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CONTENTS OF THIS ISSUE

Winter 2021 Issue

Volume 13 | Number 1

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Traveling with Children

Stan Grogg, DO, FACOP, FAAP
Certificate in Travel Medicine
Contact: Stanley.grogg@okstate.edu

Barbara C Grogg, APRN-CNP
Certificate in Travel Medicine
Contact: Barbara@powerofanickel.org

Case Study
A family with a 2 and 4 y/o are taking their children on a Disney cruise in 6 weeks and want your advice as a healthcare professional regarding anything they should know prior to departure. They have scheduled a conference with you next week. What topics should be discussed with the family who plan to fly from Cleveland, Ohio to Miami, Florida to depart for the cruise?

Family travel can be an adventure to remember. A positive attitude is a must. Preparing appropriately will make the trip more enjoyable.  Whether with infants, toddlers, children, or adolescents, reviewing the groundwork for the journey is an important aspect for a happy outcome. As pediatricians, we need to be familiar with the general airline rules and regulations and general suggestions to give our patients traveling with children of different ages.

Traveling with infants (1, 5, 6, 8, 9, 10)

The Federal Aviation Administration (FAA) does not require the purchase of a domestic airline ticket for any child 2 years of age and younger.  If the child does not have a paid ticket, he/she will be expected to remain in the lap of the caregiver.  If a ticket is purchased for the child, the following are FAA recommendations (5):

The Academy of Pediatrics (AAP) has called for a federal requirement of restraint use for children on aircraft, including those younger than 2 years. (9)  A bonus is that younger children tend to sleep better in a familiar car seat. (10)

Tips for travel with children

Discounts
Check with the airline to see if discounts are available for children in car seats. (8)

Seat Location
Try to book bulkhead rows located at the front of each section of the aircraft. (1, 9) These seats typically offer more space than is allotted between other rows.

On-board items
Advise checking the baby gear at the gate so the parent will have one less item to lug on board. Recommend the family dress in easy-on, easy-off layers so that they are prepared for whatever in-flight conditions that may occur. Remind parents to bring a change of clothing, a favorite blanket or stuffed animal (1) and cleansing wipes.  To make travel easier, parents should make the most of modern-day conveniences. If possible, they should use rolling luggage, Smarte Cartes, and baby strollers or carriers.

Keeping the child occupied (3, 10)
Children often become restless and irritable while flying and in airports. The following strategies may help keep the child “happy.”

Avoid ear pain
As for ear pain caused by the change in cabin pressure, a great many babies never show the slightest sign of discomfort. Infants can breast feed, suck on a pacifier, or bottle feed during takeoff and initial descent. (1) Older children can try chewing gum or drinking liquids with a straw. Caregivers should consult the healthcare provider if the child is flying within 2 weeks of an episode of an ear infection or ear surgery. 

Preventive considerations
To help prevent infections, wash hands frequently, and consider bringing hand-washing gel and disinfectant wipes. This is a great time to evaluate the child’s vaccine status for routine vaccinations. (7) To reduce jet lag, adjust your child’s sleep schedule 2-3 days before departure. After arrival, children should be encouraged to be active outside or in brightly lit areas during daylight hours to promote adjustment. (2)  Caregivers should understand how to treat the most common health problems among child travelers which include diarrheal illnesses, dermatologic conditions, including animal and arthropod bites, and sunburn and respiratory disorders. (2)

Safety
Remember safety first. (3) Stay within arm’s reach of children while swimming. Pools may not have safe, modern drain systems and both pools and beaches may lack lifeguards. Ensure that your child wears a life jacket when on smaller boats and set an example by wearing your life jacket. Conditions at hotels and other lodging may not be as safe as those in the U.S. Carefully inspect for exposed wiring, pest poisons, paint chips, or inadequate stairway or balcony railings. When traveling, be aware that cribs or play yards provided by hotels may not meet current safety standards. (1) Road travel can be extremely hazardous. Make sure each passenger is buckled and that children use the appropriate car safety seat. All infants and toddlers should ride in a rear-facing car safety seat until 2 years of age or until they reach the highest weight or height allowed by the car safety seat manufacturer. Once your child has outgrown the rear-facing height or weight limit, they should ride in a forward-facing car safety seat. All children under 13 years of age should ride in the rear seat of vehicles. Updated recommendations on safe travel can be found on the AAP parenting web site: www.healthychildren.org/carseatguide. If you are not traveling with your child’s car seat, and are renting a car at your destination, be certain to pre-book an approved infant/child car seat that meets your child’s age and weight restrictions.

International Travel with Children: (2, 4, 7)
An estimated 1.9 million American children travel internationally each year, and the number is increasing. Healthcare practitioners need to discuss issues regarding trip preparations as well as measures to prevent illnesses when families are planning international travel with infants and children.  A very good resource for international travel is www.cdc.gov/travel.  Now, with the Zika threat, healthcare providers should encourage families to check the status of disease at the destination.  Most accurate and up to date information can be found at https://www.cdc.gov/zika/geo/. Additionally, travelers should familiarize themselves with travel restrictions due to Covid-19.

Families should secure appropriate travel documents, contact health insurance plans regarding coverage while traveling, including where to go for health care if needed, and to compile a list of important contacts and phone numbers (e.g., American consulate or embassy) for each country of travel. Older children should be involved in the planning stages of the trip and may understand the cultural differences better if exposed to books, music, or videos about the places where they will be going. Younger children also can benefit from this preparation and may need familiar objects to decrease the stress of traveling. Finally, parents should be advised to expect changes in daily routines and eating habits.

Check off list for families traveling
The following are paraphrased AAP’s recommendations for traveling with children. These recommendations can be printed with appropriate attribution of the source (AAP) and given to your parents as check off lists in preparation for travel.  (3)

Traveling by Airplane (3)

Traveling by Car (3)

In conclusion, family traveling can give parents and their children excitement and memories which last forever.  With the proper advice, pediatricians can make traveling with children a positive experience for their patients and families.

References:

  1. Tips for Traveling with Baby: https://pathways.org/blog/traveling-with-baby/?gclid=Cj0KEQjwrYbIBRCgnY-OluOk89EBEiQAZER58hhkJEnuG8dLxq4PZL0QiuHT-UFDxC1vjITNNDqrMBEaAlje8P8HAQ  (Accessed 4/30/2017)
  2. International Travel with Infants & Children: https://wwwnc.cdc.gov/travel/yellowbook/2016/international-travel-with-infants-children/traveling-safely-with-infants-children. (Accessed 4/30/2017)
  3. Travel Safety Tips: https://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/travel-safety-tips.aspx. (Accessed 4/30/17)
  4. International travel with children: http://pedsinreview.aappublications.org/content/26/8/306 (Accessed 4/30/17)
  5. Family Friendly Flying: https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Family-Friendly-Flying.aspx (Accessed 4/30/17)
  6. Car Seats: Information for Families; https://www.healthychildren.org/English/safety-prevention/on-the-go/Pages/Car-Safety-Seats-Information-for-Families.aspx  (Accessed 4/30/2017)
  7. Precautions for International Travel: Information for Parents: https://www.healthychildren.org/English/health-issues/conditions/prevention/Pages/Precautions-for-International-Travel.aspx (Accessed 4/30/17)
  8. FAA flying with children: http://www.faa.gov/passengers/fly_children (Accessed 4/30/17)
  9. In-flight injuries often involve children sitting on laps or in aisle seats: http://www.aappublications.org/news/2017/02/24/Airplane022417. (Accessed 4/30/17)
  10. Car Seat Lady, Airplanes:  http://thecarseatlady.com/airplanes (Accessed 4/30/17)

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