October 23, 2011
Posted in Air Travel 
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Are infants likely to catch colds and other infectious diseases during air travel?
I have been asked that question hundreds of times, more than any other involving children and travel. And even though I’ve had decades in pediatrics and travel medicine to think about it, read all I could find on the subject, and talked to dozens of experts in related fields, I have no definitive answer. (What I tell parents is at the end of the article.)
Here is what we know – and mostly, what we don’t know:
1. There is nothing in the medical literature on the subject. Much of the advice in the media is simply hearsay or extrapolated from information on adults (who do become infected, but, rarely) and infants’ susceptibility to various diseases on the ground.
2. No infants were involved in known in-flight disease outbreaks. There are about a dozen documented cases where numerous passengers contracted an infectious disease (in one case, tuberculosis) from a fellow passenger. About a billion flights are taken each year worldwide and estimates are that one million are by infants less than one year of age (about one percent of passengers). With so few known outbreaks and relatively few infants traveling by air, it is very possible that, by chance, no infant was exposed.
3. Likely, many disease outbreaks are never recorded. Most infectious diseases have incubation periods of days or weeks; symptoms can’t occur during flight from illnesses caught on that flight. And, after landing, passengers scatter. Unless there are a very large number of passengers involved or it is a serious illness, an in-flight outbreak remains unknown.
The illnesses that parents claim that their children contracted in-flight were, in fact, caught days earlier, or the children are reacting to fatigue and other discomforts associated with air travel. (Disease outbreaks are frequently reported on cruise ships. The reason: passengers spend days or weeks together and see the physician aboard ship. Outbreaks on ships calling at American ports must be immediately reported to the U.S. Public Health Service.)
4. Attempts to ban individuals who are ill from traveling by air are rarely effective. Airline personnel can refuse to board an ill-appearing passenger – but rarely do so. Coordinated attempts to identify ill passengers during known epidemics, Severe Acute Respiratory Syndrome (SARS) and H1NI in recent years, were only partially successful, for several reasons. Infected individuals spread disease-causing organisms several days before symptoms surface. Some passengers travel knowing they are ill. Symptoms are fairly easy to disguise and changing travel plans at the last minute is cumbersome and, sometimes, expensive.
5. Air travel favors the spread of infectious diseases. Infected individuals exhale, cough up and sneeze out disease-causing organisms. Nearby passengers inhale the organisms. The longer the exposure, the more organisms inhaled, and the greater the risk of infection.
6. Very long flights further increase the risk of infection. Such flights further increase exposure time and, often, are to and from Asia or the Southern Hemisphere, areas where different disease causing organisms exist. SARS and HINI influenza originated in Asia. Influenza viruses in the two hemispheres differ sufficiently that there are separate vaccines for the two. People living in one hemisphere have little immunity to the influenza viruses found in the other. Young children are especially susceptible to influenza.
7. However, sophisticated ventilation systems minimize organisms in the cabin air. Air is continuously pumped into the cabin during flight. Outside air at cruising altitude is sterile and, in most aircraft, the air passes through the hot engines, killing all organisms. In the cabin, half the air passengers breathe comes from the outside and half is recirculated through hospital-grade filters, removing almost all organisms. Cabin air is exchanged numerous times per minute, more often than in most public buildings. And air circulation goes vertically, from ceiling to floor, not horizontally throughout the cabin. If an individual is traveling with a contagious disease, only passengers sitting within a row or two are exposed.
8. Risk of infection may be greatest when aircraft are on the ground. Often passengers sit in aircraft for prolonged periods before takeoff, and sometimes after landing. During such times ventilation systems may be inoperative, increasing the risk of illness. New regulations limit the time that passengers can be kept in an aircraft on the ground.
9. Airlines are required to keep seating plans after flights. If an individual is diagnosed with a serious contagious disease soon after air travel (tuberculosis or meningitis, for example), passengers who sat in nearby seats are notified of their exposure. They may need preventative medication. However, the notification system has shortcomings: sick individuala are not always reported to the proper authorities, passengers change seats during flights, and difficulty locating exposed passengers.
10. What can you, the parents, do to protect your children? Not much. Using nasal sprays may help. Cabin air is dry. Dryness prevents the hairs in the nose from killing organisms inhaled. Also, wiping down seats and trays and frequently wash children’s hands; some organisms survive for days on inanimate objects.
Products available at airports to “boost” the immune system – Echinacea, and large doses of Vitamin C and Zinc, for example – are inappropriate for young children (and probably ineffective at any age).
My opinion: Air travel is a low risk activity for healthy young children when there are no reported epidemics. The chances of contracting illness are remote, far less than at daycare, early childhood classes, and birthday parties.
