Protecting your kids from a dozen or so nasty childhood diseases has become a no-brainer. You take them regularly to where they get their shots and you can relax. Available vaccines are extremely safe and effective.
Protecting your kids from rabies is different – it’s up to you.
1. Rabies is caused by a virus. The virus is present in the saliva of infected animals. When a rabid animal bites, the virus is introduced into the wound, and then travels via nerve fibres to the brain, causing irreversible brain damage. Rarely, rabies spreads from the scratch of an infected animal when the paw is contaminated with that animal’s saliva.
2. Rabies leaves no room for error. Rabies is virtually 100% fatal if untreated. Optimum, prompt treatment is 100% effective. About 40,000 Americans, a majority of them, children need anti-rabies injections each year. The number of deaths from rabies in the US is down to one or two a year. For a possible exposure to a known animal – a pet cat or dog, for example – make sure that the animal’s rabies vaccination record is current.
3. Young children may be more at risk of rabies than adults. Children are attracted to animals and animals often seem to be attracted to children. Children may not report encounters with animals and, due to their size, are more likely than adults to be bitten around the head and neck. Skin in this area has numerous nerve endings, providing the virus with more pathways to the brain.
4. Instruct children to keep their distance from unknown animals. They should not pet, feed or photograph them. Hikers and bicyclers may be at increased risk. Never eat around monkeys; they may jump for food in your hands and bite/scratch you in the process.
5. Bats can cause rabies. Bat bites usually occur when victims are sleeping and in some cases victims are unaware of having been bitten. Bites are mildly painful and leave marks that may be easily overlooked. Seeing a bat in a bedroom – if you are unable to capture the bat – is sufficient reason to treat.
6. You must recognize when your child may have been exposed. Suspect all animal bites, licks and scratches until proven otherwise. Be suspicious if you find a bat inside your house or tent. Immediately report a possible exposure to rabies to your doctor, local health department or E.R. If exposure occurs overseas, especially in developing countries, check that the appropriate vaccines are available (see below).
7. Clean all bite wounds immediately and thoroughly. Wash for five minutes using plenty of soap and water. This reduces or eliminates viruses before they can enter nerve fibres. Then take the child to the nearest medical facility.
8. Experts must decide if vaccination is essential. Any mammal can be rabid. Generally, vaccination is NOT necessary if the biting animal is vaccinated, does not run wild, and is available for testing. Rabies from dogs has been virtually eliminated in the US, Canada and western Europe due to effective vaccination programs. Don’t overlook cats as a source of rabies (see kidstraveldoc.com). Check with a veterinarian before adopting stray animals. See list below of wild animals that may be rabid.
9. Optimum treatment requires two types of injections: rabies immunoglobulin (IG) and rabies vaccine. Both should be started immediately. One dose of IG provides immediate antibodies to neutralize the virus but is effective for only about a week. The vaccine requires a week to take effect. Three more doses of vaccine, given over a month, provide optimum protection.
10. Rabies treatment is safe and no more painful than other vaccines. Years ago, horse serum-derived vaccines were used. These required numerous injections, usually into the abdominal wall, were painful, and frequently caused side reactions, sometimes severe ones. In some developing countries such vaccines may still be used.
11. Rabies remains a serious problem in many developing countries. About 50,000 victims worldwide die each year, mostly in Africa, Asia, and South America. In these countries dogs are the most common source. Travellers to areas where rabies is prevalent, especially if they plan to stay for long periods or they are hikers or bicyclists, can receive preventive vaccination prior to traveling: this eliminates the need for IG, should exposure occur. In many poor countries IG is unavailable or of inferior quality. Check with your Embassy, if necessary.
Most common animals to be rabid in the US and Canada: •Racoons •Skunks •Foxes •Coyotes •Bats
Animals almost never rabid and not known to have caused human rabies in the US and Canada: •Squirrels •Rats •Mice •Hamsters •Guinea pigs •Gerbils •Chipmunks •Rabbits •Hares
New cars and new babies may be a volatile mix.
New car smells may be hazardous to humans, especially infants. That odor emanating from the interior of new automobiles, an odor that many of us inhale slowly and deeply to better enjoy the aroma, may be toxic, very toxic. A British newspaper describes the enjoyment of the smell as “akin to glue-sniffing.”
1. Most of the interior of cars is made of plastics. Many of these plastics are volatile organic compounds that give off vapors. In animals, these vapors in high doses and over long periods are linked to birth defects, liver toxicity, premature births and early puberty. While such data cannot be precisely transposed to infants who generally spend far less time in new cars, researchers suggest minimizing exposure of infants.
2. Vapors are especially high in new cars, and persist for years. In one study, the day the car was delivered some of the vapors were more than 35 times the health limit. Four months later the vapors had fallen under the limit but increased again in the hot summer months, taking three years to permanently remain below safe limits. When cars are left in the sun on hot days, the heat in the car leaches toxic vapors out of the plastics.
3. Air out new cars.* Do so especially if you transport infants. Leave the windows down whenever you can – while you’re driving, while the car is parked in your driveway, when you stop at a park.
4. Dust it out. With cars, old or new, wipe the interior with a damp cloth regularly. The dust can be loaded with contaminants like flame retardants from the seat cushions (especially if your car is older and the cushions are beginning to degrade). While toxic dust may be a long-term health risk for everyone, it is an immediate issue for kids with allergies and asthma. To further reduce dust, run vents on high for 10 minutes with the windows down.
5. Vacuum it out. Before you wipe it down, vacuum your car’s upholstery and flooring with a machine that has a HEPA (high-efficiency particulate air) filter, or use the high-powered machines available at most car washes. You’ll suck up chemically-laden dust, allergens, and the dirt that’s tracked in on your feet (that could have lead, pesticides, or gasoline mixed in).
6. Wash it out. A good microfiber cloth and plain water can do wonders for washing the interior and exterior of cars. This may be as effective as all those magical car cleaners.
7. Don’t allow kids to wash cars. No need to expose them to the toxins that may be present. Both the interior and exterior of cars can be heavily contaminated. The outside, from road dirt, bird droppings and dead bugs, for example. Gasoline residue may linger around the fuel opening.
8. Keep your distance behind diesel trucks. The fumes are sucked into your car even if you have the air conditioner on. If possible take routes with less traffic.
9. Don’t make your old car smell like a new car. Car fresheners are available that duplicate the odor of new cars – and may contain some of the problematic toxins of new cars. Manufacturers of car air fresheners do not have to post the ingredients of their products.
10. Check on all car (and room) air refreshers. Some contain the same chemicals as new car smells; these volatile products allow the smell to emanate better. Many air fresheners merely mask other smells, they do not remove them. There are industrial-strength odor eliminators available that chemically neutralize smells and remove them.
* Some of the suggestions regarding minimizing new car smells were taken from the web page of Healthy Child/Healthy World. Go to their website for more information.
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.