This advice note was originally published as a Medical Director’s Bulletin which can be also accessed on line.
Written by Dr Harvey Pynn & Dr Lucy Obolensky
There are vast numbers of websites that provide recommendations for travelling with children of all ages. Clearly the advice for travelling with a baby are at odds to those travelling with a teenager as the threats and risks faced are so different. Here Dr Harvey Pynn, with the expert input of Dr Lucy “Boo” Obolensky who has travelled widely with her two little ones, try to distil the key advice for travelling with babies and toddlers.
Pre-trip preparation
As with all trips to wonderful and possibly wild places, sound and timely preparation will hopefully reduce the incidence of problems on the trip itself.
1. Research where you are going and travel implications to those areas. www.travelhealthpro.org.uk has reliable up to date country specific advice). Better still, use contacts in country who have children to determine the actual risks.
2. See your GP /travel clinic in good time and follow their advice regarding the use of medications and first aid kit supplies. Get vaccinations early – in addition, if adventurous travel is likely, get vaccinations such as yellow fever, rabies and BCG whilst children are still small and they will forget it quickly.
3. The prevalence of malaria can very hugely within a country so research the specific region. Malarone is the ideal anti-malarial for most regions of the world but does not come as a syrup and is not licensed for under ones. Paediatric Malarone tablets can be crushed and if mixed with milk will enable maximum absorption in the gut. For older children, the adult tablets can be cut (effective tablet cutters are small and available on line). However, ensure rigorous bite avoidance – cover up at dusk and dawn and sleep under permethrin impregnated bed nets (consider a Koodie pop up travel cot / Clipsafe cot net).
4. Think about nappies, milk and food options. Formula may not be available so consider whether weaning onto UHT milk is viable. You may need to opt for reusable cloth nappies.
5. Take a plentiful supply of Milton tablets to enable effective sterilizing.
6. Take spare bottles and sippy cups that are essential but may not be available in country.
7. Try a good natural insect repellant but take some Repel Once (34% DEET, suitable for babies > 6 months and for breastfeeding mothers) with you or Boots Kids insect repellant; if your natural formula isn’t working you need something with a proven track record.
8. Source rigorous travel insurance to include repatriation. It is prudent to research the paediatric medical provision in-country prior to arrival.
9. Consider downloading apps for your devices prior to travel – children’s apps for long journeys / cloud baby monitor. Be sure to have a back up phone charging system that doesn’t rely on mains power.
10. Prepare a sensible, compact but effective first aid kit with general supplies for all and for children specifically add:
Tympanic thermometer
Dioralyte or similar (or sugar / salt spoon to make your own), calpol / ibuprofen (sachets are better for travel), kiddie piriton syrup, plasters, bandage, savlon
Antisthan cream for itchy bites
Sterile sharps kit suitable for age of child (just in case you go to local hospital)
Consider paediatric adrenaline autoinjector (for anaphylaxis)
Additional supplies (for medical professionals)
Powdered amoxicillin and cephalosporin (meningitis)
Salbutamol inhaler and spacer
Creams: fucidin, clotrimazole, hydrocortisone
Stethoscope and mini otoscope
Buy – artemether and albendazole or mebendazole syrup when in-country – ensure you bring home with you too (see below)
Travel to your destination
Travel to the airport is likely to be your biggest battle! Generally, people are more than willing to help when they see a single parent or family travelling with children. Accept and ask for help!
Some airports have specific child / family areas, including soft play zones.
Take extra milk and snacks for the journey – you may / will have delays.
Be flexible with any routines you might have in place. Giving milk or food at different times on travel day won’t put their routines out of kilter.
Give milk, a drink or something they can suck during take-off and descent as this helps to equalize the pressure in their ears.
There are lots of baby and kids’ apps to keep them entertained so have no guilt in using these!
Give careful thought as to taking bulky accessories such as buggies – they are cumbersome to travel with but useful in the airports and are a safe place to sleep. Consider the need for an all-terrain buggy versus a Maclaren style lightweight model. A baby sling may be a better option (Ergobaby).
The destination
1. Take lots of pictures! You will treasure the experience and will want to share the memories with your children when they’re older.
2. Be realistic! Don’t plan too much either in a day or for the trip as a whole.
3. Be flexible and have plan A, B and C for each day.
4. Hiking and walking are good for children under about three if they are used to going in a rucksack. However, children between the ages of three and six are unlikely to be able to walk long distances.
5. Be cautious if travelling to altitudes above 2500 metres. Young children will be unable to vocalise Lake Louise criteria and it is likely (though no data to support) that young children are more susceptible to AMS.
6. Be cautious in the heat. Ensure children wear light coloured hats, sunscreen and UV resistant clothing.
7. CONSIDER ROAD TRAVEL very carefully. It is the most dangerous aspect of travel. Check the serviceability of the vehicle and driver! Wear seatbelts, use a booster (Trunki booster) or car seat if available. Carry a foldable car sunshade.
8. Get in to the habit of checking tents, mattresses, sleeping bags, clothes and shoes for insects, scorpions and snakes each morning and evening and after every time you’ve taken clothes or shoes on or off.
9. Be aware of swimming pools or swimming in lakes and rivers – not all with have high cleanliness standards.
10. Buy a local sim card and use on an unlocked phone (store useful local numbers in phone) as you will need comms if you or your children become ill or your travel plans change.
11. Enjoy local food – make sure it’s peeled and cooked well! Avoid western buffet style foods (esp. salads) that will have been out all day (or longer….).
Local communities tend to be very welcoming to people travelling with children and proud that you have brought children to their country. Take this opportunity to engage with the local culture and community, share stories, food, cups of tea etc. However, a word of caution – young children may be overwhelmed by the amount of attention that they get from the locals.
Returning home
1. Worming – routinely de worm your kids (and yourself) on return using mebendazole (Ovex).
2. Monitor for fever very closely for up to three weeks post travel – this is the time when malaria is most likely to present though it can take longer. The fever is likely just to be due to returning to the viral hot bed of nursery / school but have a high index of suspicion for malaria.
3. Plan the next adventure! Travelling with babies and toddlers is challenging but can be a hugely rewarding and bonding experience.