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October 3, 2011
Posted in Outdoor Recreation, Prevention, Safe & Healthy Travel, Travel Comments Off
Thank you for making our website, KidsTravelDoc and our newsletter, TenTips the sources for keeping kids healthy and safe for travel and outdoor recreational activities. TenTips has almost 7,000 subscribers in about 55 countries. Our articles frequently make the top five references on Google.
In fact, we have many more readers than subscribers. Many of you forward TenTips to friends. And many physician readers (35% of subscribers) print TenTips to distribute in their offices or post on their websites.
Readers ask if they can add friends to our mailing list. Yes. Click here to do so. If you have more than one name to add, please send the list to travhealth@aol.com . (We never share or sell addresses.)
All our newsletters are indexed and updated on our website, KidsTravelDoc. Below are seven topics which may be of interest. Click on topics you want to read.
Airport/Children/ Navigating security: Avoiding hassles. (Each year several infants are accidentally placed on conveyer belts at security and pass through the machines…)
Outdoors/Sick children/Old wives’ tales/Bed rest/Fresh air: Caring for sick children is never child’s play. But outdated advice – keeping them quiet, for example, only make them more irritable – and more irritating.
Air Travel/Long flights/Children/To sedate or not sedate?: This 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?
Infants/Car safety seats/New recommendations: Just when you thought that you knew all you had to know about children’s car safety seats, the experts come up with a slew of new recommendations, forcing you to rethink what you were sure that you already knew.
Children/Animal encounters: Children may become ill from visiting petting zoos. But they also become ill in well-managed daycare centers and get hurt in modern playgrounds. You need to judge the risk/benefit ratio for any activity your child engages in.
School/Vacation/Priorities: You want to take your family to Disneyworld. You are as eager to go as they are; you’re feeling guilty. Lately you’ve spent too little time with them: work schedules and such. You find an ideal and affordable package. But they will miss three days of school. It’s a case of family bonding versus teaching kids priorities. Do you go?
Traveling/Living overseas: Children make great travelers. They are inquisitive, fun and, when motivated, adaptable and inexhaustible. Time spent overseas, whether a week in Paris or a year in a developing country, helps enrich their education, builds self-confidence, promotes family cohesiveness, and creates memories for tomorrow.
Posted in Outdoor Recreation, Prevention, Safe & Healthy Travel, Travel Comments Off
September 17, 2011
Posted in Air Travel, Safe & Healthy Travel Comments Off
Tags: Air Travel, airport screening children, airport screening kids, airport screening rules for kids, airport security checks for kids, does my child have to remove shoes at airport, effect of metal detectors on children, full body images, kid medication, metal detectors, pat-down, rules about children at airport screening, security checks kids, tsa children
Children/Airport Security/ New Rules
Good news for parents traveling by air with their children. The U.S. Transportation Security Administration (TSA) has announced that it is easing airport security screening procedures for children under the age of 12 years, and is also easing the rules for carrying liquid medications. But expect occasional exceptions to the new rules.
Here are the reasons for the new rules and the effects they will have on you and your children.
1. Children will no longer have to remove their shoes. Removing shoes during checkpoint screening was begun in 2001 when an operative tried to set off a bomb built into his shoe on a flight in December 2001. But few countries around the world adopted this requirement; countries in the European Union have never required travelers to remove their shoes. Apparently there are other methods to prevent such acts.
2. There will be fewer pat-downs of children. Screening procedures can be upsetting for young children; they are taught at an early age not to allow strangers to touch them. Screening is especially troubling for children with serious psychological and other behavioral issues.
3. Rules have been simplified for carrying liquids through security. This includes medications. You are now permitted to carry multiple liquids in quantities up to 3 oz. (100 ml) when placed in a quart (liter)-size, clear plastic, sealable bag. Medications in volumes larger than 3 oz. are permissible if placed separately and declared verbally or in writing to security personnel. A doctor’s letter explaining the medical need of the item is helpful but not essential. “Reasonable” quantities expedite checks.
4. New rules will not compromise safety. To reduce the number of pat-downs screeners will send children through metal detectors or the walk-through imaging machines multiple times to capture a clear picture, and use more explosive trace detection tools such as hand swabs.
5. New security devices are safe. There is no evidence that children will be harmed by metal detectors, even if they pass through the devices numerous times, or from hand swabs used to detect explosives.
6. Does full body screening violate children’s rights? Yes, say some child advocacy groups in the US and in Great Britain. These groups believe that screening devices that show full body images of naked children violate anti-pornography laws. Adults can refuse such screenings and accept pat-downs. Adults can make the same choice for their children.
7. Security checks of children will continue. According to counterterror experts, the psychological profile of terrorists does not rule out them using children – their own and others’ – in deadly missions, that children as young as ten years have been recruited to carry out missions, and that there is evidence that terrorists have planned to plant explosives in teddy bears and other children’s toys.
