Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Are you teaching your kids the latest findings on hand washing?
Hand washing/drying is rapidly becoming a science, “Hand Hygiene”, with ongoing research and frequent updates in recommendations (the importance of proper hand drying, for example). Hand Hygiene is a simple, low tech, low cost method that can prevent 1 in 3 diarrhea-related illnesses and 1 in 5 respiratory infections (cold or the flu, for example). The World Health Organization has designated October 15 World Hand Washing Day.1. Learning good hand washing/drying techniques is important for young children. Cleanliness is a foreign concept for them. It is easier to learn good hygienic practices than to unlearn bad ones. Young children touch everything, play in the dirt, frequently place their fingers in their mouths, have poor toileting habits, and can be reservoirs for disease-causing microorganisms (germs). Travel, participating in outdoor activities, and attending childcare centers increase the risk.
2. Teach children to wash their hands with running water. Avoid washing in a sink or basin of standing water; this can cause re-contamination of hands. Turning faucets on and off between different phases of washing saves water and does not significantly contaminate faucets. Warm water is no more effective than cold water. Water sufficiently hot to kill organisms is too uncomfortable for everyday use and may cause skin irritation.3. Substances in soap plus the friction of rubbing hands together lifts soil and organisms from skin. Completely cover palms, back of the hands, and between fingers with lather. The process should take at least 20 seconds, the time it takes to sing the song “Happy Birthday” twice. Rinse well with running water until all lather is removed. Soaps marked “antibacterial” and “antimicrobial” do not improve outcomes when used for routine hand washing.
4. Fingernails need special attention. Organisms are often concentrated under nails. Keeping nails short eases keeping them clean. Teach children to routinely clean the accessible parts under the nails each time they wash their hands and to use a nailbrush when possible. Most children enjoy using such brushes.5. Ideally, use liquid soap with hands-free controls for dispensing. However, for everyday purposes, powdered soap and soap bars are just about as effective. Soap bars may retain some organisms from previous users. However, this is not a problem if all soap lather is removed in the rinsing process.
6. Use alcohol-based hand sanitizers containing at least 60% alcohol when soap and water are not available. Such sanitizers, when used correctly, quickly reduce the number of organisms on hands. However, they do not eliminate all diarrhea-causing ones, may not remove harmful chemicals on the skin, and are not as effective when hands are visibly dirty or greasy. Use sanitizers until soap and water become available. Store safely. Teenagers may drink sanitizers for the alcohol content.
7. Avoid non-alcohol-based hand sanitizers and sanitizers containing less than 60% alcohol. These may not kill some types of organisms but merely slow down their rate of multiplying and increasing their chances of developing resistance. Such sanitizers are also more likely to irritate skin.8. Use hand sanitizers correctly. Read labels to apply appropriate amounts. Apply to one palm and then spread the sanitizer to cover all parts of the hands. Rub hands and fingers together until hands are dry. Approved sanitizers are safe for infants, young children and pregnant women. Supervise children when using sanitizers. Children licking their hands soon after sanitizer are applied should not cause health issues. However, swallowing can be hazardous.
9. Few children dry their hands properly. Children tend to shake their hands in the air to dry them or wipe hands haphazardly against their clothing, leaving moisture and organisms on their hands. Transmission of organisms is more likely to occur when skin is moist. The friction of proper drying removes organisms that washing loosened.
10. Single-use, disposable paper towels are the preferred drying choice. Reusable cloth towels, especially when slightly moist from previous users, aid in the spread of disease. Dry until no moisture remains on the hands.For additional information, please see: Centers for Disease Control: “Hand Hygiene” at https://www.cdc.gov/handhygiene/providers/guideline.html.
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Hotel bathroom décor ranges from child-unfriendly to child-hostile
“I’ve got to go to the bathroom, very badly!”
These are often the first words you hear from your young child as you check into a hotel after many hours on the road. However, no matter how urgent their pleas and how much they jump up and down, check the bathroom first to see if it is safe for them to use alone. (Ditto when visiting friends and family.)
