“I carry a light-weight blanket when I travel with my breast-fed infant. If someone seems bothered by my nursing – even though I do it discreetly – I offer them the blanket so they can cover their eyes.” (From a website on breast-feeding.)
1. No reason to curtail your travel plans because you breast-feed. Stories that travel-related stress significantly interferes with milk flow are hearsay. In fact, the alternative, bottle-feeding, is a bigger hassle, requiring you to carry formula, bottles and paraphernalia for sterilization, for example. (However, most experts say that sterilizing bottles and nipples is necessary only where sanitation is very poor.) Until infants are six months of age, exclusive breast-feeding is recommended, negating the use of solid food – which also can be problematic where sanitation is poor.
2. Restriction on breast-feeding in public, once common in the US, is now legal in 47 states and the District of Columbia. Two of the three remaining states, South Dakota and Virginia, exempt breast-feeding women from indecency and nudity laws, making breast-feeding legal. Idaho is the only state that has no laws regarding breast-feeding in public. Outside the U.S., attitudes for breast-feeding in public are far more relaxed with few, if any, restrictions. No airline restricts breast-feeding.
3. Many mothers are wrongly advised to discontinue breast-feeding for travel-related issues. Limitations on breast-feeding generally come from people, including health care professionals, who are overly cautious and not familiar with the latest findings, says the American Academy of Pediatrics. Check with lactation and travel medicine practitioners. For information on medications and breast-feeding, go to LactMed.
4. Check with your health care providers back home if you become ill while traveling. Routine illnesses virtually never require discontinuing nursing. However, being away from home, especially being overseas, tends to make illnesses seem worse than they are. Your own health care providers usually can advise you if you need to take medication or to seek medical care – or do nothing, which increasingly is the suggested cure for most minor illnesses. Carry your providers’ telephone numbers. Virtually all over-the-counter medications are safe while nursing.
5. Be fully vaccinated. Both mother and infant. Most vaccines given to mothers do not protect their infants; infants need their own age-appropriate vaccines. Only one vaccine, for preventing yellow fever, is contraindicated while nursing. This disease is limited to mostly rural areas of tropical Africa and South America. The vaccine can cause serious problems for young infants. Neither mother nor infant should receive this vaccine if the infant is less than nine months of age. Consult a travel medicine professional.
6. Overseas travel may also require changes is preventative medications. Malaria, for example, exists in large areas of tropical Central and South America, Africa, and Southeast Asia. Malaria can affect infants beginning at birth. Anti-malarial medications given to mothers do not pass through breast milk. Infants need their own medication, which may be different from that given to adults. Consult a professional.
7. Air travel. At US airports, inform security agents if you are carrying expressed breast milk in excess of the allowable 3.4 ounces (100 millimeters) for liquids. If yes, the milk will be X-rayed – which does not harm the milk. If you prefer that the expressed milk not be X-rayed, agents will pour a small amount into a container to be examined for prohibited substances. Ice packs and breast pumps are allowed in carry-on luggage. Rules governing security issues may change and vary overseas. The latest US information is available at www.tsa.gov/traveling-formula-breast-milk-and-juice.
8. Never breast-feed infants in moving cars. Infants should be securely restrained at all times – as should adults, making safe nursing virtually impossible. For example: An unrestrained mother is nursing her infant in a car going about 40 miles (63 kilometers) per an hour. The car hits another car. In a millisecond, the infant becomes the equivalent of a missile weighing hundreds of pounds and flies forward at about 40 miles per hour.
9. Travel with an infant-carrying sling. Slings help maintain breast-feeding by allowing opportunities for unrestricted nursing, help protect infants from surrounding hazards, ease the burden of carrying the infant and, because slings free the hands, simplify many travel-related tasks (boarding an airplane, for example).
10. Miscellaneous. The use of sunscreens and insect repellents by mothers has no adverse effects on the infant. However check the web regarding the use of these substances on the infant. No need for mothers to drink extra fluid during air travel. Dehydration during air travel is a myth. And no need for nursing mothers to offer infants extra fluids in hot weather. Breast-feeding suffices.
All children should learn to swim at an early age. However, there is no consensus as to the optimum age to start; guidelines vary from six months, and sometimes even younger, to four years. In addition, there are health issues to consider regarding placing infants in public pools.
♦ The number of young children taking swimming lessons is steadily increasing. At the same time, the drowning rate for this age group (and for most other age groups) has decreased by about 50% in the past twenty years. However, the two may not be related. The decrease is credited to more adults being better informed about water-related hazards.