8. There will be exceptions to screening rules. And you will not be able to object if your child is asked to take off his or her shoes and is patted down, says the TSA. “There will always be some unpredictability built into the system, and there will always be random checks even for groups that we are looking at differently, such as children.” This is to help keep terrorists guessing.
Posted in Air Travel, Safe & Healthy Travel Comments Off
August 24, 2011
Posted in Destinations, Prevention, Safe & Healthy Travel Comments Off
Tags: bathroom accidents, bathroom hazards, bathroom safety children, children safety, Dr. Karl Neumann, hot water, hotel bathrom safety, hotel bathroom, hotel bathroom accidents, hotel bathtubs, slip-proof, toilet drowning, water pressure
Warning: hotel bathrooms are hazardous for your children – even more hazardous than the bathrooms in your home.
1. Upscale hotel plumbing is all about sleek appearance. Even adults have difficulty deciphering the numerous knobs on tubs and showers, for example. One never knows where the water is going to come out, and at what temperature. Most knobs have no ONs or OFFs, HOTs or COLDs, shower or tub, symbols or arrows. Overseas, different letters represent “hot” and “cold.” Call housekeeping for interpretations, if necessary.
2. All bathrooms are hazardous for children. U.S. emergency rooms annually see 43,000 bathroom-linked injuries in children 18 years or younger. (Many more injuries are treated elsewhere.) More than half of the injuries occur in children less than four years of age. More than eighty percent are due to falls and 4% are hot water-related.
3. Check hotel bathrooms on arriving. Are there locks on the inside of the door? Young children tend to be better at locking than un-locking. Many hotels in developing countries have reachable candles and matches on sinks in case of electricity outages. Remove accessible hair dryers, razors, and such. When visiting friends and relatives, check medicine chests, cabinets under the sink and wastepaper baskets for potentially harmful products.
4. Children who can shower and bathe alone at home may need supervision away from home. Young children generally assume that if situations/conditions closely resemble ones that they have previously encountered, they are identical. They fail to recognize subtle differences and do not make the necessary mental adjustments. Hence the high injury rates in children in places like bathrooms. Poor coordination and lack of strength also play roles.
5. Bathtubs are the site of 79% of bathroom injuries. Many hotel bathtubs are large, deep, and have wide sides to straddle. Tubs themselves have slippery surfaces. (Slip-proof tub surfaces and adhesive strips are often not used because they are difficult to maintain and appear “dirty,” which takes away from appearance.) Grab bars, which help adults get in and out of tubs, usually are not reachable by young children. Instead, children reach for towel racks which are not intended for weight bearing; the racks can be pulled off the wall. Bath mats without rubber backing are not slip-proof and are worse than no mat. Don’t use towels for bathmats. Insist that children sit for baths, not walk in the tub.
6. Keep floors dry. Easier said than done; children like to splash and most hotel bathroom floors are slippery, even when dry. Falls in bathrooms are more likely to result in injury than falls elsewhere. Bathrooms are generally small so falling often results in striking tubs, toilets or sinks, causing head trauma, lacerations and broken bones. Mop up constantly. Ask for extra towels. Make sure that shower curtains and doors keep water in.
7. Test the water temperature before children get in. A survey of major U.S. hotel chains found that many occasionally had water at scalding temperatures, probably due to malfunctioning anti-scald valves. Hot water temperature should not exceed 130° F (54° C). Especially monitor water temperatures in inns, guest houses and in hotels in developing countries which are more likely to have faulty temperature control mechanisms. Don’t add hot water to baths while children are sitting in the tub. Bathtubs are not swimming pools. Use the shallowest amount of water possible when bathing young children.
8. Tubs are generally safer than showers. Shower water temperature is harder to control, as water temperature can change suddenly and cause burns. Tripping is likely to occur when children (and adults) attempt to rapidly escape sudden bursts of hot or cold water, especially when showers are in bathtubs.
9. Instruct children on “don’ts” around toilets. Injuries have occurred when lids break from children jumping on them. Seats may be delicately balanced and fall on children’s hands and, in boys, on their penises. Children fall while standing on toilets and stretching to reach sinks to wash up; sinks may be further from the toilet than at home. Consider traveling with an appropriate stepstool. Some children-friendly hotels have them. Keep toilet lids down when not in use. In a recent five-year period in the U.S., 16 toddlers drowned by falling headfirst into toilets.
10. Miscellaneous safety tips. Luggage, clothing and towels on the floor of hotel rooms and bathrooms are common causes of falls. Keep a small light on at night. Spa-type tubs are inappropriate for small children due to strong sprays, water currents, and excessive heat. Infant bath seats are not safety aides. Recently the government upgraded mandatory standards for seats to prevent seats from tipping over. Such seats are involved in an average of 7 deaths a year in the U.S. Keep infants within an arm’s reach at all times.
