Can infants and young children travel by air? Answers to frequently asked questions. An update.

1. Can healthy newborns travel by air? Healthy newborns, yes. However, two groups of infants 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 pediatricians until they reach their first birthday, even if they show no symptoms. Rarely, they have difficulty compensating for lower oxygen levels in aircraft cabins at cruising altitudes.

2. How soon after giving birth can mothers safely travel by air? The general rule: one week after uncomplicated routine deliveries, three weeks after uncomplicated C. sections. Likely, you can fly sooner. However, “What’s the rush?” Discuss your plans with your healthcare provider. How important is your trip? Air travel worsens fatigue. Are you breast-feeding? Is it going well? Are there medical facilities at your destination? In flight, drink lots of fluids, exercise your legs frequently, and walk when possible. This helps prevent blood clots from forming in your legs. Clots are rare, the result of prolonged sitting in confined spaces.

3. Is cosmic radiation a threat to infants? The increased amount of radiation at cruising altitudes compared to exposure on the ground is negligible, even on ultra-long flights, and should cause no problems. Such exposure also appears to be safe for the fetuses of women who fly occasionally. (Curtailing flight hours is recommended for pregnant flight crewmembers.)

4. Do airlines have lower age limits for infants? Only a few airlines still ask for letters from a physician stating that an infant less than two weeks of age is in good health. (The recommendation is rarely enforced.) Check your airline’s webpage (see “Infants”) or call the airline’s reservation number.

5. Are aircraft equipped to handle infant-related in-flight health issues? Problems occur extremely rarely. Flight attendants are trained in first aid and aircraft carry kits with common medications and basic lifesaving equipment. However, the equipment and medications are not infant-oriented and may be used only by licensed physicians – if one happens to be aboard and volunteers to treat. Few physicians are trained in emergency medicine, let alone treating infants in flight. In emergencies, the crew can contact specialists on the ground for advice.

6. What kind of problems occur during flight? Mostly accidents, rarely illnesses. Most accidents are preventable: infants rolling off adults’ laps; adults holding infants and tripping while walking in aisles; burns due to hot beverage spills; luggage falling from overhead bins, for example. Place infants in window seats to minimize risks. Most illnesses are ones that occur at home. Carry appropriate medication. For on-going conditions, consult the child’s health care provider prior to travel.

7. Are infants likely to contract infectious diseases? Unlikely. Infants are partially protected by immunity obtained from their mothers. Most contagious diseases spread through the air. Cabin air is replaced every few minutes with mostly sterile air. 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. Saline (salt water) nose drops restore moisture to nasal membranes and may help warding off cold-causing germs. Washing infants’ hands frequently and wiping down tray tables and toilet lavatory surfaces with disinfectants may help prevent intestinal illnesses.

8. Do infants need extra drinks to prevent dehydration? No. In-flight dehydration is a myth. Feed no more than at home. Adults erroneously interpret parched mouths/throats as dehydration. This dry feeling results from air conditioning removing moisture from the cabin air. Extra feedings are counterproductive. 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 add unnecessary bulk and air and may cause fussiness.

9. Is it OK to sedate infants for long flights? No. Surprisingly few infants cry, considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and sometimes uncomfortable positions and, if 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. Sedating medications (antihistamines, for example) make some infants more active. Herbal supplements and melatonin (a hormone that controls the body’s day/night circadian rhythm) are inappropriate for sedation.

10. Should infants with colds, nasal congestion or ear problems travel by air? Discomfort may occur, most commonly during descent. However, serious or permanent damage to ears does not seem to happen. Child-sized earplugs that claim to lessen ear pain are not very effective. Noise-cancelling headphones are safe but of questionable necessity. Decongestants and nose drops are not effective at this age. Allowing children to briefly breastfeed or suck on a bottle or pacifier may avoid or relieve symptoms. Carry acetaminophen to treat pain.

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