Kids Travel Doc
A Pediatrician's Guide to Travel and Outdoor Recreational Activities
Disneyland/Unvaccinated children/Your children are at risk
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.
Children/Motion sickness/Prevention/Treatment
Everyone has a threshold for motion sickness. It may be a hurricane at sea, riding camels for several hours, space travel, or “amusement” park rides that spin you in three dimensions simultaneously, often while you are strapped in upside down. Camels cause it because they sway side to side while they walk. Astronauts experience it even though they are screened, trained and medicated to deal with it. Children also have thresholds for motion sickness. Here is what you should know.
1. Consider motion sickness when infants are unusually fussy in moving cars. Most infants fall asleep in moving cars. A cause of the fussiness may that infants face backwards for safety reasons, a position known to increase motion sickness in adults. For infants with a history of fussiness in moving cars, wait until they are asleep before starting the car.
2. Children two to 12 years of age seem especially susceptible. A rough way to test kids is to have them read or draw in the back seat of a moving car. If they can do so without showing symptoms, chances are they can handle reasonable motion – airplane turbulence and merry-go-rounds, for example. Serve motion sickness-prone children small, light snacks before and during trips and offer them frequent sips of water, juice or soda.3. Recognize early symptoms. Children with impending motion sickness lose interest in their activity – wanting to get off the merry-go-round, lying down on a ship, or curling up in their seat on a plane, for example. Next comes “queasiness” – dizziness, paleness, stomachache, sweating, headache, yawning, and rapid breathing. Take immediate action to avoid the ultimate disaster, vomiting.
4. Preventing vomiting. Distract kids with singing and word games. When possible, expose them to fresh air, well-ventilated areas, or air conditioning. Have older children breathe slowly and deeply. Indoors, tell them to close their eyes and keep their heads still. Avoid sights and odors of food. Separate them from people who are already sick, especially from people who are already vomiting.
5. Air travel. The larger the plane, the smoother the ride. Avoid propeller planes, if possible. Opt for window seats. Looking out at the horizon helps minimize symptoms. Listen to music or watch TV. Sitting over the wings or over the middle of the plane, though often suggested, does not seem to be helpful. If symptoms appear, recline seats and aim the air vent at the child’s face.
6. Sea travel. Choose the right sea voyage. Small fishing boats and yachts in open waters are problematic. For cruise vacations, choose large ships with stabilizers, smooth seas (inland waterways, for example), and calm seasons. Find cruises where ships pull up at docks rather than use small boats to bring you ashore. Cabins at the center of ships are not helpful.7. Carsickness. If possible, raise car seats so that young children can see out the windows. Tell older children to focus on distant scenery. Stop frequently and expose them to fresh air. Also stop if children show early symptoms. Keep the car cool and well ventilated. Avoid strong odors. Fill up with gas when children are not present. If possible, avoid winding roads and frequent traffic stops. Drive during children’s usual sleeping hours. Expert opinion is divided whether watching DVDs increases, decreases, or has no effect on carsickness.
8. Amusement park rides. Merry-go-round-type rides are more troublesome than roller coasters that go up and down. Outdoor rides are better than indoor ones. Rides simulating space travel are prone to cause illness; many supply motion sickness bags. Sit facing forward. Ask ride operators if many children become ill. (Generally, they prefer losing a fare than having to clean up the mess.)
9. Medications. Over-the counter antihistamines – dimenhydrinate (Dramamine) and diphenhydramine (Benadryl), for example – help reduce incidence and severity. Read labels regarding lower age limits, dosage, and time and frequency of administration. Side effects range from sleepiness to agitation. Use these medications infrequently; they are no longer recommended for general use in young children for colds and allergies due to side effects. Injectable medications are available on cruise ships. Transderm Scop, the most frequently used medication for adults, is not approved for children because of possible side effects. 10. Other remedies. Many are available although there is little evidence that they are effective. Ginger may reduce vomiting. A diet high in carbohydrates allegedly helps. Acupuncture and acupressure applied just above the wrist is sometimes recommended.