♦ Teaching young children to swim doesn’t “drown-proof” them. Infants who swim generally do so only when an adult hovers over them, rarely when they fall into the water unseen. Moreover, their ability to swim may give some parents a false sense of security, making parents less vigilant around water, perhaps increasing the risk of drowning. An adult caretaker should be within an arm’s reach at all times.
♦ Lessons for infants younger than one year of age are controversial. Some swimming courses have websites with films showing infants performing amazing aquatic stunts with no adult in sight. Some instructors claim that the younger the infants, the greater their affinity for water, a throwback to their existence in the womb. “What your child will learn depends on their developmental readiness, but in all cases, at minimum, they will learn to roll onto their backs, float, rest, breathe, and maintain this position until help arrives.” Perhaps some infants will do this, but certainly not all.
♦ Starting swimming lessons should not be determined by age alone. The American Academy of Pediatrics has lowered their recommended minimum age from four years to one year of age. This is based on a small study that suggests that an infant’s ability to swim may help survival rates, but only slightly. The American Red Cross (ARC) recommends that lessons start at two years of age. Both the ARC and the YMCA have programs for infants age six months and older to “teach infants and parents basic aquatic safety and help infants and parents grow closer together”.
♦ One year-olds do not learn to swim in less time than three or four year-olds. Nor do they necessarily become more proficient later on. Early swimming lessons do not increase intelligence, concentration or alertness, as some programs claim. Early lessons should emphasize water safety for parents and water-related fun for both parents and infants/toddlers. (Parents rarely make good instructors for their own children.)
♦ Flotation devices save lives, when used correctly. Numerous types are available. Check the web. Many are designed to keep young children’s heads above the water. Devices should fit properly and comfortably; some are weight-specific. Toddlers should wear floatation devices when they play near the water, not only when they are in the water or on boats. Many young children who drown or near-drown were not supposed to be in the water. Note that many air-filled swimming aids and air mattresses are toys, not flotation devices These toys may deflate suddenly, or the child may slip off them.
♦ Infants should go swimming even if they do not swim. Blame the English language for the confusion. “Swimming” is synonymous with “bathing in a body of water.” Do place infants in water to acquaint them with it, helping them to overcome fears and preparing them for lessons. Start with sprinklers. Choose lukewarm pools. Let them splash with their hands. Don’t rush progress. Stay within arm’s reach. Infants can go under in split seconds, without making a sound.
♦ Skip swimming when your child is ill. And hope other parents do the same. Even in optimally maintained pools, children who place their heads in the water become ill more often than children who do not. They swallow water. The more crowded and the smaller the pool, the more likely illness will occur. Some swimming facilities insist that infants wear special swim diapers, designed to keep stool from leaking out. However, at best, swim diapers slow leakage.
♦ Miscellaneous. Strong chlorine odors are not signs of well-chlorinated pools. On the contrary, it may mean chlorination or ventilation systems are malfunctioning. Infants can drown or near drown in six inches of water, in bathtubs, fishponds, ditches, fountains, rain barrels, watering cans and bucket used to wash cars. Empty containers of water when not in use.
Safety alert! When traveling, many parents put their infants to bed in unsafe positions or locations, increasing the risk of SIDS (sudden infant death syndrome) and other injuries.
1. Safe sleeping arrangements are often difficult to duplicate away from home. Until infants are one year of age they should be put to bed on their backs on a fairly hard surface with no nearby toys or bumpers, says the American Academy of Pediatrics (AAP).
2. No exceptions to these rules. Not for one night. Not for short naps. Not if the child wakes up at night – which may occur more often away from home. When infants wake up at night, parents tend to make practical rather than sound decisions as to how to get the infant back to sleep, says the AAP. Advise baby sitters to follow the rules. One in five infants who experiences SIDS was in the care of someone other than a parent.
3. Never “co-sleep.” Infants sleeping in bed with adults have been injured when an adult rolled onto them or the infant fell off the bed – no matter how ingeniously adults tried to prevent problems. Breathing issues may occur when infants bury their heads into pillows, comforters and loose bed linen. Also, co-sleeping when traveling may make it difficult to get infants to sleep alone upon returning home.
4. Car seats are not for overnight sleeping. Infants sleep well in car seats but should never be left unattended in them. Problems that have occurred include compromised airways when the infant’s head flops onto its chest, entanglement in straps wrongly applied, and falling out of seats. Many car seats are unstable unless properly strapped into cars. (Also, infants should not sleep unattended on sofas, recliners, bouncy chairs or swings.)
