Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Young Children Flying Alone: An update
Did you know that five-year old children may fly unaccompanied on major US airlines?
1. In airline parlance these children are “UMs”: unaccompanied minors. Each airline has its own rules for transporting UMs. The rules are outlined on each airline’s webpage. There are no government regulations. In Canada and the United Kingdom, children must be eight years old to fly unaccompanied.2. Typically, children between five and seven may fly alone but only on nonstop or direct flights. Children between ages 8 and 11 can fly with connections. Children 12 years and older can fly alone, just like an adult. However, many airlines will provide UM services (for a fee) for 12- to 17-year-olds, when requested. Some airlines bar UMs from “red-eye” flights (flights that depart before 5:30AM (0530) or arrive after 10PM (2200)), and small aircraft with no flight attendant aboard. Visiting grandparents or a divorced parent are common reasons for UM travel. In the US, estimates are that UMs take several million flights annually. Some UMs qualify as frequent flyers.
3. Is your child ready to be an UM? Ideally, young children should have flown accompanied by an adult before flying alone. Ask yourself if he or she is sufficiently mature to be alone, among strangers, sitting strapped in for hours in new surroundings and having to use the toilets on his or her own. (Ask flight attendants how UMs manage and they tell you that virtually all, even the youngest, “ace” the flights.) Prepare your UM for in-flight noises from engine reversal and bumps from turbulence and landings, for example; these can be scary. Make them aware that takeoff and descent can make one’s ears hurt, that swallowing or yawning several times, or chewing gum may help.
4. Planning the trip. Check the airline’s website for documents needed for dropping off and picking up children. Documents, often quite lengthy, must be filled out correctly and accompanying photos may be required. On departure day, check the local weather at connecting cities and at the destination. Airlines may not accept UMs if weather predictions are “iffy.”5. Transporting UMs is not cheap. Many carriers charge adult fares plus a surcharge of $50 to $150 each way, and sometimes for each leg of a trip. If siblings are traveling, there may be only one surcharge. Overseas trips may be more expensive and require more paperwork. Check with the consulate of the country your child is entering. An entry visa and documents signed by both parents may be necessary. Airline personnel generally assist children through security and customs.
6. Packing. Supply your UM with a small carry-on. Airline personnel will carry it, if necessary. Include snacks/meals of the child’s favorite foods. Drinks must conform to current airport security policies. Electronic games keep kids busy. (Crayons for coloring books typically end up on the floor.) Telephones are helpful for older children. Flight attendants can spot UMs returning home – they’re overloaded with too many presents. Ask grandparents and exes to send UMs home similarly to the way they arrived.
7. Dropping off UMs at the airport. Generally, you will get a special pass to accompany your child to the gate, sometimes even aboard the plane. Airline personnel will take your child onto the plane and introduce him or her to the flight attendants. Remain at the gate until about thirty minutes after takeoff in case the plane returns to the gate for mechanical or other reasons.
8. In-flight supervision is basic. Upon boarding, flight attendants introduce themselves to UMs, make them comfortable, help unpack toys, buckle seat belts and point out call buttons. They monitor UMs periodically but are not baby sitters and are not required to help feed them or take them to the toilet. (Take them to the toilet just before the flight.) One airline suggests you pack an extra set of clothing – some children vomit during turbulence – but says nothing about whether or not flight attendants will help the child change clothing. Warn children to report inappropriate advances from strangers; several such incidences have been reported.
9. Retrieving UMs on arrival. Airline personnel deplane UMs before or after other passengers and bring them to prearranged locations. The pickup persons must have their documents in order. They should make sure they go to the correct airport in areas where there is more than one and leave plenty of time for delays due to traffic and becoming lost within airports. Children scheduled for additional flights are taken to a common holding area or the gate of the next flight and assigned to a new flight attendant.10. Stranded children. If children are stranded by aircraft diversions, missed connections or failure to be picked up (usually due to misunderstandings), the airline will notify you. Such scenarios are extremely rare. If journeys cannot be completed that day, most airlines place children in hotels with an airline representative, sometimes with other UMs. If no one claims the child at the destination you will be asked to contact the designated person. The airline will help you. The airline representative will remain with the child for a reasonable length of time. If no one appears, alternatives will be discussed with you, including transporting the child back to you.