Debunking Old Wives’ Tales: Children/Colds/Playing Outside
Hey parents, stop bugging your kids with antiquated notions about keeping healthy outdoors in wintertime. True, practically none of you still hang garlic around your kids’ necks, or place slices of onion in their socks, or force-feed them cod liver oil, all to ward off cold germs. But let’s face it; some old wives’ tales are slow to fade away. And new old wives’ tales are popping up, some based on that mysterious super force, our immune system. Here is some sense to replace the “non-sense.
1. Blame our forefathers for confusing “cold” as in weather with “cold” as in illness. Understandably, they linked the two; cold and colds occurred concurrently while microorganisms were yet unknown. And, in fact, the two are linked, but indirectly, and especially concerning kids. Cold weather forces kids indoors, often into crowded daycare centers and schools, with windows shut and the heat turned up. This dries out the air and lowers humidity, conditions which allow viruses to travel farther through the air and stay viable longer. Also, low humidity dries out nasal membranes, making them more fertile ground for viruses to take hold and multiply.2. Neither rain nor snow nor the gloom of night increases the risk of catching colds. Nor does wet hair, drafts, wearing winter clothes indoors or, within reason, being “run down” or lack of sleep. There is no need to keep kids indoors when they already have colds; doing so does not make them less susceptible to the next cold.
3. Exposure to cold does not significantly lower the body’s immune system. We’re talking about appropriately dressed kids playing in the snow or skiing/ice skating with adults checking on them from time to time. Only extreme and prolonged exposure to cold and wetness, hypothermia, causes the body’s internal (core) temperature to tumble significantly and increase susceptibility to infection.4. Giving kids vitamins and other “immune system boosters” helps parents to feel better. Even less than optimal diets suffice to keep the immune system functioning adequately. The value of zinc and Echinacea and other health food remedies is mostly unproven. Ditto for using room humidifiers, serving foods rich in antioxidants, honey and gargling with warm water.
5. Keeping kids dry outdoors is more important than keeping them warm. Modern fabrics are so efficient in retaining heat and repelling rain/snow that perspiration through the skin can produce a pint of water in a few hours. Wearing clothing wet from perspiration or the elements is like standing naked in the cold. As perspiration increases, remove layers of clothing, open ventilation zippers, take off head coverings, unbutton jackets and take sleeves out of gloves.6. Warm drinks have negligible effects on warming up the body. Encourage kids to drink outdoors, even when they aren’t thirsty. This compensates for fluids lost by perspiration under heavy clothing and deeper breathing. If kids like hot cocoa, fine. If they don’t, let them drink whatever else is appropriate, hot or cold. Milk does not increase mucus production. Positive effects, if any, from warm beverages are psychological.
7. Treatments for colds can be worse than the cold. Cough and cold remedies, mostly antihistamines and, dextromethorphans, are no longer recommended for children because of occasional serious side effects. (Some remedies may help adults.) Use acetaminophen and ibuprophen to reduce fever and relieve aches, but understand these do not shorten the duration of colds. The old saying, “feed colds and starve fevers” is nonsense. For young children who are playing outdoors or are involved in non-competitive sports, let them eat as they wish. With almost no exceptions, there are no poor/picky eaters. Cold weather increases the need for calories, but it increases appetite appropriately.
8. Young children in daycare/school may have cold-like symptoms much of the winter. Hundreds of cold viruses exist. Newborns have little protection against colds; immunity is acquired by infection, one virus at a time. Fortunately, many viruses cause no symptoms. In daycare/school, kids are crowded together, practice poor hygiene, and shed viruses for many days after symptoms have disappeared, longer than adults do. Illness from a single cold may last two or three weeks. In that time kids may have contracted additional viruses, extending the period of illness for a month or more. Cold viruses do not “ping-pong” back and forth within a family. A second round of colds is generally due to a new virus.9. Kids who come inside with runny noses are not necessarily ill. The nose warms and humidifies dry inhaled air by secreting moisture. Some of this moisture reaches the cold tip of the nose and condenses into a watery discharge.
