children about guns is helpful, don’t become complacent. Few children younger than 8 years can tell the difference between real and fake guns, for example.
9. Realistic-looking fake guns are hazardous. Older children have been injured and killed by police and others who failed to realize that it was a child brandishing what looked like a real weapon. Many psychologists believe that all toy guns are inappropriate for children. In many jurisdictions adults face fines and jail time if a minor in their charge is found handling a real gun, even when no accidents occurs. Adults are expected to take “reasonable steps to deny access by children to guns. ” This includes gun purchase, ownership, storage, and transport, for example.”
10. BB, pellet, and paintball guns are not toys. According to the Consumer Product Safety Commission (CPSC), some of these guns can shoot at velocities that approach those of real guns at short range, causing more than 20,000 injuries and about four deaths each year, with a large percentage of injuries and deaths in children. Injuries often involve the eyes. Also children should not put caps for toy guns in their pockets: they can ignite due to friction and cause burns and loud noises that can damage hearing.
Parents: Be aware that unvaccinated children are a serious threat to your children’s health, sometimes even when your children are optimally vaccinated. And travel increases that risk. Plan family vacations so as not to return home with a souvenir you did not bargain for, a child with a serious, totally unnecessary illness. Presently, 68 unvaccinated American children (and the number is growing) have caught measles at Disneyland. These children then traveled home and spread measles to other unvaccinated children around the country. Similar outbreaks happen from time to time.
1. Illness and travel are intertwined. Many of the great epidemics of history were spread by travelers. For example, European explorers brought illnesses with them to the Americas and Africa, decimating local populations that had never been exposed to these diseases before.
2. Nowadays you need not be adventurous to be exposed to troubling diseases. No need to leave the country – that healthy looking person sitting near you on a local flight or standing near you at a theme park may be infected with a vaccine-preventable disease. With most such diseases people start spreading the disease days before they have symptoms.
3. Parents who refuse vaccinations are gullible and naive. They are taken in by non-scientific nonsense told to them by “friends” or that they read online. Controversies over vaccines are irrational. The link between measles vaccine and autism, for example, was concocted by a British physician paid large sums of money by lawyers searching for evidence to get money from pharmaceutical companies making the vaccine. The medical journal that published the report retracted the article yet gullible people still believe it.
4. Vaccination is one of the greatest achievements in the history of medicine. It saves millions of lives yearly, mostly those of children, and saves countless children from crippling and disfiguring diseases – and does so with no known serious downside.
5. Parents refusing vaccinations on religious grounds fail to see the ethical consequences of their actions. They are placing their own children and other children, both vaccinated and unvaccinated, at risk of serious, occasionally life-threatening diseases. Several small tightly-knit religious groups in the US who refused vaccines in the past have changed their opinions after children were afflicted by polio. The disease was introduced by visitors from similar groups overseas.
6. Crediting non-vaccine factors for the sharp decreases in vaccine-preventable diseases is erroneous. True, better sanitation, less crowding, and healthier diets are likely contributing factors but vaccines are by far the main reason for the decreases. Statistics bear this out.
7. The fact that most vaccine-preventable diseases are rare in this country is no reason to discontinue vaccinations. Just the opposite. Depending on the disease, the organisms continue to exist in soil, sewage, blood, and, sometimes, in perfectly healthy individuals. Only vaccines keep the diseases from resurfacing.
8. Non-vaccinated children are getting a “free ride” so to speak, from the children who are vaccinated. The more children vaccinated, the less chance that a non-vaccinated child will come in contact with someone who is infected. (You can’t have a forest fire where only a few, widely separated trees stand.)
9. Non-vaccinated children delay the day that some vaccination programs can be terminated. The only known method to permanently eliminate most childhood infectious diseases is to eradicate the causative organisms. And the only known way to do this is to vaccinate virtually every person in the world. Eliminating measles, mumps, rubella, and polio, for example, is theoretically possible – it happened with smallpox.
10. Asking to “spread out” accepted vaccination schedules is counterproductive. Experience with tens of billions of doses of vaccines given to billions of children has delineated the earliest age that vaccines are effective and the optimum number of doses necessary to yield maximum long-term protection. Achieving immunity is delayed by waiting until children are older to vaccinate, increasing the time interval between doses, or giving one vaccine at a time. A single dose of many multi-dose vaccines gives little or no protection. There is no known adverse effect from giving multiple vaccines at the same time.