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Home Alone
Is it reasonable for parents of young children to go on a seven-day vacation if they leave their child(ren) with a competent caretaker?
Lots has been written on the subject. Google has 5,520,000 entries! No, I did not read them all. However, I did look at several dozen and read those who had thoughtful opinions. A clear majority of these authors recommend “go,” and include tips on making such vacations successful.
1. Start informing young children about your vacation plans about a week before departure. In age-appropriate language tell them where you are going, what you will be doing, and that you will return soon. Some school age children need assurance that nothing will happen to you in your absence. Younger children need to be told that your leaving them is not abandonment, punishment for misbehavior, for example. Speak to children in an upbeat, happy voice. Consider leaving them a major toy, one that will occupy much of their time in your absence.
2. Frequent contact with your child may or may not be beneficial. Skype and smart phones enable you “to almost be there.” For many children, especially between about eighteen months and five years of age, such communication can give them a sense of security. However, some children are upset by such contact. These are children who cry briefly at nursery school when parents leave, are then totally content while parents are gone, and cry briefly when parents reappear, for example. The length of time that parents are away seems unimportant, probably because many young children have a poor sense of elapsed time.
3. Avoid leaving children between six and thirteen months of age. This is the period for separation anxiety, a normal developmental stage. Before six months, infants appear unaware of their surroundings and probably do not recognize their parents (though many parents disagree). After about 13 months, infants seem to grasp that parents cannot be present continuously and do return after being out of sight.4. Some parents, more often mothers, sabotage their own vacations. They have great difficulty separating themselves from their young children and, in subtle ways, even encourage children to remain dependent on them. Symptoms may include children never being left alone, even when capable caretakers are available, and breast feed and co-sleep well into the second year. Such children are prone to experience their own separation anxiety, such as school phobia, later on. A bit of separation, cutting the umbilical cord, so to speak, may be beneficial for both parent and child.
5. All children may benefit by the occasional absence of their parents. Such experiences help build a sense of independence and maturity and how to deal with different adults. Moreover, rested and relaxed parents make better parents.
6. School-age children successfully vacation without their parents. There are no known ill effects on the millions of children who go to sleepaway camps, some for eight weeks. Generally, parents and children find such camps positive experiences, occasional homesickness notwithstanding. And most camps severely restrict contact between parents and children, allowing limited or no telephone calls, prohibiting texting, and permitting one visiting day for those staying many weeks and none for those staying a week or two. (Some camps with one visiting day are adding a second one to accommodate divorced parents.)
7. Children generally prefer routine to change. Ideally, leave children in their own home. Encourage friends, both yours and your children’s, to visit. But caretakers need not be your clone. Don’t leave rules “written in stone.” Letting kids stay up a little later and taking them for ice cream more frequently helps bonding between caretaker and child.8. Have caregivers shadow you for a day or two before you leave. This allows them to observe real life situations, temper tantrums, for example (which tend to occur less frequently when parents are away.) It also familiarizes caretakers with the nuts and bolts of the household: how car seats work, which neighbors you count on, and where food, medications, and emergency lists are kept. Tell older children, in the presence of the care taker, what their chores will be.
9. Fears that you will have a serious accident while away are unrealistic. Likely, vacations in places where you would take the children are no more risky than you driving for a night out for dinner or a movie.
10. Consider one parent one child vacation. It greatly simplifies leaving children at home. It is ideal for spending quality time with one child, especially for a parent who works long hours or often works away from home. One parent, one child vacations can be geared to the interest of that child and avoids sibling bickering. To prevent jealousy in the child left at home, schedule such vacations when children reach a certain age, concepts children understand.