10. Flu (influenza) vaccines do not protect against colds. Flu is a specific cold-like disease but causes more severe symptoms and may lead to complications. Rarely, young children with flu require hospitalization. All children at six months of age should be vaccinated against the flu. There are no known adverse reactions to the vaccine.
Infant car safety seats are unsafe for infants away from cars
Infant car safety seats are life savers when correctly used, reducing traffic-related fatalities by about 70%.* But the seats are responsible for numerous problems and, rarely, deaths when inappropriately used away from cars. Moreover, car seat plus baby is heavy. Improper carrying can cause you, the carrier, needless aches and pains.1. In the US, about 10,000 infants suffer car seat-related injuries away from cars. Most of the injuries occur in infants less than 4 months of age. Head injuries are most common, followed by broken arms and legs. Of the injuries, 85% are related to falls: 65% with the infant falling out of the car seat and 15% with seat and infant falling from elevated surfaces such as shopping carts, tables, and counters.
2. Car seats are unstable when standing alone. Sometimes they are accidentally tipped over by adults or older children. Older infants can wiggle sufficiently – even when properly strapped in – to topple the seat over. Some parents neglect to strap infants in when seats are not in cars. If young infants turn seats over onto couches they may land with their mouths on soft fabric and have difficulty breathing.
3. Never place seats atop washing machines and dryers. These locations are convenient while you do the laundry; the rhythmic noise tends to lull infants to sleep. However, the vibration of the machines can move the seats towards and over the edge.4. The least dangerous place for seats is the floor or ground. When you must put the seat down, (to open the car door, for example), check the area for unfriendly animals and make sure the seat is visible to other drivers. Never place car seats on the hood or roof of the car.
5. Carrying car seats incorrectly can cause you pain. Don’t carry seats in the fold of your elbow; this may cause shoulder/neck pain or pain in your hand due to compression of the nerves in your elbow (nerves that lead to your hand). Also, carrying the seat in one hand places the seat at hip level, forcing you to bend your hip for balance and twisting your lower spine, causing lower back pain.6. Carry seats in front of you at waist height and use both hands on the handle bar. Or carry the empty seat in one hand and the baby on your shoulder with the other hand. Or use a sling carrier. Plan ahead for the shortest distance to carry. Car seats that pop into strollers are an ideal solution.
7. Car seats and shopping carts are a hazardous mix. Shopping carts have their own safety issues, injuring thousands of infants each year. Placing car seats on top of shopping carts is fraught with danger. Some shopping carts have attachments for car seats. If you use such carts, make sure that you correctly buckle the seat into the cart. A safer method is to place the seat inside the shopping cart, if it fits. (However, this leaves little room for groceries.)8. Ideally, infants should not sleep in car seats. They should sleep on their backs on firm mattresses, greatly reducing the risk of SIDS (Sudden Infant Death Syndrome). But most infants sleep well in moving cars. Fortunately, cases of SIDS related to car seats have virtually disappeared. Present day seats prevent infants’ heads from flopping forward and compromising the infants’ airways. Transfer sleeping infants to a proper sleeping surface at your destination, even if doing so will wake them up.
9. Stay in touch with your car seat manufacturer. Make sure that your car seat is registered with them and that they can get in touch with you, especially if you move. Recalls of seats for safety reasons occur. Some manufacturers send out helpful safety tips and other useful information.
