September 2, 2010
Posted in Air Travel, Outdoor Recreation, Prevention, Safe & Healthy Travel 
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Tags: Air Travel, Ear infections, ear problems, ear problems air travel, flight, Infants, pediatric travel advice, safe to travel, travel safety, young children
Ask pediatricians whether infants and young children can travel by air with ear infections and the likely answer is, no, they cannot.
Ask pediatricians if they have ever seen a child with serious ear issues resulting from air travel and the likely answer is, no, they have not.
There is virtually nothing in the medical literature to make evidence-based decisions about ear infections/air travel. And while saying “no” is prudent, it may ruin long-planned family trips. Occasionally, families are stranded on vacation, told that they cannot fly home until the infection resolves – and who knows when that is.
One reason for pediatricians saying “no” is the fear that air travel will cause pain or damage the ear. Children, as do adults, occasionally experience pain when they fly. But one small study shows that children with ear infections are less likely to have pain than children without infections. The plausible reason is that middle ear infections are often accompanied by fluid in the middle ear. Normally there is air there. And changes in atmospheric pressure during ascent and descent of the aircraft causes the air to expand and contract, both of which may cause pain. Simply stated: no air, no pain.
Ask pediatric otolaryngologists (ENTs) and aviation physicians the same questions. The vast majority has never seen a problem and would allow children with ear infections to travel by air. A small number have seen mild changes in the eardrum that were possibly related to air travel. But none contacted had personally seen or heard of a case where air travel caused serious, on-going ear pathology in this age group despite the fact that millions of children fly each year.
These findings do not mean that air travel for infants and young children with ear infections has been proven 100% safe. But the findings are based on mail surveys of more than one hundred professors of pediatric ENT at major medical centers in the US and Europe, interviews with dozens of other pediatric ENTs, from shows of hands at three conferences of aviation medicine physicians and at numerous pediatric meetings – and from fifty years of intense personal involvement in pediatrics and travel medicine. These findings seem sufficient to warrant questioning conventional wisdom and starting a dialogue on this subject.
What do you think? Send your comments to travhealth@AOL.com
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August 23, 2010
Posted in Prevention, Safe & Healthy Travel Comments Off
Tags: backyard pools, bathing caps, canal opening, chlorinated swimming pools, ear discomfort, ear drainage, ear drops, ear infection, ear wax, earache, eardrum, earlobe, fungi, hot tubs, medical care, muffled hearing. bacteria, non-chlorinated, oral antibiotics, outer ear canal, recreational water, salt water, skin lining the outer ear canal, swimmers earplugs, swimmer’s ear, whirlpools
When children complain of ear discomfort in the summertime, chances are that they have swimmer’s ear, a condition important for you, the parent, to recognize. Early treatment can save you from a few days of having a very unhappy child on your hands and, perhaps, from having to seek medical care and all the hassle that entails.
Here is what you should know:
1. Swimmer’s ear is an infection of the outer ear canal. The canal extends inward for about an inch or so and ends abruptly at the eardrum. If pulling down on the earlobe or pressing on the canal opening causes pain, it is nearly always a case of swimmer’s ear. Other early symptoms include increasing discomfort, drainage, and muffled hearing.
2. Where you swim determine the odds of becoming infected. Swimmer’s ear is caused by bacteria and fungi that are plentiful in non-chlorinated recreational water such as lakes and streams, particularly polluted ones, and in poorly chlorinated swimming pools, hot tubs and whirlpools. Backyard pools are common culprits. Chances of becoming infected are considerably smaller in optimally chlorinated pools and in the ocean. Salt water retards the growth of these organisms.
3. Infection is due to organisms invading the skin lining the outer ear canal. Prolonged exposure to contaminated water, continuing moisture in the ear canal and high humidity allow these organisms to flourish. In temperate climates, cases of swimmer’s ear are far less common in non-summer months when kids swim less often, backyard pools stand empty, and the air tends to be dryer.
4. Damaged skin is more likely to become infected. Skin lining the outer ear canal is very thin, taut and tightly attached to the underlying bone, therefore easily damaged. Skin elsewhere moves more freely. The more damaged the skin, the fewer organisms necessary to cause infection.