> At home, bathrooms are the most hazardous room in the house. (The kitchen is a close runner up.) U.S. emergency rooms annually see about 20,000 bathroom-related injuries in children less than four years of age. Many more injuries are treated elsewhere. More than 80% are due to falls and 4% are hot water-related.
> Unfamiliar bathrooms are more hazardous. Young children think that if conditions resemble ones that they are accustomed to, they are identical. They fail to recognize that subtle differences require making mental adjustments. For example, home bathroom sinks may be reachable by standing on the toilet and stretching. Elsewhere, the stretching distance may be greater, making falls more likely.
> Can the bathroom door be locked from the inside? Make sure it can’t. Kids are better at locking than unlocking. Sometimes they need you in a hurry. And even if no catastrophe occurs, merely being locked in, even for minutes, is a frightening experience.
> Children who bathe alone at home may need assistance away from home. Many modern tubs have numerous faucets, often with no markers: no ONs or OFFs, HOTs or COLDs, symbols or arrows. And it can be a guessing game where the water will come out and at what temperature. Overseas, if indeed faucets are marked, different letters may represent “Hot” and “Cold.” Spa-type tubs are inappropriate for young children due to strong sprays, water currents and excessive heat.
> Some new-fangled sinks consist of old-fashioned basins sitting atop bathroom counters. This elevates the sink another six to ten inches (15 to 25 centimeters.) Young children may have to climb onto and sit on the counter or use a stool to wash up. Some hotels supply stools at your request.
> Getting out of tubs can be tricky. Some are large, deep, and have wide sides to straddle. Grab bars help adults to maneuver but the bars may not be reachable by young children so they reach for towel racks, if present. These racks are not intended for weight bearing and can be pulled off the wall.
> Showers may be the ultimate challenge for children – and for adults! Mishaps occur when children try to hurriedly escape shower water that is too hot or too cold. Feet can get caught in shower curtains. Sometimes the messages imprinted on walls in shower stalls, while meant to be helpful, are anything but.Water Temperature. Turn the lower control to change the water temperature, up to 104 degrees Fahrenheit (40 degrees Centigrade). To increase the temperature further, press the end of the override switch on the side of the control and continue turning.
This speaks for itself.
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Is air travel safe for infants/young children? Answers to your questions
(Folklore says that infants traveled by air centuries ago and the flights were healthier than those today. Storks “delivered” infants. Storks had the wisdom to skim rooftops, eliminating concerns of high altitude and the accompanying ear issues, dehydration, and excessive stomach air. Each newborn was a sole passenger enjoying fresh rather than recirculated air, with no worry of acquiring illnesses from disease-causing organisms coughed up and sneezed out by other passengers.)1. Can healthy newborns travel by air? Yes. And the duration of the flight does not matter. However, it’s important to be aware that there are two groups of infants who require medical evaluation prior to flying: those born significantly premature and those having heart and lung issues at or soon after birth. Such infants should be evaluated by pediatric health care professionals until they reach their first birthday, even if they show no symptoms. Rarely, such infants may have difficulty compensating for lower oxygen levels at cruising altitudes.
2. Do airlines have lower age limits for infants to fly? Most major airlines no longer have such restrictions. Check your airline’s webpage (see “Infants”) or call the airline’s reservation number. A few airlines still ask for letters from a physician stating that infants less than two weeks of age are fit to fly.
3. Are aircraft equipped to handle infant-related in-flight health issues? Flight attendants are trained in first aid and aircraft carry kits with some basic life saving equipment and medications. Some of the equipment and medications can be used only by licensed physicians, if one happens to be aboard and volunteers to do so. Crews can contact specialists on the ground, and if necessary, land at the nearest airport. However, the training of crews and the equipment and the medications aboard are ill suited for infants. And most physicians are not trained in emergency medicine, let alone treating infants in flight. Fortunately, problems occur rarely.4. What kind of accidents occur during flight? Accidents outnumber illnesses. Many are preventable: infants rolling off adults’ laps; adults holding infants tripping walking in aisles; burns due to hot beverage spills; luggage falling from overhead bins, for example. See preventing accidents.