======================================================
Shower instructions at a five-star hotel in St. Andrews, Scotland:
Water Pressure. Turn the upper control anti-clockwise to activate water at the standard pressure. To increase the water pressure, press the end of the override switch on the side of the control and continue turning.
Water Temperature. Turn the lower control to change the water temperature, up to 40 degrees Centigrade. To increase the temperature further, press the end of the override switch on the side of the control and continue turning.
Posted in Destinations, Prevention, Safe & Healthy Travel Comments Off
August 7, 2011
Posted in Outdoor Recreation, Prevention, Safe & Healthy Travel, Sun Comments Off
Tags: acclimatization, air conditioning, air temperature, baby carriers, children, Dehydration, drinking water, fluids, healthy, heat index, heat-related illness, HI, hot weather, Infants, national weather service, obesity, perspiration, Prevention, relative humidity
Common sense, air conditioning and readily available drinking water have greatly reduced the incidence of heat-related illness in infants and children. But don’t let your vigil down. Cases do still occur, generally due to lack of forethought, and sometimes with horrific results.
Here is what you must know:
1. The younger the child, the more susceptible to heat-related problems. Young children produce more heat per body weight and their ability to perspire is less efficient. Perspiration is the main mechanism for the body to rid itself of excessive heat.
2. Pay attention to the heat index (HI). During heat spells the HI is well publicized by the National Weather Service and the media. The index combines air temperature and relative humidity. The higher the humidity, the less efficient perspiration becomes and the more heat remains in the body. (Conversely, dry air removes perspiration from the skin, and removes heat from the body.) In short: high HI = rethink outdoor activities. Consider staying indoors.
3. Fluids. Fluids. Fluids. Drinking appropriate types and amounts of fluids helps prevent dehydration, one of the roots of heat-related issues. In hot weather the body needs fluids to produce perspiration to keep cool and to keep the brain and other vital organs functioning optimally.
For infants and young children, the type of fluids taken is not particularly important. Offer them additional breast milk, formula or water. Encourage them to drink, but never force them. Older children participating in strenuous activities may benefit from sports drinks to replace sodium, chloride and other elements lost with perspiration. Encourage older children to drink even when they are not thirsty.
4. Forget old wives’ tales. You do not become ill from air conditioning blowing on you (though many adults find this annoying) or from going in and out of air conditioning. In very hot environments, fans merely blow hot air around with virtually no cooling effect. Cold drinks do not cause illness, though some children (and adults) experience mild, fleeting stomach discomfort from such drinks. Nor do cold drinks appreciably cool the body – unless you consume many liters. At best, cold drinks give some people a psychological boost. Eating spicy foods does not increase perspiration and has no cooling properties.
5. Dress children in lightweight, light-colored, loose-fitting cotton garments. Loosely fitting shirts allow wind currents to remove heat from the skin and absorb perspiration. This helps cool the body and helps prevent heat-related rashes. Leave diapers loose, when possible. Avoid sunburns. Click here to see our TenTips on preventing and treating sunburn.
6. Recognize early warning signs. In hot weather, think “heat” when children display nausea, vomiting, headache, dizziness, changes in mental status, profuse perspiration, paleness, muscle cramps, tiredness, or weakness. If symptoms occur, seek professional help. For children in organized programs, make sure that the staff understands heat-related issues. And consider “heat” when preverbal children become inexplicably irritable. First get them to a cool place (air conditioned cars are often handy), offer them fluids – and then check for other possible causes.
7. Children require several days to acclimatize. Their bodies take longer to adjust to heat than adults. Summer football workouts and travel to hot, humid climates are common sources of heat-related problems. Gradually increase the length of time and intensity of exertion. Athletes may take up to a week to acclimatize completely.
8. Be aware of risk factors. Being overweight decreases heat loss; layers of fat under the skin are good insulators, keeping heat in the body. High school football players suffer heat-related problems ten times more commonly than athletes in other high school sports; 47% are obese (Centers for Disease Control statistic), they wear heavy equipment, and practice begins in summer with little time for acclimatization. Other risk factors are illness, rarely exercising, previous episodes and the use of certain medications.
9. Other considerations. Choose baby carriers made from lightweight nylon. Heavy fabrics, your body heat and the snugness of the carrier produce heat. Limit use of car safety seats outdoors on hot days, at picnics, for example; the seat partially surrounds the infant with heavy fabric.
Diet plays little role in staying cool. In hot weather, older children and adults generally gravitate away from meats and hot foods, which add some heat to the body, and towards fruits and vegetables, which are marginally beneficial because these foods have high liquid content.
10. Never leave children unattended in or near cars, especially in hot weather. This may seem like needless advice. Not so. In 2010, in the U.S., 49 young children died and many more were injured, some permanently. Most were left intentionally with parent planning to return immediately, but becoming distracted, meeting a friend, or receiving a cell phone call, for example. Other children were forgotten, usually having fallen asleep. A few children climbed into unattended cars, locked themselves in and were unable to exit. In hot weather, the temperature in a closed car can increase from 80 to 120° F (27 to 49° C) in 15 minutes.