5. Even a cotton tip applicator can abrade this skin. Moreover, cotton applicators push wax deeper into the canal and remove the thin layers of wax that helps protect the skin from moisture. Clumps of wax can solidify and develop sharp edges capable of damaging the skin. Instruct children not to try to remove wax or relieve discomfort with paper clips, hairpins, fingernails or similar objects. (An old tongue-in-cheek saying is: the only object to insert into an ear is an elbow.)
6. Wearing earplugs for swimming is controversial. If they fit well, they do keep moisture out of the ear canal. However, poorly fitting ones – which most are – allow moisture in and may abrade the skin. Competitive swimmers wear earplugs specifically molded for their ears.
7. Swimmer’s ear may occur in non-swimmers. Repeated water in the ear, perhaps from frequent and prolonged showers and baths, damaged skin in the canal, hard wax and a few stray organisms, suffice to cause infection in susceptible individuals.
8. Dry the ear canal as soon as symptoms occur. Use equal parts of rubbing alcohol and acetic acid (vinegar), prepared at home or available as eardrops in drug stores. This mixture is also a mild antibacterial/antifungal agent. Hair dryers aimed at the ears are also effective. Bathing caps and cotton in the ears interferes with drying.
9. Apply drops correctly. Have children lie on their side and pour the alcohol/acetic acid solution into the ear until the canal is full. Have them lie there for five minutes. Do the other side, if necessary. Do this several times a day. Continue until several days after the pain is gone. For children with previous swimmer’s ear, apply drops before and after each time they swim. Note: do not use eardrops if a child has a perforation of the eardrum or other serious, ongoing ear problems.
10. Seek medical help if pain is severe or symptoms continue. Occasionally cases of swimmer’s ear require eardrops containing other substances: specific antibiotics, an anesthetic for pain, and steroids to promote healing and decrease swelling. Such eardrops need prescriptions. Sometimes debris (such as wax) must be cleaned to allow drops to reach the damaged skin. Rarely, oral antibiotics are necessary.
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August 12, 2010
Posted in Air Travel, Destinations, Outdoor Recreation, Safe & Healthy Travel, Travel No Comments »
Blame well-meaning parents for many an infant’s miserable air travel.
Conventional wisdom says that infants become dehydrated in flight unless you keep pouring fluids into them. Columnists write, “Make infants drink a bottle for every hour in the air.” “Never let a flight attendant pass by without asking for fluids.” “Make them drink, drink, drink.”
In-flight dehydration is a myth. Solid medical evidence says it does not exist. Adults 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.
Dehydration occurs with severe vomiting and diarrhea, heavy exercising in a hot environment, profuse sweating, and no access to fluids. Air travelers are at rest, in a cool environment and not ill. Fluids are available.
Adults are advised to drink at least eight ounces of fluids for each hour of flying. For adults, this is not harmful. It may even be beneficial, in a roundabout way – it forces them to walk to the lavatory and wait on line. This helps minimizes swollen feet.
But pouring fluids into infants is counterproductive. At cruising altitudes of jet aircraft the lower atmospheric pressure causes stomach and intestinal air to expand by about 20-30%. For adults, this merely causes mild bloating. But infants’ organs are smaller and may expand more. Add to this the bulk of the fluids and the air swallowed by sucking. At home, overfeeding makes infants irritable. Likely, in flight, overfeeding makes them feel even worse.
Advice: Feed infants no more often in flight than at home. Bottles during takeoff and landing may help prevent ear discomfort – though this is largely unproven. Stay tuned.
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August 5, 2010
Posted in Destinations, Safe & Healthy Travel, Travel No Comments »
Tags: Air Travel, Altitude, cabin air, child restraint systems, Ear infections, feeding infants, inflight, nasal allergies, newborn, safe travel, sedation, upper respiratory infections, window seat
There is nothing novel about infants traveling by air. They have been doing so since time immemorial, long before adults. Legend has it that they were “delivered” by storks, and were never the worse for their trips. Of course, stork flights skimmed rooftops, eliminating concerns of high altitude and accompanying ear issues, dehydration, and excessive stomach air. And each newborn was a sole passenger, enjoying fresh air, with no worry of acquiring illnesses from disease-causing organisms exhaled, coughed up and sneezed out by other passengers.