5. What kind of illnesses occur in flight? Most are routine, ones that infants and young children experience at home. Carry medications to treat them. For children with cardiac and pulmonary conditions, asthma, diabetes and other on-going conditions, consult the treating health care provider before air travel.
6. Are infants likely to contact infectious diseases? Very unlikely. Infants are partially protected by immunity obtained from their mothers. Most contagious diseases that affect infants spread through the air. Cabin air is replaced every few minutes with mostly sterile air. And air circulates from ceiling to floor, not through the entire aircraft, making passengers susceptible only to illnesses from those sitting nearby. Infants should be up-to-date with their immunizations.7. Do infants need extra drinks to prevent dehydration? No. In-flight dehydration is a myth. Feed infants no more in flight than at home. Adults erroneously interpret in-flight parched mouths and throats as dehydration. This dry feeling results from air conditioning removing most of the moisture from the cabin air.
8. Why are extra feeding in flight not advisable? At cruising altitudes the air in the stomach and intestine is already expanded by 20%, the result of lower atmospheric pressure. (This gives adult bloated feelings.) For infants, excessive liquids and solids and the act of sucking adds unnecessary bulk and air to the stomach and intestine and may cause fussiness.
9. Is it OK to sedate infants for long flights?Not a good idea. Some infants will cry whether they are medicated or not. In fact, 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 an adult’s lap, are disturbed every time the adult moves. No studies show which medications are effective and how much and when to give them. Some sedating medications (antihistamines, for example) make some infants more active.10. Should infants with upper respiratory infections, nasal congestion, and ear issues travel by air? Discomfort may occur, perhaps somewhat more often than if these symptoms did not exist. However, according to experts, serious or permanent damage to ears from flying with these symptoms does not seem to occur. [See: Young children, air travel, ear problems. ] Decongestants and nose drops/sprays do not help infants. Air pressure regulating earplugs do not reduce ear discomfort in children. Carry acetaminophen and ibuprofen to treat pain.
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Update on Poison Ivy: The Scourge of the Great Outdoors
Poison ivy is a good example for parents that if something is identified as “natural”, “organic”, “fresh” or “pure”, it is not necessarily “healthy” or “wholesome” — as advertisers and marketing people would have you believe. Poison ivy and its close cousins, poison oak and poison sumac, have no known redeeming qualities, except, perhaps, a subtle reminder from Mother Nature to watch your step, even when surrounded by nature.1. The “poisons” are a North American phenomenon. They exist only in the continental US and southern Canada. Visitors from overseas are generally unaware of the problem and baffled by the resulting rash. For them it is a traveler’s disease.
2. The plants are booby traps. The common saying about poison ivy “if the leaves are in three, let them be” helps identify only some of the plants. Many have more than three leaves and their shape, color and berries depends on the local environment and the season of the year. The same can be said for the less common poison oak and poison sumac. Moreover, many non-poisonous plants also fit these descriptions. For more detailed descriptions of these plants click here.
3. Know your poison.The chemical that causes the rash is urishiol, an oily, sticky substance. It is present in the leaves, stem and roots of the plants and remains active even in dead plants. Bruising any part of the plant releases urishiol. Susceptibility to the oil varies but few, if any, people are immune. Infants rarely get severe cases; likely it takes repeated exposure to become sensitized. Exposure to an amount of urishiol the weight of one grain of table salt causes rashes in 80 to 90 percent of adults.