11. Even recommended vaccination schedules do not completely protect children from unvaccinated children. Take measles, for example. Infants are born with immunity but this immunity wanes by 6 months or so. Measles vaccines are not given until 12 months; present vaccines do not give reliable, long-lasting protection until that age. This creates a “window” where some infants are susceptible. Vaccinating all children against measles at 12 months eliminates this loophole. A somewhat similar situation exists with pertussis (whooping cough) and a few other vaccines.
12. Non-vaccinated children become non-vaccinated adults. Many vaccine-preventable diseases – measles, mumps and rubella, for example – are far more serious for adults than for children. Before the age of vaccinations, children were infected at early ages, mainly because these diseases are so contagious. Now that most children are vaccinated, chances increase that non-vaccinated children reach adulthood without being infected and with risk of more significant problems if they do become infected.
Everyone has a threshold for motion sickness. It may be a hurricane at sea, riding camels for several hours, space travel, or “amusement” park rides that spin you in three dimensions simultaneously, often while you are strapped in upside down. Camels cause it because they sway side to side while they walk. Astronauts experience it even though they are screened, trained and medicated to deal with it. Children also have thresholds for motion sickness. Here is what you should know.
1. Consider motion sickness when infants are unusually fussy in moving cars. Most infants fall asleep in moving cars. A cause of the fussiness may that infants face backwards for safety reasons, a position known to increase motion sickness in adults. For infants with a history of fussiness in moving cars, wait until they are asleep before starting the car.
2. Children two to 12 years of age seem especially susceptible. A rough way to test kids is to have them read or draw in the back seat of a moving car. If they can do so without showing symptoms, chances are they can handle reasonable motion – airplane turbulence and merry-go-rounds, for example. Serve motion sickness-prone children small, light snacks before and during trips and offer them frequent sips of water, juice or soda.
3. Recognize early symptoms. Children with impending motion sickness lose interest in their activity – wanting to get off the merry-go-round, lying down on a ship, or curling up in their seat on a plane, for example. Next comes “queasiness” – dizziness, paleness, stomachache, sweating, headache, yawning, and rapid breathing. Take immediate action to avoid the ultimate disaster, vomiting.
4. Preventing vomiting. Distract kids with singing and word games. When possible, expose them to fresh air, well-ventilated areas, or air conditioning. Have older children breathe slowly and deeply. Indoors, tell them to close their eyes and keep their heads still. Avoid sights and odors of food. Separate them from people who are already sick, especially from people who are already vomiting.
5. Air travel. The larger the plane, the smoother the ride. Avoid propeller planes, if possible. Opt for window seats. Looking out at the horizon helps minimize symptoms. Listen to music or watch TV. Sitting over the wings or over the middle of the plane, though often suggested, does not seem to be helpful. If symptoms appear, recline seats and aim the air vent at the child’s face.
6. Sea travel. Choose the right sea voyage. Small fishing boats and yachts in open waters are problematic. For cruise vacations, choose large ships with stabilizers, smooth seas (inland waterways, for example), and calm seasons. Find cruises where ships pull up at docks rather than use small boats to bring you ashore. Cabins at the center of ships are not helpful.
7. Carsickness. If possible, raise car seats so that young children can see out the windows. Tell older children to focus on distant scenery. Stop frequently and expose them to fresh air. Also stop if children show early symptoms. Keep the car cool and well ventilated. Avoid strong odors. Fill up with gas when children are not present. If possible, avoid winding roads and frequent traffic stops. Drive during children’s usual sleeping hours. Expert opinion is divided whether watching DVDs increases, decreases, or has no effect on carsickness.
8. Amusement park rides. Merry-go-round-type rides are more troublesome than roller coasters that go up and down. Outdoor rides are better than indoor ones. Rides simulating space travel are prone to cause illness; many supply motion sickness bags. Sit facing forward. Ask ride operators if many children become ill. (Generally, they prefer losing a fare than having to clean up the mess.)
9. Medications. Over-the counter antihistamines – dimenhydrinate (Dramamine) and diphenhydramine (Benadryl), for example – help reduce incidence and severity. Read labels regarding lower age limits, dosage, and time and frequency of administration. Side effects range from sleepiness to agitation. Use these medications infrequently; they are no longer recommended for general use in young children for colds and allergies due to side effects. Injectable medications are available on cruise ships. Transderm Scop, the most frequently used medication for adults, is not approved for children because of possible side effects.