Check cribs for safety in hotels and when visiting friends and relatives. Cribs should look new and have firm, tight-fitting mattresses (two fingers should not fit between the edge of the mattress and the side of the crib; a 12-ounce soda can should not fit between slats). Cribs should not have protruding parts, screws, bolts or cutouts in the head or footboard, which can trap an infant’s head or limb. Cribs with sides that slide up and down are no longer considered safe. If possible, check whether cribs have been recalled by the manufacturer for being unsafe. Recalls occur almost yearly.
6. “Heirloom” cribs and cradles may not meet current safety specifications. Stringent upgrades in crib design went into effect in 1970 and again in 2000. Very old cribs may have been painted with lead-containing paints. Cradles are popular overseas. While they are quaint, infants in cradles can roll so far to one side that the cradle topples over. Most cradles have pins to prevent this but the pins may be broken or missing.
7. Place cribs in safe locations. For older infants, avoid areas near window blinds, shades and drapes to prevent strangulation, and away from furniture that can make it easier for the infant to climb out. Place cribs either flush against the wall or several feet from the wall so that if infants do climb out they will not become wedged between the wall and the crib. Place pillows on the floor around the crib, just in case. Secure wheels.
8. On flights, try not to fall asleep with an infant on your lap. Infants have slipped off laps, landing on the floor and, very rarely, suffocated when a parent’s sleeping body rested over the child’s face. Safety officials recommend using an airline-approved safety seat. Some car seats serve this purpose but few parents use them. The seats are clumsy to carry and may require paying an extra fare.
9. Buy a portable travel crib.They’re very handy for car trips, can be used outdoors, are lightweight, fold easily and compactly, are easy to clean, and have not been used by others. Some are specific for infants of certain heights and weights and constructed so that older infants cannot easily climb out. Learn how to assemble and disassemble it. Have infants sleep in a portable crib for a week before leaving home.
10. Miscellaneous. Don’t medicate. Some sedating medications (antihistamines, for example) may make infants sleep less, as well as having other side effects. Take along your infants’ blankets, sheets and pajamas. Familiar textures and odors seem to make infants more comfortable. Don’t overdress them. Keep rooms on the cool side. Air conditioning does not cause illness. Ask hosts not to smoke. While travel necessitates change, try to follow home feeding/napping/going outdoors/bathing schedules. Avoid keeping infants awake for evening get-togethers and such. Products that claim to reduce the risk of SIDS (wedges, positioners, special mattresses, and specialized sleep surfaces) are not effective.
When traveling with children safety is no accident, especially when you’re overseas. At home, you intuitively sense hazardous situations. Away from home, you must retrain your brain to be on the lookout for hazards in new surroundings and during unfamiliar activities.
1. When checking into a hotel room, crawl around on your hands and knees. (You read correctly.) See the room from a child’s perspective. Are there reachable unprotected electric plugs, lamps that can be pulled down, or coffee tables with sharp edges, for example? Check the bathroom. Can children who bathe and shower by themselves at home operate the plumbing without scalding themselves? Can they lock themselves into the bathroom? Check the balcony. Can infants fit under the railing or between the supports that hold the railing? Do the same checking when staying with friends and family
2. Stop at visitors’ centers in rural parks. Information is available on safe activities, areas to avoid, hazards to look out for, weather forecasts, and emergency telephone numbers. In such parks, children are injured by falls, cooking fires, and getting too close to wild animals. Many children have their own cameras. Don’t let them open car windows and lean out to take pictures when large animals are nearby. Camera-related accidents also occur from going too close to thermal pools or cliffs to get better views.
3. Check the safety features of new activities. Snowmobiling, scuba diving, and parasailing, for example, require training, proper equipment, and age or size limits. Get safety information before you go. Virtually all sport activities have national associations with websites. Many accident-prone activities take place in areas with no medical services.
4. You are the safety inspector at amusement parks. There are almost no mandatory federal safety standards for the rides and state and local government oversight is often murky. Don’t let kids “please, please, please” you into letting them go on rides not intended for them – even though you’re there to please them. Be especially cautious of rides at small, seasonal parks, even more so if the rides are part of a traveling carnival. Observe rides before allowing children on them.
5. Appoint a designated “toddler watcher” at family gatherings. Especially at outdoor ones. Everyone wants to play with infants and toddlers. But when “everyone” watches them, no one is in charge, and toddlers can wander or crawl away. When not overseeing your child yourself, make sure that someone responsible is, and that they personally return the child to you.