10. * Installing car seats properly is complicated. Three out of four parents purchase less than optimal models or install seats incorrectly. Consider consulting professionals. To find a car seat inspection center near you, go to http://www.safercar.gov/cpsApp/cps/map/findfitting.htm?q. In most cases there is no charge for the inspection.Should young infants travel by air? (An update)
No single answer fits all infants nor all situations. Moreover, the answer changes based on new findings – like the one that just came to light: apparently, very rarely, parents may accidently suffocate infants sitting on the parent’s lap.Here is what is known:
No government agency regulates the age at which newborns may fly. Each airline has its own policy. Lower age restriction on major US and international airlines vary from no restrictions to 2 days, 7 days and 14 days. Some airlines allow infants younger than the airline’s stated cutoff age to fly if parents carry a letter from a doctor. Airlines’ policies are posted on each airline’s website. No reasons are given for rulings. Recommendations are not based on flight lengths.
Overall, air travel for infants is extremely safe. Millions travel each year; only an infinitesimal percentage experience recognizable health issues. Some restrictions date from the early days of aviation when aircraft were poorly pressurized, oxygen was sometimes required, and little was known about newborn physiology.Some infants should have medical clearance before flying. Infants born with significant medical issues (prematurity or heart and lung problems, for example), even if they appear totally healthy at home, may have difficulty compensating for lower cabin oxygen concentrations at cruising altitudes. Clearance is essential until age 12 months.
Infants may suffocate when held on a parent’s lap. (Journal of Pediatric Critical Care Medicine, September 2014.) A small number of infants with no known medical issues have died during flights, with deaths more common among infants held on laps than those in their own safety seats. Possibly, the adult holding the infant fell asleep and their bodies rested on the infant’s face, blocking the infant’s airways. Some of the deaths showed similarities with SIDS (Sudden Infant Death Syndrome), infants suffocating while sleeping on their stomachs. Infants should sleep on their backs and on firm surfaces.
Infants may contract infectious diseases in flight. Air circulates in aircraft cabins from ceiling to floor, not through the entire cabin. Air is replaced every few minutes. Therefore, infants’ (and other passengers’) exposure to disease-causing organisms exhaled by passengers is limited to those sitting in nearby seats, not from the entire aircraft.An infant’s immunity to contagious disease varies. Infants inherit some immunity from their mothers but its effectiveness depends on innumerable factors and this immunity wanes over the first few months of life. Infants begin receiving immunizations at two months, but optimum immunity requires several doses of a vaccine over many months. Immunizations against other diseases (measles, for example) begin at twelve months. This leaves “windows” during the first year in which infants are vulnerable to infections. Moreover, there are no immunizations against cold-like contagious diseases. Yet very few infants are known to have become infected in-flight.
Is Ebola a threat to infants traveling by air? Probably not. In Africa, the virus shows no predilection for infecting children. Moreover, Ebola spreads by skin contact with body fluids from infected individuals, not through the air, and spreads only after the victim shows signs of illness. People ill with most other infectious diseases spread the disease-causing organisms before they themselves are ill, greatly abetting the spread of the disease.Be safety conscious. Avoid aisle seats when holding an infant on your lap. Aisle seat-related accidents include: infants’ dangling arms and legs into the aisle and being struck by food carts; burns from hot beverages spilled by flight attendants or other passengers; and luggage falling from overhead bins. Also, walk carefully in aisles while holding an infant. He or she blocks your view, sometimes resulting in you stumbling over feet protruding into the aisle.
Miscellaneous. There is no evidence that air travel damages infants’ ears – though it may cause ear pain… Use disinfectant cloths to clean seat trays and other objects that infants may touch. Some disease-causing organisms survive for days on inanimate objects. Wash infants’ hands often. Aircraft toilets (door handles and sink surfaces, for example) are likely sources of organisms… Opt for the first flight of the day, when possible. Aircraft are thoroughly cleaned during the night. During the day only trash is removed.
Are you, the mother, fit to fly? Many obstetricians recommend delaying air travel for one to two weeks after routine vaginal deliveries and three weeks after caesarian sections. Post-delivery issues that may arise include blood clotting, bleeding and infection. For both mothers and infants, check if there are competent medical facilities at your destination.
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