Posted in Outdoor Recreation, Prevention, Safe & Healthy Travel, Sun Comments Off
July 17, 2011
Posted in Safe & Healthy Travel, Travel Comments Off
Tags: australia, Brazil, canada, China, Driving, family travel, India, jetlag, local transportation, Mexico, Morocco, motor vehicle related accidents, motor vehicle safety, motor vehicles, Nigeria, Norway, overseas, overseas motor vehicle, road hazards, Russia, traffic circles, traffic signals, traffic signs, UK, US, Vietnam
Motor vehicle-related accidents – not illnesses – are the biggest threat for families traveling overseas. While illnesses occur far more frequently – and children are especially susceptible – most illnesses are minor. On the other hand, injuries, whether to car occupants or pedestrians, are the leading cause of death of Americans overseas and of British children overseas.
1. The poorer a country, the more ominous the statistics.
Representative risks of motor vehicle-related deaths per 10,000 vehicles per year
| Nigeria |
193 |
|
Brazil |
4 |
| Morocco |
34 |
|
US |
2 |
| China |
26 |
|
UK |
2 |
| India |
26 |
|
Canada |
2 |
| Russia |
15 |
|
Australia |
2 |
| Vietnam |
14 |
|
Norway |
1 |
| Mexico |
4 |
|
|
|
(These figures are for local populations. The risk for visitors is likely less; they generally use safer transportation. These figures offer country to country comparisons. Americans driving in Mexico are involved in more accidents than when driving at home, for example.)
2. Consider leaving the driving to others. Reputable local drivers can better deal with language issues, driving customs, and road conditions. Rules regarding passing, signaling and headlight use vary from country to country. Make clear to drivers that you are in no hurry. Request safe routes rather than the fastest or most scenic ones. Check vehicles for safety features for young children. Take bus tours with reputable travel agencies.
3. Don’t drive immediately after long flights through many time zones. Jetlag, fatigue and lack of sleep interfere with cognitive thinking and reaction times – essential for driving on unfamiliar roads. Cranky, jetlagged children worsen the mix.
4. Familiarize yourself with 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. Rapid development in many countries worsens the situation by placing ever more cars on roads without improving the roads. Driving at night is especially hazardous. Drivers turn off headlights to save fuel.
5. 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. Misbehaving children are a serious distraction.
6. Familiarize yourself with regulations regarding children. In many European countries having a reflective vest for each child (and, sometimes, for adults) is mandatory. The vests must be worn in emergencies (if children have to stand at the side of the road, for example). Also, strict laws regulate seatbelt use and where children must sit. In some countries, children under the age of twelve, regardless of size, must sit in a rear seat.
7. Rent cars from well-known international companies before leaving home. Such agencies are more likely to have well maintained cars. 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. Think twice before using quaint local transportation. Riding three-wheel taxis, small open vans, and other inexpensive and colorful local vehicles make for memorable family photos but such vehicles are unsafe. 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.
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 higher rates of injuries than locals. Mishaps occur even at low speeds. Check lower age limits for teenagers to ride such vehicles.
9. 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 well ingrained (“kneejerk”) reactions.
10. Sources of current safety information:
U.S. State Department: http://travel.state.gov/travel/tips/tips_1232.html
United Kingdom: http://www.fco.gov.uk/en/travel-and-living-abroad
International Road Travel (ASIRT): http://www.asirt.org/
Make Roads Safe: http://www.makeroadssafe.org/Pages/home.aspx
Posted in Safe & Healthy Travel, Travel Comments Off
July 4, 2011
Posted in Prevention, Safe & Healthy Travel, Vaccinations Comments Off
Tags: africa, australia, canada, cardiology, CDC, centers for disease control, chicken pox, Cruise ships, diphtheria, disease outbreaks, e. coli, e.coli germany, eurotravnet, foreign travel, geosentinel, hemophilus meningitis, hepatitis a, hepatitis b, immunizations, international society of travel medicine, istm, Malaria, measles, measles france, menigococcal meningitis, mumps, new zealand, obstetrics, paralysis, pediatrics, pertussis, polio, rubella, russia polio, soviet union, tetanus, varicella, who, whooping cough, World Health Organization
Polio in Russia. Measles in France. E. coli in Germany. Diseases that are particularly harmful to children. Diseases that you thought you would no longer hear much about are popping up in countries where you least expect to find them.
Health-wise, is foreign travel become more hazardous?
1. On the contrary. Foreign travel is less likely to cause illness today than at any time in history. Ironically, dire sounding news reports about disease outbreaks reflect how safe travel has become.