6. Be wary of pets. No dog is totally predictable, especially ones not accustomed to children. Two-thirds of dogs that bite have no history of aggressive behavior. Toddlers may innocently incite dogs by suddenly running towards them, arms flailing and making happy noises – behavior dogs may interpret as threatening. Pets are edgy during large gatherings: owners spend less time with them, many unfamiliar people are present, and there is much activity and noise.
7. Teach young children to “Hug a Tree.” If children lose sight of you outdoors, they usually panic, look all around, and then run as fast as they can in whatever direction they happen to be facing, greatly increasing the chances of hurting themselves and complicating locating them. Teach them to stay put and that you will be right back. Avoid using the word “lost” (it seems to scare them.)
8. Have children wear life vests when playing near the water. Most children who drown or near-drown were not supposed to get wet. They wandered away from family picnics, were walking along a canal, or slipped crossing streams, for example. At pools and beaches, check if lifeguards are present (don’t rely on signs) and whether the guards are attentive. Also check the depth of the water before diving. Stated depth may not extend far from signs. Partially filled pools reduce depths.
9. Think safety at waterfront facilities. Are older children roughhousing? Are waves too high? Drowning and falling while climbing on slippery rocks are the leading causes of death and serious injuries in many national parks. Toddlers who have learned how to swim with an adult standing next to them generally panic when they fall into the water and no adult is there.
10. Stop driving when children become distractions. Crying infants and unruly children are as distracting as texting and using cell phones. For drivers this compounds the fatigue of long hours on the road, driving after long flights, and driving on unfamiliar roads. The more children in the car, the greater the likelihood of problems occurring. Take a break if children need your attention.
Your family is picnicking in a rural park about a half hour from where you parked your car. A thunderstorm sneaks up on you. What do you do?
1. The risk of being struck by lightning in the US is small: one to two per million people per year. However, this adds up to more than 400 serious incidents (often involving permanent neurological injuries) and about 50 deaths. Children are at the same risk as adults. Factors slightly increasing the risk include being in Florida, Texas or Colorado; summertime; late afternoon; rural and mountainous terrains; and being in, on, or adjacent to a body of water. Florida is considered the “lightning capital” of the country.
2. Heed thunderstorm warnings. A “thunderstorm watch” means conditions are favorable for severe weather to develop in an area; a “warning” means severe weather has been reported in the area. While meteorologists can usually predict thunderstorm activity for an area, they cannot always pinpoint where a storm will pop up and the track it will take. This results in many false alarms and makes some people weary of warnings, often ignoring them, especially when they have long-standing plans for the day.
3. Recognize the signs of an approaching storm. The sound of thunder is proof positive that lightning is sufficiently close that it can strike you imminently. While most strikes are preceded by rapidly darkening skies, strong winds and heavy rain, they can occur when the sky is blue and rain is absent. Note that in some mountainous areas thunderstorms are especially common, weather reports may be less accurate, mountains may hide approaching storms and dampen the noise of thunderclaps, and shelter may not be readily available.
4. Don’t wait to see if the storm will pass. Lightning can strike when the time from the lightning flash to the thunder crash is less than 30 seconds. Most lightning strikes involving people occur in the first ten minutes of the storm. Investigations of lightning-related injuries show that many victims chose inappropriate shelter when better ones were available or were minutes away from appropriate ones.
5. No outdoor place is totally safe from lightning. Ideally, find shelter inside solid, non-concrete four-wall structures with a roof. Concrete often contains metal wires that can attract lightning. However, the presence of electrical and telephone wiring and plumbing improves safety; wires and plumbing conduct electricity into the ground. This makes small buildings without plumbing or electricity less safe. Enclosed cars, large caves and narrow valleys are also protective.
6. Most lightning victims are hit in open fields or under a lone tree or a tree that towers over other trees. Being under many short trees gives some protection. Avoid being around flagpoles, light poles, tents, bleachers, picnic shelters, baseball dugouts, ski lifts and porches. Never use a rocky overhang for shelter.
7. If caught in a storm, avoid being the highest point. Get off elevated areas such as hills, mountain ridges or peaks. Crouch low, with as little of your body touching the ground as possible. Do not lie down. Lightning causes electric currents along the top of the ground that can be deadly over 100 feet away. Separate family members to reduce the number of people at risk. Running may help reduce the threat from ground current as it limits the time both feet are on the ground at any one time. Get out of and away from bodies of water.