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Protecting infants and young children from the sun
Parents! Take this quiz: In which month is sun protection for infants and young children especially important?
a) June b) July c) August d) September1. The (maybe surprising) answer: a) June. Many adults erroneously associate sun problems with hot weather and believe that serious sun protection is not necessary until the hot summer months of July and August. In fact, weather has nothing to do with sun intensity. In June, the sun is directly overhead and the sun shines more hours a day, resulting in more exposure. Also, in June protective tans from the previous summer have vanished, leaving children (and adults) somewhat more vulnerable to burning.
Here some facts about protecting kids:
2. Infants’ skin is especially prone to sun damage. Their skin is thinner and contains less melanin, the substance in skin that blocks harmful ultraviolet rays. Keep infants less than 6 months of age out of the sun. If exposure is unavoidable, dress them in clothing that covers their bodies. Include wide brims hats to shadow their faces. If sun exposure is unavoidable, make the exposure period brief and use the same protective measures (clothing and sunscreens) used for older children. Using sunscreens is safer than risking sunburns.3. Tanning is unhealthy. Tans are mild sunburns. The immediate damage is imperceptible. Generally, even sunburns heal promptly and leave no visible scarring. Don’t let this lull you into complacency. The sun’s ultraviolet (UV) radiation causes irreversible damage to the DNA in skin cells. The damage is cumulative for life. Deliberate tanning to prevent burning is counterproductive; frequent tanning may cause more cumulative damage than an occasional sunburn. Common skin damage includes wrinkling and skin cancer, often melanoma, a very aggressive type of cancer. One blistering sunburn in childhood or adolescence almost doubles the risk of developing a melanoma.
4. Summer vacations tend to increase sun exposure. Vacations increase time spent outdoors, often at beaches or around pools, while wearing flimsy attire. Families travel to tropical and mountain resorts where UV radiation is more intense. Traditional “protective” beach apparel – white T-shirts, for example, especially when wet – provide virtually no protection. Clothing that is virtually 100% protective is available. The more skin covered by such clothing, the greater the protection and the less the need for sunscreens. Note that bodies of water reflect UV rays, virtually doubling the amount of UV radiation reaching you. Also, UV radiation penetrates three feet (one meter) of water, placing water sport participants at higher risk.
5. Car rides can lead to unintended sun exposure. Ultraviolet Type A radiation (UV-A) penetrates car window glass and damages skin DNA, says the Skin Cancer Foundation. In the US, by law, front windshields are treated to filter out most UV-A, but side and rear windows generally aren’t. Consider buying a UV-A shield, which you can hang over any window that allows sunlight to reach the child’s car seat. Or, consider professional protective window film (but check local regulations for these). Otherwise, it’s best for infants to wear sun-protective clothing in cars.6. Familiarize yourself with the UV Index. Daily readings of sun intensity are available on the web for every location in many countries. Forecasts include predictions for the next few days and recommendations for minimizing skin damage based on the day’s sun intensity. In the US, see https://www.epa.gov/sunsafety/uv-index-1.
7. Eye protection is as important as skin protection. Infants’ eyes absorb more harmful radiation than do adults’. Ideally, infants should wear sunglasses or stay out of the sun to reduce the risk of cataracts in later life. Get sunglasses that wrap around towards the ears to protect the sensitive skin of the eyelids. Avoid “fun” or “novelty” sunglasses. These are marketed for young children for fun but offer no protection. Buy sunglasses at reputable stores that sell eyeglasses. (Convincing infants to keep sunglasses on is challenging. See kidstraveldoc.com/sunglasses for tips.)8. Other protective measures. Hats with four-inch brims help protect the eyes, neck and forehead. Being in the shade of a building but having a blue sky or fluffy white clouds directly above offers little protection. Being under a beach umbrella protects from direct radiation but allows considerable radiation reflected from water and sand. Have sunshades on strollers; some specifically block radiation. Dirt, grass and concrete reflect comparatively little radiation.
