Tips for healthy travel with children

Children (those under the age of 15) make up a small but important group of travellers. Their smaller bodies and developing immune systems make their travel health needs unique.

There are many considerations to take into account when travelling with children. It is important to consult a health care provider or visit a travel health clinic to discuss your travel plans preferably six weeks before you and your child travel.

Vaccines for children

• In general, there is a higher risk for most vaccine-preventable diseases when travelling abroad and these diseases tend to be more severe in children than in adults. If you are planning to travel, discuss the following with your health care provider:
• Verify whether your child’s routine vaccine schedule needs to be adjusted to ensure that they are fully protected before travelling.
• Consider the influenza (flu) shot for children over the age of six months. Flu season usually runs from November to April in the Northern hemisphere, from April to October in the Southern hemisphere, and year-round in tropical regions.
• Consult a travel health provider to determine if a child should receive vaccines that are not part of the routine vaccine schedule before travelling. There may be age limitations to some travel vaccines. If you are planning to travel with an infant to an area where there is a risk of a vaccine-preventable disease, discuss your options with the health care provider.
• Most vaccines are safe for breastfeeding mothers. If you are a breastfeeding mother, discuss vaccination options with your health care provider.

Malaria and children

• Avoid taking children to areas with a risk of malaria. Children are particularly at risk of developing severe malaria.
• If you must travel with children to a malaria risk area, visit a travel health care provider to determine if anti-malarial medication is recommended.
• Whether taking anti-malarial medication or not, protect children from mosquito bites. 
• If anti-malarial medication is prescribed, keep them in child-proof containers and out of reach of children.
• It may be difficult to give children anti-malaria medication because it tastes unpleasant.
• Malaria tablets may be crushed and then mixed with small amounts of food or drink to mask the taste. Ask your pharmacist for recommendations.
• Seek medical attention immediately if your child develops a fever while travelling or after your return (even up to a year after travel). Tell your health care provider that your child has recently travelled to an area where malaria occurs.

Transportation risks

Air travel

• Air travel is safe for healthy infants and children. However, it is recommended that you wait until newborns are one to two weeks old before flying. Some airlines will not allow newborns to fly.
• Ear pain due to changes in pressure during landing is more common in children than in adults. To lessen the pain, infants should bottle or breast feed. Older children can chew gum or be encouraged to swallow or yawn.
• Plan ahead before taking children on a plane.

Jet lag

• Jet lag can develop after crossing multiple time zones. Children with jet lag may have difficulty falling asleep at night and may wake up earlier than usual. They may also be irritable and tired during the day.
• Long daytime naps may worsen jet lag by making it difficult to fall asleep at night. Encourage short daytime naps.
• Exposure to sunlight and following the local time zone schedule can help to minimize jet lag.

Motion sickness

• Children between the ages of 2 to 12 are particularly at risk of developing motion sickness.
• To prevent motion sickness, children should avoid reading or other activities while in a moving vehicle.
• Children may also find that shutting their eyes or looking at the horizon lessens the feeling of motion sickness.

Road transportation

• Traffic laws differ around the world. Even if the use of safety devices like car seats, seat belts, and bike helmets is not required in the destination country, caregivers should follow the practices recommended or legislated in Canada as closely as possible. Remember to bring your age-appropriate car or booster seats from home as availability abroad may be limited.
• Consider bringing a baby/child carrier rather than a stroller for areas with unpaved roads.

Environmental and recreational risks

High altitude

• Signs and symptoms of altitude sickness in children are often vague and may be confused for other illnesses. A child with altitude sickness may vomit, lose his or her appetite, or be irritable. Older children may also complain of headaches, nausea, or difficulty breathing. Discuss all planned activities with your health care provider.
• As it is difficult to tell if a child is developing altitude sickness and since altitude sickness can develop rapidly in children, it is recommended that you travel to no higher than 2,500 m (8,200 feet).
• If travelling to areas higher than 2,500 m (8,200 feet) cannot be avoided, it is recommended that you ascend a little at a time: no more than 300 m (984 feet) per day, with a rest day every 1,000 m (3,280 feet).