2. Many disease outbreaks make headlines specifically because the diseases have become so uncommon. Twenty years ago cases of polio in most of the world were not newsworthy. There were tens of millions of cases yearly, mostly in children, with tens of thousands of children left with serious lifelong health issues and some dying. Last year, there were only about a thousand cases, all in countries in Africa, the Indian subcontinent, and in some countries of the former Soviet Union.
3. Sophisticated surveillance systems monitor disease activity in all
areas of the world. Outbreaks of diseases are tracked immediately. The World Health Organization (WHO) in Switzerland and the Centers for Disease Control (CDC) in the US compile data from national health departments all over the world and from other sources. The WHO oversees that all symptoms suggestive of polio (usually paralysis) are immediately tested for polio. If polio is diagnosed, WHO promptly sends teams of experts to study the outbreak and to vaccinate all children who are at risk.
Also, designated research centers keep track of which drugs are currently effective against malaria, as drug resistance keep changing. Cruise ships calling at American ports must (by law) report to the CDC unusual disease activities occurring aboard ship.
4. Travel medicine has become a recognized and respected profession.
In the lead is the International Society of Travel Medicine (ISTM) with about 2500 members in 75 countries, with many members certified by examination. In addition, many countries have their own travel medicine societies. And, increasingly, “travel” is a topic in journals and at meetings of specialists in cardiology, obstetrics, pediatrics, and other specialties. ISTM has a “chat room” where every day dozens of travel health practitioners from all over the world pose and answer pertinent questions.
5. Travelers are monitored for unusual diseases. Travelers are often the culprits who spread disease from country to country, endangering themselves and people they come in contact with. Two organizations, GeoSentinel and EuroTravNet, are networks of mostly travel clinics that have agreed to report the presence of new diseases among travelers or unexplained increases in known diseases. The information is processed and relayed to travel medicine practitioners, often before the news appears in the media. Travel medicine practitioners were among the first to learn about the recent outbreak of E. coli in Germany.
6. Private subscription services offer an array of information for travel medicine practitioners. These services compile up-to-the-minute travel health data from all available sources and provide tailor-made, traveler-specific computer printouts for travel itineraries. Occasionally, countries require immunizations based on countries previously visited on that specific trip, for example.
7. Vaccines routinely administered to children greatly reduce their risks of becoming ill overseas. No other country gives as many vaccines as the U.S., and in multiple doses, guaranteeing optimum immunity. Parents who refuse vaccines for their children, or who delay doses, make their children vulnerable to numerous illnesses. Parents should also insure that their own immunity is current.
| Routine immunizations in the U.S. |
| Diphtheria |
Varicella (chicken pox) |
| Tetanus |
Polio |
| Pertussis (whooping cough) |
Hemophilus meningitis |
| Measles |
Meningococcal meningitis |
| Mumps |
Hepatitis A |
| Rubella |
Hepatitis B |
Also, children, even in the poorest countries, are being vaccinated in ever-greater numbers, reducing the risk of visitors becoming infected. However, in many countries much work remains to vaccinate all children.
8. There is far more to travel medicine than immunizations and preventative medications. Travel health practitioners usually know when it is safe for travelers to return to areas affected by a nuclear accident, tsunami, earthquake, or an El Nino climate change. Such events can affect visitors’ health for prolonged periods. It may take years to restore sewage treatment facilities, making food and drinking water safe, for example. Climate changes affect mosquito patterns. In recent years, smoke from huge forest fires in Indonesia badly polluted the air in Southeast Asia, sometimes a thousand miles from the fires.
9. Informative websites are available to travelers. In the U.S., the CDC (http://wwwnc.cdc.gov/travel/destinations/list has specific, detailed travel health-related information on every country in the world with just about everything you want to know. Similar services are available in most other countries. Examples: )
Canada: www.phac-aspc.gc.ca/tmp-pmv/index-eng.php
United Kingdom: www.travelhealth.co.uk
Australia: www.smartraveller.gov.au/tips/travelwell.html
New Zealand: www.safetravel.govt.nz/beforeugo/health
10. Avoiding accidents and crime. Traffic accidents are the most common cause of deaths among travelers overseas. (Waterfront-related accidents are second.) The U.S. Department of State has current information on driving and personal safety in every country (travel.state.gov/travel.) In other countries, check the websites listed above.
(Our next Newsletter will deal with the hazards of families driving overseas.)
Posted in Prevention, Safe & Healthy Travel, Vaccinations Comments Off
June 5, 2011
Posted in Sun Comments Off
Tags: 400 IU, 600 IU, breast milk, calcium, childhood diabetes, children sun exposure, kids vitamin d, megavitamin, protective sunglasses, skin cancer, Sun exposure, sun protection, sun screen, tissue damage, tobacco smoke, ultraviolet rays, vitamin d, vitamin d breast milk, vitamin d levels, vitamin d production
Yes, you read it correctly. So many parents have become so conscientious about protecting their children from sun exposure that an increasing number of children are getting too little sun.