9. There is no need to expose children to the sun to maintain healthy bones. True, the sun’s UV radiation enables the skin to absorb Vitamin D. In turn, vitamin D allows the intestine to absorb calcium from food. Calcium is necessary for strong, healthy bones, especially in young children. However, studies show that the necessary exposure time to the sun to absorb Vitamin D in otherwise healthy children is so minimal that no special time period needs to be set aside for this purpose. Moreover, many foods are fortified with Vitamin D.10. African-American children also need protection from the sun. It is a misconception that children with much melanin in their skin are immune from sun damage. While the incidence of skin cancer in this group is very low, parents must be especially vigilant. The darker the skin the more difficult it is to spot skin abnormalities.
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“Flying” through the airport with young children: An update
If a car seat containing an infant is placed “just for a moment” on a non-moving conveyor belt at an airport security machine, the infant may pass through the machine.
It has happened. How? Parent places car seat on the belt. Parent turns around to take off his/her shoes or to tend to another child. Belt starts. Infant enters machine. Parent becomes hysterical. Security officer is puzzled. Infant is unharmed. Radiation, if any, is negligible. (One grandmother, traveling alone with her granddaughter, intentionally placed the infant in a baggage bin and sent her through the machine, thinking it was mandatory to do so.)
Here’s how to “fly” through airports.
1. Security screening machines are safe for infants (and pregnant women.) Modern screening techniques have been extensively studied and there are no known harmful effects. However, you do have the option to decline such screening in favor of pat-downs. On conveyor belts, low dose X-rays – of the magnitude of being out in the sun for a short time – are used to scan items. The radiation causes no known harm to milk, other foods or medications. For details on screening children in the US, see https://www.tsa.gov/travel/special-procedures/traveling-children.2. Sign up with
. For travel within the US, the Transportation Security Administration (TSA) has programs especially helpful for parents. The program allows adults and their children under the age of twelve to go to the head of the security line on domestic flights. Registering for the program requires filling out a form online, a onetime visit to a TSA office (usually at an airport) and a onetime fee. For details, see https://www.tsa.gov/precheck
3. Prepare for the screening process. Carry tickets and ID items in an easily accessible place. Empty your pockets – and those of your children – of items that set off alarms to avoid passing through the detector again or a hand search. Wear shoes that are easy to remove. Place strollers on the belt first so that they will be available first on the other side, enabling you to place your infant in the stroller while you retrieve other belongings. Consider wearing a sling carrier to hold infants, freeing your hands for other tasks.4. Instruct older children not to make comments about terrorism, weapons or explosives. Security personnel take mention of such subjects seriously, even from children, possibly resulting in delays, missed flights and (extremely rarely) fines. Authentic-looking toys and knives may cause similar problems.
5. TSA also has a website and a telephone helpline for screening children with disabilities. “TSA works closely with disability advocacy groups to help understand their needs and adapt screening procedures accordingly.” Call the helpline (1-855-787-2227) about 72 hours ahead if you’ll need specific assistance for your child. If necessary, they will arrange for personnel to assist you on your arrival at the airport.
6. Think safety! Consider using harnesses on children, especially rambunctious ones. (Ignore stares and comments from strangers. See http://kidstraveldoc.com/are-leashes-appropriate-for-children/) Harnesses prevent children from running and injuring themselves falling over luggage or darting in front of carts transporting people, and from becoming separated from parents. (At airports, lost children are quickly retrieved.) Count children if you have several in tow. Yes, parents have forgotten children at airports.
7. Avoid escalators. Injuries result from carts, luggage and strollers falling down escalators or falling over people who fail to quickly step away from escalators when getting off. Leave a few stairs empty before entering an escalator. Be careful with strollers. On down escalators, the first few steps are level at the onset, forming a platform, giving you a sense of false security. Use elevators. Wherever there are escalators there is an elevator nearby, often out of sight. Ask.8. Airport parking lots intermingle people and cars. Airport lots entail walking between cars. Drivers back in and out of spaces. Young children can be near impossible for drivers to see. Much time is spent milling about to load/unload children. Toting luggage leaves no hand to hold children. Be extra vigilant.