10. Other remedies. Many are available although there is little evidence that they are effective. Ginger may reduce vomiting. A diet high in carbohydrates allegedly helps. Acupuncture and acupressure applied just above the wrist is sometimes recommended.
Hey parents, stop bugging your kids with antiquated notions about keeping healthy outdoors in wintertime. True, practically none of you still hang garlic around your kids’ necks, or place slices of onion in their socks, or force-feed them cod liver oil, all to ward off cold germs. But let’s face it; some old wives’ tales are slow to fade away. And new old wives’ tales are popping up, some based on that mysterious super force, our immune system. Here is some sense to replace the “non-sense.
1. Blame our forefathers for confusing “cold” as in weather with “cold” as in illness. Understandably, they linked the two; cold and colds occurred concurrently while microorganisms were yet unknown. And, in fact, the two are linked, but indirectly, and especially concerning kids. Cold weather forces kids indoors, often into crowded daycare centers and schools, with windows shut and the heat turned up. This dries out the air and lowers humidity, conditions which allow viruses to travel farther through the air and stay viable longer. Also, low humidity dries out nasal membranes, making them more fertile ground for viruses to take hold and multiply.
2. Neither rain nor snow nor the gloom of night increases the risk of catching colds. Nor does wet hair, drafts, wearing winter clothes indoors or, within reason, being “run down” or lack of sleep. There is no need to keep kids indoors when they already have colds; doing so does not make them less susceptible to the next cold.
3. Exposure to cold does not significantly lower the body’s immune system. We’re talking about appropriately dressed kids playing in the snow or skiing/ice skating with adults checking on them from time to time. Only extreme and prolonged exposure to cold and wetness, hypothermia, causes the body’s internal (core) temperature to tumble significantly and increase susceptibility to infection.
4. Giving kids vitamins and other “immune system boosters” helps parents to feel better. Even less than optimal diets suffice to keep the immune system functioning adequately. The value of zinc and Echinacea and other health food remedies is mostly unproven. Ditto for using room humidifiers, serving foods rich in antioxidants, honey and gargling with warm water.
5. Keeping kids dry outdoors is more important than keeping them warm. Modern fabrics are so efficient in retaining heat and repelling rain/snow that perspiration through the skin can produce a pint of water in a few hours. Wearing clothing wet from perspiration or the elements is like standing naked in the cold. As perspiration increases, remove layers of clothing, open ventilation zippers, take off head coverings, unbutton jackets and take sleeves out of gloves.
6. Warm drinks have negligible effects on warming up the body. Encourage kids to drink outdoors, even when they aren’t thirsty. This compensates for fluids lost by perspiration under heavy clothing and deeper breathing. If kids like hot cocoa, fine. If they don’t, let them drink whatever else is appropriate, hot or cold. Milk does not increase mucus production. Positive effects, if any, from warm beverages are psychological.
7. Treatments for colds can be worse than the cold. Cough and cold remedies, mostly antihistamines and, dextromethorphans, are no longer recommended for children because of occasional serious side effects. (Some remedies may help adults.) Use acetaminophen and ibuprophen to reduce fever and relieve aches, but understand these do not shorten the duration of colds. The old saying, “feed colds and starve fevers” is nonsense. For young children who are playing outdoors or are involved in non-competitive sports, let them eat as they wish. With almost no exceptions, there are no poor/picky eaters. Cold weather increases the need for calories, but it increases appetite appropriately.
8. Young children in daycare/school may have cold-like symptoms much of the winter. Hundreds of cold viruses exist. Newborns have little protection against colds; immunity is acquired by infection, one virus at a time. Fortunately, many viruses cause no symptoms. In daycare/school, kids are crowded together, practice poor hygiene, and shed viruses for many days after symptoms have disappeared, longer than adults do. Illness from a single cold may last two or three weeks. In that time kids may have contracted additional viruses, extending the period of illness for a month or more. Cold viruses do not “ping-pong” back and forth within a family. A second round of colds is generally due to a new virus.
9. Kids who come inside with runny noses are not necessarily ill. The nose warms and humidifies dry inhaled air by secreting moisture. Some of this moisture reaches the cold tip of the nose and condenses into a watery discharge.
10. Flu (influenza) vaccines do not protect against colds. Flu is a specific cold-like disease but causes more severe symptoms and may lead to complications. Rarely, young children with flu require hospitalization. All children at six months of age should be vaccinated against the flu. There are no known adverse reactions to the vaccine.