Water safety

• While travelling, follow the same recreational water safety recommendations in Canada.
• Children should always be supervised closely and wear age-appropriate life jackets or personal floatation devices. These are not available in every country so consider bringing one from home.

Personal protective measures for children

Food- and water-borne diseases

• Practise safe food and water precautions. For infants, exclusive breastfeeding is the best way to prevent food- and water-borne diseases.
• Wash bottles, pacifiers, teething rings, and toys in water that has been disinfected.
• In addition to eating or drinking contaminated food or drinks, diseases like schistosomiasis and leptospirosis can be transmitted by swimming in fresh water. Children should not swim in any fresh, nonchlorinated water such as ponds or lakes, where these diseases could be transmitted.

Insects and illness

• Many travel-related diseases are spread by infected insects such as mosquitoes, fleas, flies, and ticks. Take precautions to protect children from insect and tick bites.
• Use insect repellents containing DEET or Icaridin on exposed skin, and avoid applying it on children’s hands.
• Insect repellents are usually not recommended for use on children under the age of six months, but in areas with dengue or malaria, these diseases pose a greater risk to children than the potential adverse effects of insect repellent.
• Ask your travel health provider for age-specific recommendations regarding how often to apply insect repellent.  
• Insecticide treated clothing can be worn and a bed net can be placed over playpens, cribs, or strollers to protect young children.

Animals and illness

• Diseases like rabies can be transmitted from animals to humans.
• Children are considered at higher risk of rabies because they often play with animals, are less likely to report bites or scratches and are more likely to be bitten in the head and neck area.
• Vaccination should be considered for children who are too young to understand either the need to avoid animals or to report contact with animals.
• Warn children about the dangers of approaching animals; however, they need to be assured that if they do get bitten or scratched, they won’t get in trouble and they should immediately tell an adult.
• If your child is bitten, scratched, or licked on broken skin or mucous membranes (eyes, nose and mouth), it is important to clean the area thoroughly by washing and flushing with soap and water for at least 15 minutes and seek medical assistance immediately to assess the risk and discuss treatment options.

Person-to-person infections

• Children, especially those who have not received all of their vaccinations, are often at a higher risk of getting infections from other people.
• Caregivers should wash their and their children’s hands often. Children should be taught to cough and sneeze into their arm, not their hands.

Pack a travel health kit 

• Parents should pack a travel health kit that contains enough supplies to prevent illness and handle minor injuries or illness such as a cut, insect bite or sting. It is important to know what to do and where to go in the case of a more severe illness while travelling.

Travellers’ diarrhea in children

• Travellers’ diarrhea is a particular concern in children because they become dehydrated more quickly than adults.
• Avoid using bismuth subsalicylate (e.g., Pepto-Bismol®) to treat diarrhea in children. Breastfeeding mothers should also avoid using bismuth subsalicylate.
• Dehydration is best prevented by an oral rehydration solution (ORS). 
• Infants should continue to receive breast milk or their usual formula in addition to ORS. Children who are no longer nursing should continue their usual solid food diet in addition to ORS.
• Dehydration can also be caused by vomiting. In this case, children can usually keep an ORS down if it is offered in small sips by spoon or oral syringe for infants or by straw for older children. Children must take small sips frequently to receive an adequate amount of ORS.
• Seek medical attention if your child:
• appears to be severely dehydrated;
• has bloody diarrhea;
• has diarrhea accompanied by a high fever, or persistent vomiting; or
• does not improve despite the use of ORS.

Travel-related stress in children

• Unfamiliar environments and a change in routine may cause stress for children.
• For older children, familiarize them in advance with the food, customs, and language of the destination and involve them in developing the travel itinerary.
• For younger children, a favourite toy or special snacks may help them adjust to a new environment.