9. Many airports provide children-friendly facilities. Ask. They generally have playrooms, restrooms, diaper changing facilities, and breastfeeding rooms. Many airlines provide free transportation within the airport for families with children. Some airports have special attractions. Chicago O’Hare has an interactive exhibit featuring a cargo plane that needs fueling, a cockpit in a fantasy helicopter, and an air traffic control tower. San Francisco International has an aquarium and a weather-themed play area. Boston Logan has an indoor playground featuring a baggage-claim slide and an “airplane” to climb on.10. Avoid hassles at airport in foreign countries. Countries may require that all children have their own passports, proof of guardianship when only one parent is accompanying a young child, and/or proof of guardianship if a child’s surname is different from that of the accompanying adult(s). Check with your airline or the consulate office of each country you will visit. Also, carry a letter from a physician if your child is taking psychotropic medication, in case of a customs inspection. Some countries have strict regulations regarding such medications.
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Can you outsmart insects? Your kids’ health depends on it.
Part l: An update on zapping insects.
May 1, 2018. The number of diseases caused by insects, mostly mosquitoes, has tripled in recent years, and children may be especially at risk, warns the Centers for Disease Control (CDC) in a special report. No longer must you visit tropical rain forests or other faraway places to pick up Zika, West Nile, Chikungunya, dengue and other mosquito-transmitted diseases. Nowadays they may come and visit you at your home. (Your neighborhood may already be the residence of disease-causing ticks, says the CDC. We’ll discuss protection against ticks in future postings.) There are no vaccines or medications to prevent these diseases. And there are no medications to cure them.
1. Global warming is believed to be a significant factor in increasing the number of such illnesses. Mosquitoes especially wallow in warmth. A warmer environment enables them to multiply more rapidly, enlarges their habitat, and lengthens their breeding and biting seasons. Milder winters allow more of them to survive to breed and bite again next summer.2. But insects are only the messengers, so to speak. Most bites are merely annoying. It is the microorganisms that insects can harbor that are the nemeses. Many of the mosquitoes, for example, that spread disease in the tropics already exist in North America, Europe and in other temperate climates – but are not (yet?) carrying these organisms. However, if an infected traveler from the tropics – even one without symptoms – after returning home is bitten by mosquitoes capable of carrying dengue fever virus, for example, those mosquitoes can then infect subsequent persons with dengue fever. Another route of infection is an infected mosquito hitching a ride on a plane from the tropics.
3. Ridding your neighborhood of mosquitoes is your first line of defense.Repellents are secondary. While repellents are important, applying them correctly and frequently, especially on infants and young children, is time-consuming, expensive, messy, not foolproof, and may raise health issues. (Our next posting will discuss the use of repellents on children.)4. Know your local mosquitoes. Ask your local health department. Different species transmit specific diseases. Generally, seasonal biting begins soon after trees begin to bloom and ends with the first frost. Many species have specific times of day for peak biting activity. These vary from all day to around sunrise and sunset. Stay indoors at such times if a mosquito-borne disease alert is in effect.
5. Check that local authorities eliminate standing water in your neighborhood.Notify them about standing water in empty lots and near uninhabited houses. Generally, insecticides are sprayed to kill larvae in ponds, reflecting pools and other bodies of still water. Sometimes fish are placed in water to eat larvae.6. Insecticides appear to be safe for infants and children. According to the US Environmental Protection Agency, “The chemicals used in approved insecticides, when used correctly, do not pose unreasonable risk to public health and the environment. Insecticides do not cause asthma. Rarely they may cause mild, temporary eye irritation.” Some experts suggest you keep family members with serious respiratory issues indoors during sprayings. Health departments will supply dates and times.
7. Eliminate standing water on your property. Mosquitoes breed in poorly maintained swimming pools and in standing water on tarpaulins covering pools. Empty children’s wading pools at least once a week. Check for standing water in backyard toys, abandoned tires, flowerpots, trashcans, and even bottle caps.8. “Bug proof” your residence.Cover gaps in walls. Use weather stripping under doors. Check bathroom exhausts. Make sure windows and chimneys are properly screened and repair any holes. Remove piles of wet leaves from yards and roof eaves. Air conditioning and fans are effective deterrents; mosquitoes prefer still air. Fans are effective on porches and terraces.