What are parents to do?
1. Several years ago we wrote: “The sun does to skin what tobacco smoke does to lungs. Both produce progressive, cumulative, and irreversible tissue damage, often culminating in cancer and other very serious health issues decades later.” In fact, information regarding the sun is becoming grimmer. Cases of skin cancer are being seen in young children, albeit, for now, very rarely. See the four articles on sun protection.
2. But we also wrote, “The amount of sun exposure skin needs to produce vitamin D for growing bones is negligible; occasional and fleeting exposure suffices to produce vitamin D.” Wrong. According to new data, 8% of children between one and five years of age and 15% of children six to eleven years of age have less than optimum vitamin D levels. For teenagers and young adults the figure is 30%.
3. “Occasional and fleeting sun exposure” may be inadequate to produce essential vitamin D levels. No one seems to know optimum exposure time. Past attempts to quantify that amount – length and frequency of exposure and the amount of skin that needs to be exposed, for example – have not been very helpful.
4. It is virtually impossible to predict how much sun exposure an individual child (or adult) requires for optimum vitamin D levels. There are too many variables: age, skin pigmentation, latitude of residence, weather, lifestyles, and time of year, to mention just a few. And what is adequate one year may be inadequate the next year.
5. Sunscreens limit vitamin D production. Sunscreens are crucial in protecting skin from sun-related damage. But they do so – and do so very effectively – by blocking the ultraviolet rays of the sun, the rays required by the skin to produce vitamin D. Sunscreens, if used as directed, may reduce vitamin D production up to tenfold. However, most people use sunscreens incorrectly; they apply insufficient amounts and reapply them too infrequently. This may raise vitamin D levels, but at the expense of skin damage.
6. Maintaining adequate levels of vitamin D is more important than previously realized. Its major function is maintaining normal body levels of calcium and phosphorus, thus helping to build and maintain a healthy skeletal system. But there is increasing evidence that vitamin D plays a role in the immune system and that low levels may increase the risk of cancer, heart disease, certain infections, and possibly, childhood diabetes.
7. “Deliberate” and “sensible” sun exposure of children to maintain their vitamin D levels is no longer recommended. There is no known sensible amount. of sun exposure. The less sun the better. (The sun also damages the eyes, for example. Have children wear protective sunglasses whenever possible. See sunglasses.) While the sun is the source of all life, it is hazardous for good health!
8. The consensus of experts: Use optimal sun protection on children and rely on food sources and vitamin supplements for vitamin D. There is no difference between vitamin D from the sun, food or from vitamin supplements. Recommended doses are 400 IU/day for infants and 600 IU/day for children between one and 18 years of age. These recommendations are especially important for children who live in the northern United States, Canada, and in northern Europe, areas with limited sun part of the year.
9. Many foods are good sources of vitamin D. See table below. Overdoses of vitamin D do not occur from sun exposure, food or recommended vitamin supplements. Overdoses may occur only from megavitamin doses taken over long periods of time.
10. Vitamin D supplements are especially important for breastfeeding infants. Though breast milk is often referred to as the perfect food, it is deficient in vitamin D. Infant formulas are fortified with vitamin D.
| Selected Food Sources of Vitamin D |
| Food |
IUs per serving |
|
| Cod liver oil, 1 tablespoon |
1,360 |
|
| Salmon (sockeye), cooked, 3 ounces |
447 |
|
| Mackerel, cooked, 3 ounces |
388 |
|
| Tuna fish, canned in water, drained, 3 ounces |
154 |
|
| Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 1 cup |
115-124 |
|
| Orange juice fortified with vitamin D, 1 cup (check product labels, as amount of added vitamin D varies) |
100 |
|
| Yogurt, fortified |
80 |
|
| Margarine, fortified, 1 tablespoon |
60 |
|
| Liver, beef, cooked, 3.5 ounces |
49 |
|
| Sardines, canned in oil, drained, 2 sardines |
46 |
|
| Egg, 1 large (vitamin D is found in yolk) |
41 |
|
| Ready-to-eat cereal, fortified. (Check product labels, as amount of added vitamin D varies) |
40 |
|
| |
|
|
Posted in Sun Comments Off
June 4, 2011
Posted in Sun Comments Off
Tags: Sun, Sunburn, sunscreens
10 Tips: The Sun is No Friend of Children
http://kidstraveldoc.com/sun.php
10 Tips for Treating Your Child for Sunburn
http://kidstraveldoc.com/sunburn.php
10 Tips for Protecting Your Children from the Sun
http://kidstraveldoc.com/sunpro.php
10 Tips: the ABCs of using sunscreens
http://kidstraveldoc.com/sunscreens.php
Posted in Sun Comments Off
May 19, 2011
Posted in Outdoor Recreation, Prevention, Safe & Healthy Travel, Travel Comments Off
Tags: AAP, car accidents, car seats, children, front-facing car seats, infant car safety seats, kids car seats, kids travel doctor, nhtsa, parents, pediatrics, rear-facing safety seats, safe car seats
Just when you thought that you knew all you had to know about children’s car safety seats, the experts come up with a slew of new recommendations, forcing you to rethink what you were sure that you already knew.
