10 Tips: Air travel/sedating infants/right or wrong?

November 16, 2008

Posted in Safe & Healthy Travel No Comments »
Tags: Airplane, Infants, Jet lag

To sedate or not to sedate infants for air travel, that is an oft-raised question. Is it truly nobler to spurn sedatives, risk an unruly child, and bravely suffer the heartaches of stares and scorn of outraged fellow passengers?  Or is it more virtuous to sedate infants, perchance they’ll sleep, and endure the thousand humiliations that parental guilt is capable of self-inflicting?   

One way NOT to handle crying infants during air travel occurred on an Amsterdam to Detroit flight. A flight attendant was later charged with assault for allegedly putting a prescription depressant in a 19-month-old girl’s apple juice to stop her crying.  The flight attendant repeatedly offered to give the girl the juice, and the mother finally consented.  

It is not clear if the infant drank any of the juice; she did not appear to suffer any ill effects. Later the mother noticed that the juice was foamy and had blue and white specks floating in it and that it tasted bitter. Subsequent analysis revealed that the juice contained Xanax, a medication for treating anxiety. Side effects include drowsiness. In an FBI investigation, the flight attendant denied drugging the child. He no longer works for the airline. The outcome of the assault charge is not known. 

We recommend NOT sedating infants for air travel. Here’s our reasoning:

1. Contrary to general belief, few infants cry during flight. We know this from our surveys and observations – handing out questionnaires to hundreds of parents before flights, personal observations while walking the aisles on about 200 flights, and asking frequent flyers how often they are disturbed by crying infants. (We tend to recall our more exasperating flights, even if they are rare.)

2. That so few infants cry in flight is actually surprising considering that air travel disrupts their sleep and feeding schedules, they rest in unfamiliar and sometimes uncomfortable positions, and, if they are on a lap, are disturbed every time the parent moves.

3. Medicating infants solely to please parents and other passengers goes against the grain of modern medical ethics. All inconveniences are not calls for drugs. (Though there is a counter argument: If we knew infants are crying because of abdominal cramps or earaches most doctors and parents would medicate to relieve the discomfort.)

4. We do not know why some infants do cry in flight. Possibly their stomachs or ears bother them. Older children complain about their ears but usually during descent. Infants during air travel seem to cry at random times.  Our surveys indicate that infants who do cry are generally the same ones who cry excessively at home, and often at about the same hours on the clock. (And, alas, we know little about why they cry at home. Theories to explain excess crying come and go. Acid reflux is currently in vogue.)

5. Drugs commonly used for sedating infants are antihistamines, substances not designed for this purpose; sedation is a side effect, and an unpredictable one. Sedating medications are generally most effective when given prior to the event requiring sedation. Since we do not know if and when infants will cry during flights, arguably, most infants aboard would require sedating to calm the few. Little is known about the correct dosage and when to repeat it.  Several million infants travel by air each year.

6. Some infants become restless from antihistamines. Some observers believe that “criers” are the ones more likely to become agitated from antihistamines. And the concept of “trying out” medications at home in the days before the flight to see an infant’s reaction – as suggested in advice columns and books – is more dosing for dubious reasons.

7. The U.S. Federal Drug Administration and the American Academy of Pediatrics discourage using antihistamines under any circumstances in young children. These medications can cause, albeit rarely, constipation, breathing issues, and may interfere with other medications being taken.

8. Many parents inadvertently worsen infants’ crying by feeding them more often in-flight than at home “to prevent dehydration.” In-flight dehydration is a myth; it does not exist. 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.

9. Overfeeding infants during flight is counterproductive. At cruising altitudes, the air in stomachs and intestines of all passengers is already expanded by 20%, the result of lower atmospheric pressure. (This gives many adults a bloated feeling.) For infants, sucking adds more and unnecessary air and food to the stomach, and may cause fussiness.  Infants need no more feedings in flight than at home.  Sucking during ascent and descent of the aircraft may prevent earaches, but this is largely unproven.  (More about that in a future communiqué. )

10. There is no evidence that sedating infants and children on long flights lessens their jet lag. Virtually nothing is known about jetlag in these age groups. Our surveys suggest that jet lag is a minor issue. Infants and children seem to adjust to new time zones more rapidly than their parents. 

Posted in Safe & Healthy Travel No Comments »
Tags: Airplane, Infants, Jet lag