Here’s how to make today’s skies healthier and friendlier for your infant:
1. With a few exceptions, modern air travel is safe for newborns.
Airlines’ lower age restrictions are unnecessary for healthy infants. The rules stem from the early days of aviation when aircraft were poorly pressurized, oxygen was sometimes required, and little was known about newborn physiology.
However, infants with significant medical issues – (premature birth or heart and lung problems, for example), even if they are otherwise healthy, could have difficulty compensating for lower oxygen concentrations at cruising altitudes. Such infants should be medically cleared for air travel until at least their first birthday.
2. In-flight dehydration is a myth.
Feed infants no more fluids 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. Adults who eat and drink during flight accumulate fluid, as is evidenced by swollen legs and feet.
3. Feeding infants frequently during flight is counterproductive.
Conventional wisdom says to feed infants during ascent and descent, and often during flight. But 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.
4. Infants need not be sedated, even for long flights.
Surprisingly few infants cry in flight, 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. Moreover, 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.
5. Air travel appears to be safe for infants with upper respiratory infections and nasal allergies.
No one is sure whether infants experience ear pain in flight. (Older children occasionally do.) But there is no evidence that air travel damages infants’ ears. And while decongestant and nose drops seem to minimize ear discomfort in adults, these do not seem to help infants. Air pressure regulating earplugs do not appear to reduce ear discomfort in children.
6. Air travel is also safe for infants with ear infections.
In-flight ear pain is due to the expansion and contraction of air in the middle ear as the aircraft ascends and descends. Ear infections generally obliterate this space, eliminating the chances of pain. Aerating tubes in ears (inserted into the ears of children with frequent ear infections to drain fluid) connect the ear canal with the middle ear air space, equalizing pressure. This eliminates the chances of pain.
7. Child Restraint Systems (CRS) (Safety Seats) increase safety, but only barely.
Infants are the only items that need not be battened down for takeoff, turbulence, and landing. In case of severe turbulence or survivable crashes, a 20-pound infant sitting on your lap effectively becomes a 300-pound weight that you cannot restrain. Serious injuries have resulted.
Ideally, infants should be strapped into CRSs. But such turbulence and accidents are so rare that placing all infants in CRSs would avoid one serious injury/death every ten to twenty years. Moreover, most airlines charge full or partial fares for the seat for the CRS. Authorities conclude that mandatory CRSs use would cause sufficient families to switch to cheaper automobile travel, a more dangerous form of transportation, increasing injuries/deaths of infants.
Alternatives to CRSs are various harnesses and vests that attach to the back of the seat or to a parent. However, these are NOT universally accepted. Check with your airline. Recently, the U.S. authorities approved the Child Aviation Restraint System (CARES) for children age one year and older and weighing between 22 and 44 pounds. It consists of a harness that goes around the back of the seat and attaches to the seat belt, eliminating the need for a CRS.
8. Watch your step at airports, literally.
Holding an infant in your arms may obscure the floor immediately in front of you. Common injuries include falling over luggage and having luggage and carts fall down escalators onto you. Using an infant carrier/sling improves your view and frees your hands, making you steadier. Leave a few stairs or a short distance empty before entering an escalator or moving sidewalk. Be careful with strollers. On down escalators, the first few steps are level at the onset, forming a platform, giving you a sense of false security. For a more detailed discussion of navigating airports with infants and children, see http://kidstraveldoc.com/wordpress/10-tips-navigating-airport-security-with-children/
9. Place your infants in a window seat.
About 4,000 passengers, nearly all sitting in aisle seats, are injured each year by baggage falling from overhead racks. Window seats also protect infants from flight attendants and other passengers serving or holding hot beverages; sudden movements by the aircraft or by an infant have caused infants to be burned.