1. The new recommendations: Children should ride in rear-facing safety seats until they are two years of age or until they reach the maximum height and weight recommended by the manufacturer of that particular seat, says the American Academy of Pediatrics (AAP). The previous recommendations had children riding rear-facing only until one year of age or until they were 20 pounds. The changes are based on updated data on how children are affected by the forces involved in sudden stops and crashes.
2. Many reports regarding the new recommendations emphasized only the age changes. In fact, car seat safety data is based almost entirely on height and weight, with weight more important than height for infants. Data shows that the severity of injuries from a crash of a given magnitude is related to the child’s size. Recommendations are age-based merely for clarity. While parents know how old their children are, few know their children’s precise heights and weights once they reach one year of age.
3. Children at any given age vary substantially in height and weight. The weight of “normal” two-year olds ranges from 23 to 32 pounds. But almost 50% of 18-month-olds have already reached 23 pounds.
The height of “normal” two-year olds is 32 inches to 36 inches but about 40% of 18-month-olds have reached that minimum height. And many “normal” children do not reach the minimal height and weight of a two-year-old until they are 2 ½ or even 3 years of age. And, as age increases, “normal” height and weight limits diverge even further.
4. All recently manufactured safety seats must (by law) state the maximum height and weight limits for which seats are designed. Maximum limits for popular model rear-facing seats vary from 22 pounds to 35 pounds. Height limits vary from 29 inches to 32 inches. Buying a seat with maximum height and weight limits allows you to use the seat for longer lengths of time.
5. Many parents prematurely switch children to front-facing seats. One reason is that many older children and adults prefer facing forward; facing backwards makes them uneasy. This may be related to motion sickness. It is not known if this occurs with infants; they do not seem to be ill at ease facing backward.
Another reason for switching prematurely is that parents are eager (and proud) to advance their children as proof that they are growing. (With clothing, for example, manufacturers know to size clothing so that it fits children somewhat older than their chronological age.)
6. Keep children rear-facing as long as feasible. You need not change out of rear-facing seats at two years of age unless your child has outgrown the seat. Riding rear-facing is considerably safer at all ages and in all kinds of vehicles. (Safety-wise, all passengers in moving vehicles ideally would face backwards – as do passengers on most military transports.)
Moreover, as children grow and advance through the various age-appropriate safety devices – forward-facing safety seats, booster seats, harnesses, and car seatbelts – each subsequent device is somewhat less safe. New recommendations allow you to keep children in each safety device until the child is larger than previously recommended. For more information, see the AAP website: www.healthychildren.org/carseatguide.
7. Safety considerations override a child’s apparent discomfort. Don’t assume that tall children are uncomfortable when they sit rear-facing and have their legs scrunched up between their bodies and the rear of the regular car seat. Few seem ill at ease. Children are far more flexible than adults. Nor will this position lead to leg injuries in case of an accident. Lower-extremity injuries are no more common for children rear-facing than forward-facing. But forward-facing increases risks of head and spinal injuries, which are far more serious than broken legs.
8. Safety considerations also override difficulties you may have in observing children when you are the lone adult in the car. While it is easier to attend to forward-facing children, in fact, if children need attention you should stop the car, regardless of which way they face. Passing snacks, bottles or other objects to infants causes you to turn the steering wheel, says Consumer Union. Don’t allow infants to eat in a moving car. This increases the chances of you having to attend to them. Give them safe toys to keep them busy, toys they are unlikely to drop.
9. Costlier seats are not safer seats. All seats must meet the safety requirements of the National Highway Traffic Safety Administration (NHTSA). (Hand-me-down seats are not recommended; many lack the latest safety updates.) Convenience features and usable lifetime of seats generally determine seat costs.
10. Make sure that your child’s seat is properly installed. Studies show that up to 80% are not. Professional assistance is available in most communities, often at no cost. Check NHTSA Child Safety Seat Inspection Station Locator at www.nhtsa.gov/cps/cpsfitting/index.cfm for a facility near you.
But even correctly installed, age-appropriate safety seats are not totally safe. A recent study at Yale University found that just over half of 378 parents interviewed reported that at least one of their children had managed to unbuckle a seatbelt. Of these children, 75 percent were aged 3 or younger; some were as young as 12 months. More than 40 percent of these children did so while the car was moving.
There is no substitute for parental vigilance.
Posted in Outdoor Recreation, Prevention, Safe & Healthy Travel, Travel Comments Off
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