8. Don’t hold objects in your hands that may contain metal. Golf clubs, fishing rods, and umbrellas can attract electricity. Stay away from wire fences, clotheslines, metal pipes, rails and other metallic objects. Cellular phones are safe to use during a storm.
9. Know when the “all clear” takes effect. The last portion of a storm is almost as hazardous as the onset. Lightning can strike after the main storm has passed and the sky is blue and there is no rain. Wait at least 30 minutes following the last roar of thunder and flash of lightning before resuming activities.
10. Miscellaneous. Up-to-the minute apps report weather activity for virtually the entire globe. People who have been struck by lightning are not “electrified” and are safe to touch. Being in your own home is not 100% safe in a thunderstorm. Stay away from windows and do not use corded telephones. See http://www.weather.gov/iln/lightningsafetyweek for detailed information.
Well-planned family trips to other countries are “surprisingly” safe and healthy, say surveys by travel medicine professionals. If problems do occur, they are more likely to be due to accidents rather than illnesses – even though there is far more information available on keeping kids healthy than on preventing accidents. The leading category of accidents is motor vehicle-related, followed by waterfront-related and falls. This posting deals with motor vehicles. Future postings will deal with the other two.
1. A comparison of the risk of motor vehicle-related deaths per 10,000 vehicles per year in representative countries. (Source: World Health Organization.)
|UK||3||Russia||19||Note that these figures are meaningful only in comparing countries. Especially in poor countries, the risk for visitors is far less than for local people. Visitors generally have access to safer transportation than do locals.|
2. Don’t drive immediately after long flights through multiple time zones. Jetlag, fatigue and lack of sleep interfere with cognitive thinking and reaction times, which are especially essential for driving on unfamiliar roads. Cranky, jetlagged children further worsen the mix. (Even at home misbehaving children are responsible for numerous accidents.)
3. Consider leaving the driving to others. Reputable local drivers can deal better with language issues, local driving customs and road conditions. Rules regarding passing, signaling and headlight use vary from country to country. Make clear to your drivers that you are in no hurry. Request safe routes rather than the fastest ones. Check vehicles for safety features for young children. Take bus tours only with reputable travel agencies.
4. Know local regulations regarding children. Rules vary from country to country. In many European countries it is mandatory to have a reflective vest for each child (and, sometimes, for adults). The vests must be worn in emergencies (if children have to stand at the side of the road, for example). Most countries have laws regulating by age, height and weight the use of baby restraints, where children may sit, the type of seatbelts that are permissible, and when airbags must be deactivated if a child sits by one. Note that height and weight measurements may be stated in centimeters and kilograms.
5. Familiarize yourself with local road conditions. In poor countries, most roads are badly designed, not properly maintained or patrolled, and have few traffic signs. Many drivers lack basic driving skills. Law enforcement is lax. Emergency medical services are inferior or nonexistent. There are ever more cars without road improvements. Driving at night is especially hazardous; some drivers turn off headlights to save fuel.
6. Don’t underestimate the hazards of driving on the “wrong” (opposite) side of the road. Problems arise when you enter a street/highway, make turns or pass other vehicles. Traffic circles (“roundabouts”), common in Britain, can be disorienting. Generally roundabouts have no signal lights, traffic moves counter clockwise, and you exit the traffic circle on the left side of the road. Avoiding errors takes total concentration.
7. Rent cars from well-known international companies. If possible, do so before leaving home.Such car rentals are more likely to have well maintained cars, provide you with the necessary documents, and supply information on what to do in case of breakdowns. Check if they have appropriate children’s restraints available or if you must bring your own. Generally, larger cars are safer but are difficult to maneuver on narrow roads.
8. Quaint local transportation may be hazardous. Riding three-wheel taxis, small open vans, pedicabs and other inexpensive, colorful local vehicles make for memorable family photos but are generally unsafe. They dart around cars and trucks and expose your family to toxic fumes from other vehicles. You must hold small children on your lap – which is dangerous if the vehicle tips over (not a rare occurrence) or is involved in a collision.
9. Think twice before allowing teenagers to use motorized bicycles, scooters and mopeds. These take practice to operate, especially on overcrowded roads. Helmets may not be available. In Bermuda, where motorized bikes are popular, visitors sustain far higher rates of injuries than locals. Mishaps occur even at low speeds. Check lower age limits for teenagers to ride such vehicles.
10. Children who cross streets safely at home may need help overseas.Crossing streets that may have no crosswalks, traffic moving on the opposite side of the road, motorbikes to dodge, and drivers who may disobey traffic signals requires consciously rethinking of well-ingrained (“kneejerk”) reactions.