10. The risk of infants contracting respiratory infections is small.
Cabin air is replaced every few minutes with air from outside (air at high altitudes is sterile) or recycled through sophisticated filters. Nevertheless, adults have contracted influenza and other infections, usually from passengers sitting nearby, and usually on long flights. 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.
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August 1, 2010
Posted in Destinations, Prevention, Safe & Healthy Travel, Travel, Vaccinations No Comments »
Tags: air travel children, air travel infants, aircraft cabin, CDC, chickenpox, contagious, disease-causing organisms, diseases transmitted, flu epidemics, ill passengers, ill travelers, in flight, infectious illness, influenza vaccination, measles, medical staff, microorganisms, mumps, passengers traveling with disease, pertussis, spreading disease, symptomatic, traveling with infants, typhoid, unvaccinated children, unvaccinated visitors, vaccinated children, vaccination children, vaccine-preventable, yellow fever
Are your children’s vaccinations up-to-date before traveling by air?
According to the Centers for Disease Control (CDC), in the past year alone there were more than 3,000 known airline passengers traveling while ill with a contagious disease.
Are your children’s vaccinations up-to-date before traveling by air?
1. The aircraft cabin environment abets the spread of disease-causing microorganisms.
Infected passengers cough up, sneeze out and exhale these organisms. Factors that favor this spread include close and prolonged contact with other passengers and, possibly, the vagaries of ventilation systems, dryness of the cabin air, and the presence of passengers originating in countries where such diseases are prevalent.
2. Likely, the number of ill passengers is far greater than the number reported. This further increases the risk of spreading disease. Some ill travelers conceal the fact that they are ill while others are in the incubation period – already contagious but not yet symptomatic and thus unaware that they are ill. The CDC recommends not traveling until 24 hours after fever subsides. But ill persons are often reluctant to cancel scheduled trips. One reason is that some airlines penalize for last-minute cancellations regardless of the reason are an additional disincentive.
3. Airport personnel can refuse boarding when passengers appear ill. But, in fact, this is rarely done. (Most people denied boarding are under the influence of alcohol or drugs.)Airport personnel are poorly trained in recognizing infectious illnesses and say it is a “hassle to get involved.” They can telephone airline medical staff for advice but the staff is rarely on the premises.
4. The CDC has guidelines for handling visibly ill passengers in flight. But the crew rarely takes action. They can ask passengers to wear surgical masks (carried on most aircraft), isolate the passengers (if room is available), contact consultants on the ground for guidance, have quarantine officers meet the aircraft on landing, and, for long flights, make unscheduled stops at a closer airport than the destination.
5. Most diseases transmitted on aircraft are vaccine-preventable. The diseases most commonly found in the CDC survey were so-called childhood diseases: measles, mumps, chickenpox and pertussis (whooping cough). Other studies, done during flu epidemics, found passengers traveling with that disease.
Optimally vaccinated children are already immune to these diseases. But an increasing number of parents refuse to vaccinate their children – though there is no known evidence that there are harmful effects.
6. Check with experts when traveling with infants. In infancy, immunity to vaccine-preventable diseases depends on many factors: the disease in question, immunity received from the mother during pregnancy, and vaccines administered to the infant. Generally routine vaccinations are started at about two months of age but infants are not fully protected until months later; many immunizations require multiple doses over many months to become protective. Sometimes, for travel, routine vaccination schedules may have to be altered, started earlier and repeated later, for example. Rarely, travel should be postponed. Decisions may depend on current disease activity at the destination.
Influenza vaccination is recommended for everyone who is six months of age and older. Influenza can be a serious disease for infants; hospitalization rates for infants from influenza approach those for the elderly.
7. Adults need vaccinations, too. Many parents who opt not to vaccinate their children erroneously believe that the so-called “childhood” diseases affect only children. Unvaccinated children become unvaccinated adults. And infected adults spread diseases. Also, for some diseases, protection from vaccine administered in childhood wanes with age; in these cases booster doses are necessary.
8. Many childhood diseases are more serious in adulthood. Compared to children, adults who do become infected are more likely to have complications, the complications tend to be more severe, and the illness may last longer, prolonging the period that the adult remains contagious and is able to spread the disease. If women become infected during pregnancy, the fetus may be adversely affected.