4. Urishiol is rapidly absorbed into the skin.Within ten minutes, 50% of the oil is absorbed; by thirty minutes virtually all is absorbed. Wherever the oil touches the skin, a rash may appear. The more oil touching the skin, the sooner the rash appears and the more severe it will be. If you suspect exposure, wash the area immediately and thoroughly with soap and water or with rubbing alcohol. Rub the skin firmly with a washcloth. After about 30 minutes there is no reliable way of removing all of the oil.5. Urishiol can also be acquired indirectly. If shoes, clothing, toys, tools, or pets, for example, bruise plants, the oil is transferred to these objects/pets and remains viable for extended periods, sometimes (albeit rarely) years. Touching contaminated objects/pets is like touching the plant. Wear gloves to wash objects/pets. Avoid inhaling smoke from brush or wildfires; it may contain urishiol. The fumes may irritate exposed skin and, if much smoke is inhaled, damage the lungs.
6. The rashes of all three “poisons” are identical: It consists of pinhead-sized, fluid-containing blisters. The blisters are often in streaks, the result of oil-covered fingers touching the skin. Depending on the amount of oil present and the sensitivity of the victim, the rash may appear in about four hours to several days after contact and remain on the skin for several weeks.7. The rash is not contagious to others.The blister fluid is the body’s reaction to the plant. It contains no oil and cannot spread the rash to other parts of the body. Subsequent appearance of the rash on new areas of skin is the result of less urishiol having contacted that area or to a new exposure.
8. The poisons grow in forests, fields, and wetlands; along streams and roads; and in urban areas such as parks and backyards. Check playing areas for plants, especially along peripheries of sandlot baseball fields. Tell children not to touch vegetation unnecessarily. Report to authorities the presence of plants in recreational areas. Employ professional gardeners to remove plants from your property. Wearing long pants, long sleeves and high socks minimizes exposure.
9. The treatments for all three poisons is identical. However, the various home remedies reduce itching but do not substantially shorten the duration of the rash. Try cool water compresses or substances containing hydrocortisone or phenol and menthol. Not recommended are topical antihistamines or anesthetics (“caine” products, for example). These can cause rashes in some individuals. Oral antihistamines reduce itching but have side effects. Read directions. Severe cases require medical attention. Keep rashes clean with soap and water and apply antibiotic ointments to prevent secondary infections.10. Miscellaneous. Attempts to desensitize people against urishiol are ineffective. Urishiol blocking creams are not recommended for children. Such creams are applied to exposed skin before possible contact with the oil and act as a barrier, similarly to sunscreens.
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Diarrhea/Young Children/Travel
As far as young children are concerned, what does visiting equatorial Africa, attending day care/kindergarten, and swimming have in common?They increase the incidence of diarrhea in young children. However, even if your child(ren) do none of these and your house is compulsively clean you’ll still deal with several episodes a year. Are you aware that current treatment recommendations for most cases is to do nothing, that many traditional treatments worsen symptoms, and that only a small number of cases require prompt medical attention?
1. Virtually all cases are due to bacteria, viruses and other microorganisms. The organisms are ingested in contaminated food and water, drinking swimming water, and indirectly, from children placing previously contaminated hands in their mouths. Improving sanitation decreases the incidence. See related article.
2. More stools than usual or looser stools in otherwise healthy children is no reason to panic. If children have no other symptoms – are happy and active, drinking and eating normally, and not vomiting, bowel movements usually return to normal within a few days. No reason to even change diets.
3. Occasional vomiting and some stomach discomfort in otherwise healthy children calls for “watchful waiting.” In such cases, anti-vomiting medications are rarely effective or necessary. Generally, vomiting lasts only a few hours, rarely more than eight hours. A decrease in appetite is also of no concern. If occasional vomiting and diarrhea continue add more fluids to their diet. Encourage them to drink small amount at a time. Start with a tablespoon. If that is vomited, go to teaspoons. Offer liquids every ten to fifteen minutes.