9. Be leery of devices that claim to repel mosquitoes.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. Sound devices worn around the neck or wrist to scare away mosquitoes are not effective. “Bug lights” are not repellents but do not attract mosquitoes as many ordinary lights do.
10. Miscellaneous. Taking vitamin B or antihistamines may reduce itching from bites, making people think they are being bitten less. Avoid scented soaps, perfumes, and hair spray; these may attract biting insects. Do mosquitoes prefer biting infants? (Maybe they taste sweeter?) In fact, no one knows if infants are bitten more often. If so, it may be because infants are unable to swat them away. Place nets over strollers and playpens outdoors.For the latest information, see https://www.cdc.gov/zika/prevention/controlling-mosquitoes-at-home.html
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Children/Travel/Tootbrush/Illness. Are they related?
Can your children’s toothbrushes make them sick? Many dentists think so. And they think it’s more likely to happen on trips and vacations.1. Germs that cause upper respiratory and intestinal illnesses thrive on toothbrushes. Moisture from saliva, food particles, cellular matter derived from gums, and high humidity in bathrooms create a favorable culture medium for organisms to grow. Storing toothbrushes in toilet kits, some airtight, impedes drying, allowing organisms to multiply even more rapidly.
2. Microorganisms encountered during travel are potentially more harmful than the ones at home. As a general rule, the poorer the area you visit, the worse the sanitation, and the more likely the local organisms are different and more virulent than the ones at home. Discard toothbrushes after returning home from such trips.3. Children tend to place their toothbrushes on sink counters. Unless counters are optimally disinfected they are hotbeds for organisms, contaminated from water splattered by washing oneself or from unsanitary objects placed there, possibly even dirty diapers. Keep sink surfaces clean and dry; bathroom humidity keeps counters wet for prolonged periods. Toothbrushes should be placed on a clean washcloth or on tissue until rinsed and dry.
4. Toothbrushes and sink countertops may be contaminated from toilets. Flushing propels organisms into the air. Close toilet lid before flushing. Hand washing before and after brushing teeth further increases the level of cleanliness.5. Show children how to rinse toothbrushes under hot water and air dry them. Rinsing removes toothpaste and other debris from the toothbrush. Air dry by standing them in a holder with bristles upwards. The bristles should not touch any object, especially another toothbrush. Soaking toothbrushes in three percent hydrogen peroxide or alcohol-containing mouthwash may make them more sanitary, says the American Dental Association (ADA). And clean toothbrush holders regularly.
6. Young children tend to use the toothbrush easiest to reach, often not their own. Away from home it may be a new toothbrush, making it more difficult for children to identify which one is theirs. Have children choose a toothbrush in their favorite color for the trip.
7. Some dentists suggest that each child have their own tube of toothpaste. It’s possible for organisms on toothbrushes to be transferred to the toothpaste around the opening of the tube and then to the toothbrush of the next user. (Whether this actually happens is debatable.) The optimal way to apply toothpaste to a toothbrush is to lay the toothbrush on a clean surface. Then apply the paste from above without touching the toothbrush.8. Children tend to swallow considerable amounts of water while brushing. Adults generally do not. In areas of extremely poor sanitation tap water may be contaminated with disease-causing organisms. Use bottled water for brushing and rinsing toothbrushes in such areas.
9. Replace toothbrushes when bristles become frayed. Routinely, toothbrushes should be replaced about every three to four months, more often if they show signs of wear or after being used inappropriately – dropping them on a wet bathroom floor, for example. Worn bristles do not penetrate between the teeth.10. The ADA recommends the following:
- Use toothbrushes with soft bristles.
- Brush for about two minutes.
- Manual or powered (electric) toothbrushes are equally effective. Many children find powered toothbrushes easier to use.
- Microwaving toothbrushes or placing them in dishwashers to sanitize them may damage the bristles and is not recommended.
- Ultraviolet light, antibacterial-treated bristles and other products available to reduce organisms on toothbrushes do not appear to reduce the risk of illness.
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