9. Vaccinations are especially important for overseas travel.
The lower the percentage of children vaccinated against a given disease in a country, the greater the risk of unvaccinated visitors contracting that disease. In many developing countries, many vaccines are largely unavailable. Moreover, travel to developing countries may require vaccines against diseases not seen back home (yellow fever and typhoid, for example).
10. Check vaccinations for cruises. Some conditions favoring the spread of disease-causing organisms in flight also occur on cruise ships: crowding (albeit less so than on aircraft), prolonged togetherness, common ventilation systems, and passengers from different parts of the world, for example. Also, check if vaccinations are necessary at scheduled ports-of call.
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July 26, 2010
Posted in Outdoor Recreation, Safe & Healthy Travel No Comments »
Tags: adventuring, backpack, biking, breast-feed, camping, child-carry backpack, Chris Van Tilburg, Columbia River, exploring outdoors, Health, hiking, Infants, kids, nutrition, Oregon, safety, skiing, Vancouver Island, young children
Hi Readers. This is a first for our website, a posting by someone other than myself. This posting is by Chris Van Tilburg, MD, author of Introducing Your Kids to Outdoor Adventure (Stackpole, 2005).
The question I get most often regarding adventuring with kids is, is it safe? When people read in magazines about my adventures with my two girls – canoeing the Columbia River, skiing the Chilean Andes, backpacking Vancouver Island, snorkeling in the Pacific – they think we’re crazy or, at least, that I’m crazy. Every since publication of my book, I’ve been speaking, writing, and continuing to learn about safe outdoor recreation and adventure travel with my daughters in tow. And yes, it’s safe, safer than driving to the mall.
Parents also ask me at what age it is safe to take infants hiking and camping so that they can experience – and, hopefully, enjoy – these and other outdoor recreational activities. Lots of outdoor enthusiasts want to get outside with their kids when they are still less than one year of age. But parents worry, and rightfully so, about weather, sun, insects, and other unpredictable issues.
A good time for basic trips is when kids are old enough to hold up their heads. At this age you will probably have them in a stroller or carry them in a child-carrying backpack or a front pack. Thus they need to be able to support their head on their own. Generally, this means they should be between six and nine months of age. But it’s earlier for some kids and later for others. If you aren’t sure, ask your doctor if your child is ready.
I believe that it is preferable to get started with outdoor recreational activities at an early age, though it may take additional time and energy on your part. But getting started early can also be easier in some ways. Nutrition is simple if children are breast- or bottle-feeding and you don’t need to worry about potty breaks if they are still in diapers. Rest assured that adventures will be fun and rewarding for you as a parent. And the more you go, the easier it gets. Perhaps most importantly, you will lay the groundwork for your kids to develop lifelong enthusiasm for the outdoors.
Start with something simple, like a short hike or baby jog. Short trips give you, the parent, some healthy alternatives to regular day-to-day activities, and your kids will have a blast. My kids started doing outdoor activities before they could walk. They loved having the wind in their face when they were little. Now, camping, biking, hiking and skiing are regular activities we do as a family.
I took my youngest child, Skylar, out hiking when she was six months old. Our first adventure was a two-hour hike up a popular trail in the Columbia Gorge National Scenic Area near our home in Oregon. Timing is very important. We picked a warm sunny day with a clear blue sky. I packed food and clothing in the morning. We waited to leave so we could make the 30-minute drive during Skylar’s morning nap. She slept during the drive and at the parking lot. This gave me time to get all the hiking stuff ready: child-carry backpack, diapers, wet wipes, extra clothes, hat, warm coat, snacks, water, and her musical stuffed Pooh doll. When Skylar woke, we took time to change her diaper and give her a snack in the car. Then we set off, with Skylar in the child-carry backpack.
Does everything always go smoothly? Of course not. About 30 minutes and one mile later, we stopped along the river in the sun to have a snack and point out birds and the rushing water. After another half hour of hiking, Skylar wanted to get out of the backpack. We found a warm spot in the sun where my wife could breast-feed her. When we had enough for our first adventure, we headed down the trail. On our way back, Skylar started crying for no discernable reason. The only thing that soothed her was my voice singing, or rather yelling, “The Ants Go Marching.” We sang it all the way down the trail. Skylar had a big smile on her face when we got back to the car.