4. Continue feeding breast milk, infant formula or cow’s milk. Withholding milk is unnecessary in otherwise healthy children. (Milk may worsen longstanding vomiting and diarrhea.) Diluting milk with water, another old custom, also serves no purpose.5. But avoid large amounts of plain water and very sweet fluids. Clear liquids – water, soda, tea, juice, and gelatin desserts, for example – lack salt and may slow recovery. Very sweet fluids can draw water from the body into the intestine, prolonging symptoms.
6. Resume feeding as soon as vomiting ceases.Withholding food is counterproductive. Food and liquids are essential to supply calories and may actually aid in protecting and restoring the damaged intestinal lining. The type of food is less important than previously believed. The BRAT diet (bananas, rice, applesauce, toast) is only marginally better than a child’s favorite food, whatever it is; children are more likely to eat and drink what they like. Less food intake is normal whenever children are ill.
7. Some traditional diarrheal remedies have serious side effects. Kaolin-pectate products (Kao-pectate) do reduce the number of stools. But they do so mostly by retaining stool in the intestine, giving false signs that diarrhea is improving. Bismuth-containing substances (Pepto-Bismol), loperamide (Imodium) and (atropine and diphenoxylate (Lomotil are not generally recommended for young children. Sports drinks (Gatorade) are designed to replace nutrients lost by perspiration, not specifically nutrients lost from the intestinal tract.8. If symptoms continue, start keeping records and get electrolyte solutions. Chart the frequency of vomiting, diarrhea and urination, and the amount of fluid intake. Electrolyte solutions, available in pharmacies and supermarkets, replace nutrients being lost. These solutions are available in liquid formulation or as powder in small packets. Mix with safe water. If electrolyte solutions are not immediately available, give clear fluids along with salty foods. pretzels, salted crackers or potato chips, for example.
9. Recognize impending dehydration. Seek immediate medical attention if vomiting or diarrhea become continuous; children refuse fluid or cannot retain it; are less active; run fever; complain of or show signs of severe abdominal pain; or there is blood/mucus in the stool.
10. Miscellaneous. While young children with moderate vomiting/diarrhea need no immediate treating, do isolate them from other children; keep them home from daycare and out of swimming pools so they do not infect others. Making your own rehydrating solution by mixing water, salt, sugar, and sometimes, other ingredients is no longer recommended; solutions are readily available and many parents prepare solutions incorrectly.
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Go Take a Hike: An Update
It’s all in the tone of your voice when you tell your children “Go take a hike. ” Are you telling them to leave you alone or are you recommending that they adopt a healthier lifestyle? (Hopefully it’s the latter.)1. Hiking benefits both adults and children. Hiking provides quality togetherness and helps prevents obesity, diabetes, hypertension, and a slew of other health issues. It requires little or no equipment, is a safe activity, and can be performed virtually anywhere, not only in the woods. You can “hike” in amusement parks, malls, and on city streets The earlier kids get acquainted with nature, the more likely they will continue their interest when they grow up.
2. 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 comfortable for you and appropriate for the infant’s age and size. (See infant carrier.) Outside, watch for branches and bushes. Protect their eyes from the sun, especially in snow country.3. 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.
4. Most four year olds will walk one mile (1.6 kilometers). A rule of thumb: motivated kids will walk/hike one additional mile for each year over four, i.e. three miles (4.8 kilometers) for a six year old. Factor in physical fitness, difficulty of the terrain, and weather. Compliment them on their achievements.5. 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.
6. Choose routes interesting to young children. Kids 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) or 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.
7. 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.)
8. Keep kids well hydrated and well fed.Loss of stamina occurs before thirst sets in. Encourage them to drink. Carry drinks they like. 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. “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.10. Miscellaneous. Allow kids to bring a friend along. (Adults are boring, friends are cool.) Expensive and sophisticated footwear and clothing add little to the kind of walking/hiking that children do. Have lists of supplies to carry: insect repellent, sunglasses, sunscreens, sun hats, extra clothing, a small first aid kit, and a cellular phone that works where you are hiking.
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