As a both a local pediatrician and travel health specialist, and a person who frequently finds himself in international locales, often I am asked about travel with children. While there is no doubt that it can be challenging, simple pre-travel preparation can help parents and children avoid many preventable problems.

If travel plans include locations where the risk of exposure to certain infectious diseases is increased, consider pre-travel immunizations. While most vaccines are administered in a single application, some are given in a series and require several months to complete.

Children who receive the routine, recommended immunizations are usually better prepared than their parents for exposure to the diseases which are far more prevalent overseas than in the US .  Special vaccines are meningitis (after 2 years of age), yellow fever (after 9 months of age), typhoid (after 2 years of age), rabies, and Japanese B encephalitis (after 1 year of age). These vaccines are for special risk exposures only, and their use should be determined by a specialist.

Travelers’ diarrhea is experienced by 50% of persons going out of the United States. High-risk destinations are the developing countries of Latin America , Africa , the Middle East , and Asia . Travelers’ diarrhea is more common in children because they frequently explore and put hands to their mouths. It is potentially more serious with young children because they are more likely to vomit as well, and this means increased risk for dehydration.

Frequent use of hand sanitizer or soap and water can minimize exposures. Breast feeding is somewhat protective against diarrhea because the milk is clean and mother passes along antibodies, educated white cells, and non-specific substances. To minimize risk for infectious diarrhea, avoid potentially unhygienic food vendors, undercooked food, and fruits that have no peel or that were peeled by a vendor. Rehydration salts should be carried to mix with clean water for preparing safe replacement fluid for children with vomiting and diarrhea.

Enteric-coated probiotics are somewhat helpful in diarrhea prevention. Health food stores stock items unproven products such as astragalus which can enhance protection against infection and Plum Blossom brand gan mao ling can be used for prevention and Plum Blossom brand Curing Pills for treatment of diarrhea (no data exists on efficacy).

Malaria and dengue fever effects are generally much more serious in young children than in adults and are just some of the tropical insect-borne diseases which you may contract. Contact with the ubiquitous mosquito and other insects can be managed through the safe use of effective insect repellents, bed nets. Safe, suppressive medication for malaria can prevent potentially-fatal diseases.

Vehicular accidents, not infectious diseases, are the major killers for overseas travelers. Do not underestimate the challenge of an unfamiliar road network and driving laws and customs. As such, seat belts and the provision of a child car seat are essential, just as at home. Do not depend on the airline to provide a container for the car seat, so take along a trash bag for it or have it wrapped.

Some special packing suggestions: a light weight, folding stroller is important if traveling with a child who is unable or unwilling to walk long distances. Sunscreen is expensive overseas, so take along more than you think is needed with at least SPF 30 for you and your child. Also take wide-brimmed hats and sun glasses.

Remember that you will pay full fare for a child under two years old to have her/his own seat. Traveling with a toddler on your lap is a trying experience as the two year old generally has a 2 minute attention span. Avoid aisles seats for your child, and be prepared for delays in transit. Carry age-appropriate snacks, toys, books, games, etc. Benadryl, Dramamine and other antihistamines can sedate but also can have surprisingly opposite effects.

In my thirty five years as a physician I have heard my patients discuss the application of a range of unique ‘methods’ to combat the health challenges they face while abroad. One nurse filled one of her 2 suitcases with gallons of water for two weeks! Some will eat only power bars or bananas, while others take pre-exposure prolonged courses of broad-spectrum antibiotics, wiping out all their friendly intestinal bacteria.

I’d like to take this opportunity to dispel some myths, based on recent studies and literature:

The insect repellent DEET is not toxic when used properly, and Picaridin is an effective, non-toxic substitute. Vitamin B12, garlic, “natural” lotions, copper bracelets and ultrasonic devises are unproven and not effective insect repellents. Some repellents require very frequent (impractical) applications.

Air travel does not significantly increase the risk for respiratory infections.

Airborne® and mega doses of vitamin C do not prevent respiratory diseases.

Air travel with a middle ear infection does not need to be avoided.

Coca tea has no proven benefit for altitude sickness.

There are no effective herbal or homeopathic preventions for malaria.

Traveling with a child can be an enriching experience and there are many resources available that will help you prepare. Be cautious with opinions and anecdotes: look for data!


Here are a few resources for further reading: (CDC)                         

About the Author
Arthur S. Dover, MD, DTMH, has practiced pediatrics for more than 30 years in South Santa Cruz County after working with the CDC in Atlanta , and teaching and researching inSouth America . He holds a diploma in tropical medicine from the London School and a certificate from the International Society for Travel Medicine. He has participated in and advised many international charity medical missions in Latin America . Dr. Dover is a provider with Physicians Medical Group of Santa Cruz County (PMG).  (831) 722-2806.