But that was an exception. In fact, she had so much fun on hikes that later that winter, just before her first birthday, we took her skiing in the child-carry backpack. She loved it.
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July 18, 2010
Posted in Food & Water Precautions, Outdoor Recreation, Prevention No Comments »
Tags: barbecues, burns, campfire safety, campfires, campgrounds, children, circle of safety, coals, cooking grills, cookout-related burns, cookouts, grills, kids, kids campfire, Kids Travel Doc, kids travel doctor, marshmellows
To prevent children from being burned at cookouts, establish a “circle of safety” or a “forbidden zone” around cooking grills and campfires. Draw the line in the ground (literally, if possible) or delineate the area in some other way.
Even though such burns are preventable with reasonable precautions, each year more than 3,000 American children experience cookout-related burns sufficiently severe to require emergency room treatment. Most of these children are under five years of age. The most common scenario is a child coming into contact with coals or grills after the cooking phase of the cookout is over. Likely, adults are less vigilant in keeping children away, not realizing that grills and campfires remain hot for hours. In campfire-related burns, 70 percent occur from contact with embers, not with flames. Burns also occur when children accidentally bump into or fall against hot items while playing, small children walk barefooted or crawl onto coals, and older children participate in lighting fires.
In an Australian study, many campfire-associated burns occur the day after a campfire is in use. Eight hours after a cookout, coals are still sufficiently hot to cause severe full skin thickness burns after one second of contact. Sixteen hours after the cookout, the core temperature of the campfire is still greater than 250 degrees F.
Campfires should be doused, preferably with water. Sand and dirt are adequate in preventing fires from spreading but may help coals retain heat, and worse, conceal the coals.
Keep kids at a distance from your cookout, but don’t let them wander far. In campgrounds and at tailgate parties, more often than not, other cookouts are going on nearby, or have been only recently abandoned.
And be vigilant at marshmallow roasts. Kids place marshmallows at one end of a stick, hold the other end, and dangle the marshmallow over the fire. The longer the stick the better; it places kids further from the fire. And the fewer kids roasting at a time, the smaller is the chance of kids poking one another with the sticks.
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July 12, 2010
Posted in Food & Water Precautions, Outdoor Recreation No Comments »
Tags: bacteria, food preparation, food safety, gastrointestnal illness, irradiated food, kids, kids health, kids travel, Kids Travel Doc, kids travel doctor, kidstraveldoc.com, non-refrigerated, picnic basket, picnics, safety
Picnics/Food safety/Kids
According to the dictionary, a “picnic” is a relaxed, pleasurable event, often family-oriented, at which meals are eaten outdoors, preferably in idyllic surroundings.
The meaning of the phrase “It’s no picnic” is a non-pleasurable event. (Perhaps, referring to becoming ill from eating spoiled food at a picnic?) According to the Centers for Disease Control, meals eaten outdoors – at picnics, barbecues, or tailgating parties – are far more likely to cause intestinal illness than meals eaten in one’s house. And infants and young children are more susceptible to these illnesses than are adults.
1. Moving food preparation outdoors increases the risk of food spoilage. Think ahead. How long can non-refrigerated risky food be kept safely on hot days? Where will food preparers wash their hands? Can chefs, especially novice ones, judge when the interior of hamburgers reaches the critical temperature to destroy disease-causing organisms? How do you prevent cross-contamination?
2. Meat, fish, and dairy products frequently contain disease-causing organisms. Refrigeration keeps the number at levels sufficiently low to prevent gastrointestinal illness. Refrigeration does not kill organisms, it merely prevents them from multiplying. Interruptions in refrigeration – letting food thaw – especially in hot weather, allows organisms to multiply rapidly. Subsequent refrigeration preserves the number of organisms at the new higher level, sometimes levels sufficient to cause illness.
3. Disease-causing organisms are most often found on the surface of foods. When meats and fish thaw, the organisms mix with moisture from the food. These “juices” then drip onto other foods and food-preparing surfaces or peoples’ hands. This is known as cross-contamination. Carry substances to clean or cover surfaces (tin foil, for example) and hand sanitizers. Transport meats and fish in sealed plastic bags. Wash hands after handling raw meat and fish. Never use the same plate or surface for raw food and prepared food.
4. Consider using irradiated food. Irradiation eliminates virtually all disease-causing organisms. While irradiation is not new, it has not gained wide popularity. Extensive studies show that such food is safe to eat; it is not radioactive. Most supermarkets carry a large variety of such foods. Note that irradiated food, once opened or defrosted, like all other foods, can be contaminated subsequently from other sources.
5. Use a food thermometer for outdoor cooking. Items made of ground meat, (hamburgers and meatballs, for example) contain surface meat – with its organisms – scattered throughout. Grilling browns the outside rapidly – sometimes, before reaching critical temperatures at the center. Even centers may turn brown before critical temperatures are reached.
Numerous types of thermometers are available; familiarize yourself with one. Read instructions. Insert the thermometer into the thickest part of the food. Make sure it doesn’t touch bone, fat or gristle, which can give misleading readings. Clean the thermometer with hot, soapy water before each use. Below are the critical minimal temperatures for various foods.
6. Wicker picnic baskets are quaint but outdated. High tech, relatively inexpensive coolers – you add the ice – help keep foods safe for prolonged periods. Use large pieces of ice or frozen chemical gel, not ice cubes, which melt quickly. Transport coolers inside cars; car trunks can become very hot. Place coolers in the shade and open infrequently. Leave food items in the cooler until you need them.
7. Keep a refrigerator thermometer in the cooler. If the cooler temperature rises above 40° F (4° C) heat-sensitive dishes should be eaten within two hours; if the air temperature is higher than 90° F (32° C), eat within one hour. Bacterial count can double in fifteen minutes at high temperatures.
8. Keep all foods cool – and clean. While mayonnaise is often implicated as a source of food poisoning, the real culprits are the items the mayonnaise is mixed with – potatoes, eggs, pasta, and tuna, for example. Wash fruits and vegetables. Scrub rough melon skins and cut them with a clean knife. Organisms can be transferred from the skins to the inside by the knife. Keep melons cool after cutting.
9. Cook eggs well. Organisms may be present inside un-cracked eggs; they enter while the egg is formed in the hen.
And keep eggs clean after boiling. Organisms can pass through cracks in shell and even the pores in an intact shell. Raw eggs have a coating that prevents organisms to penetrate the shell. Boiling destroys the coating.
10. Plan to keep insects away. Most insects are merely annoying. But some – flies, for example – can carry disease-causing organisms. Choose picnic sites away from refuse and rotting fruit. Spray your site before unpacking the food – though most outdoor liquid sprays, candles and coils are of questionable efficacy. Bring tablecloths and food hoods to cover food.
| Internal Temperatures |
Centigrade |
|
| Fresh ground beef, veal, lamb, pork |
160°F |
71°C |
| Beef, veal, lamb roasts, steaks, chops: medium rare |
145°F |
63°C |
| Beef, veal, lamb roasts, steaks, chops: medium |
160°F |
71°C |
| Beef, veal, lamb roasts, steaks, chops: well done |
170°F |
77°C |
| Fresh pork roasts, steaks, chops: medium |
160°F |
71°C |
| Fresh pork roasts, steaks, chops: well done |
170°F |
77°C |
| Ham: cooked before eating |
160°F |
71°C |
| Ham: fully cooked, to reheat |
140°F |
60°C |
| Ground chicken/turkey |
165° F |
74°C |
| Whole chicken/turkey |
180° F |
82°C |
| Poultry breasts, roasts |
170° F |
77°C |
Posted in Food & Water Precautions, Outdoor Recreation No Comments »
July 3, 2010
Posted in Destinations, Prevention, Travel No Comments »
Tags: Air Travel, air travel with infants, air travelers, Diarrhea, feeding infants, in flight dehydration, in-flight comfort, infant feeding, infant health, Infants, Kids Travel Doc, kids travel doctor, sweating, Vomiting
Facts about infants/air travel/in-flight comfort/feeding:
(This is an update of an earlier posting – but bears repeating).
In-flight dehydration is a myth – and, for infants counterproductive.
Check the top twenty entries on Google regarding infants/air travel/feeding or air travel/infants/health. Nineteen say that you must give infants lots of fluids to prevent them from becoming dehydrated. One entry says that in flight dehydration is a myth – and, for infants counterproductive. That entry is ours – and unquestionably correct. Click here to see our advice for air travel with infants.
In-flight dehydration is a myth!! It doesn’t exist. Yes, it is frequently repeated by travel writers, advice columns for parents, and physicians. But that does not make it so.
Adults erroneously interpret their in-flight parched mouths and throats as dehydration. This dry feeling results from air conditioning removing most of the moisture from the cabin air.
Dehydration means that the body has lost fluid and is no longer functioning optimally. Virtually all cases of dehydration are the result of one (or more) of the following: severe and continuous vomiting and/or diarrhea, heavy exercising in a hot environment, profuse sweating, and no access to drinks.
Air travelers are at rest, in a cool environment and not ill. And fluids are available, making dehydration virtually impossible.
Yet adults are advised to drink eight ounces of fluids for each hour of air travel, and parents are told to give infants frequent bottles or breast feedings. While such advice is not harmful for adults, it may cause problems for infants. (For adults, it may even be beneficial; forcing them to walk to the lavatory which helps minimizes swollen feet. Note that swollen feet are signs that the body is retaining, not losing, fluids.
Feeding infants frequently during flight is counterproductive. At cruising altitudes, lower cabin atmospheric pressure causes air — in the cabin and in our stomachs and intestines — to expand by about 20%. For adults, this expansion causes mild bloating. But infants’ organs are far smaller. The act of sucking and the additional (and unnecessary) milk adds bulk, further expanding these organs. At home, overfeeding makes infants uncomfortable and irritable. Likely, in flight, overfeeding makes them feel even worse.
Do not feed infants more often in flight than you do at home. Bottles during takeoff and landing may be beneficial to prevent ear discomfort — but this has not been proven. Stay in touch.
Posted in Destinations, Prevention, Travel No Comments »
June 16, 2010
Posted in Prevention, Safe & Healthy Travel No Comments »
Tags: car seats, infant car seats, Infants, Kids Travel Doc
Infant cars seats – when infants are aboard – belong strapped into the back seat of cars where they prevent injuries and save lives. They do NOT belong on beds, couches, chairs or kitchen counters, says the American Academy of Pediatrics.
Car seats are not totally stable when standing alone. Sometimes they are accidentally tipped over by an adult or an older child. Older infants can wiggle sufficiently – even when properly strapped in – to topple the seat over. Moreover, some parents do not strap infants into the seats when the seat is not in a car. And if infants turn seats over onto soft surfaces (couches, for example), they may end up with their mouths against soft fabric and have difficulty breathing.
A particularly hazardous surface for infants in car seats is atop washing machines and dryers. These locations are popular with some parents – convenient while parents do the laundry and because the warmth, rhythmic noise, and vibration lulls many infants to sleep. However, the vibration of the machines can move the seats toward the edge, says the Consumer Product Safety Commission. One report cites 23 cases of injuries in such situations.
Placing seats on surfaces has resulted in more than 40,000 injuries in the past five years in the United States. More than 3,400 of the children were injured severely enough to require hospitalization. Most of the injuries were to the head, followed by broken arms and legs.
If, indeed, you must momentarily put down a car seat with the baby in it – to open your front door or car door, for example – place the seat on the floor or on the ground and make sure that there are no unfriendly animals around.
In cars, when infant seats are properly strapped in, these seats are literally life savers. They reduce the odds of a baby dying in a crash by 75%, says the American Journal of Public Health. Car accidents are the leading cause of accidental death in children older than one year of age.
Posted in Prevention, Safe & Healthy Travel No Comments »
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