Saturday, June 18, 2011

Tips for International Travel with Infants

With summertime here, many people have big travel plans while their kids are out of school. For a lucky few, these plans may include traveling outside of the country. Traveling with an infant can be very stressful for a parent and usually comes with a lot of questions! The following is an article from the Centers for Disease Control to help parents of infants preparing for international travel.

Safe travels
Help parents prepare for international trips with young infants

Harry L. Keyserling, M.D., FAAP

When traveling outside the United States, young infants are at significant risk for serious infections, including pneumonia, acute gastroenteritis, measles, tuberculosis, malaria and other parasitic diseases. Risk of infections depends on regions of the world visited, health status and age of the child, length of stay, and activities undertaken. Travelers to developing countries are at greater risk of health problems than those visiting developed countries. Optimally, physicians should counsel caregivers and initiate interventions as early as possible before families leave the country. If parents are immigrants, physicians may consider asking them at the time of the child’s birth if they plan to travel to their country of origin. Referral to a travel medicine clinician is an option.

Insects, arthropods

Protection against mosquitoes, ticks, fleas, and other insects and arthropods is advised depending on country-specific and seasonal disease risk. Infant carriers draped with mosquito netting with an elastic edge for a secure fit are available. Bed nets should be used inside dwellings. For infants older than 2 months of age, DEET (N,N-diethyl-meta-toluamide) can be applied to the skin. Formulations should not exceed 30%. Avoid eyes, mouth and hands, and apply sparingly to the ears. DEET should be washed off when returning inside. Chloroquine is the drug of choice for malaria prophylaxis in areas with no chloroquine-resistant Plasmodium falciparum. Options for children traveling to areas with chloroquine-resistant P. falciparum include mefloquine and atovaquone/proguanil. All three anti-malarial medications are available only in tablet form in the United States and have a bitter taste. Mixing the pulverized powder with breast milk or formula will facilitate compliance. Malaria prophylaxis should not be administered to children less than 5 kilograms or 6 weeks of age; travel should be discouraged for these young infants.

Infectious diseases

For infants who are breastfeeding, exclusive breastfeeding with no water supplementation is the safest form of nutrition to prevent food- and waterborne disease. Breastfed infants younger than 6 months of age do not need water supplementation, even in hot climates. If formula is used, it should be mixed with water that has been brought to a rolling boil for one minute (no longer). In addition, bottles should be sterilized. If an infant develops gastroenteritis, it is important to have oral rehydration packets available that can be given by bottle or spoon until appropriate medical care is obtained. Anti-motility agents should not be used. Handwashing after handling diapers will decrease transmission to other individuals. To decrease the risk of disease acquisition, hand hygiene before contact with an infant should be encouraged, and contact should be minimized between infants and anyone with a febrile illness, upper respiratory infection, acute gastroenteritis or other infectious syndromes. Pacifiers, teething rings and toys should be cleaned often and after any contact with the floor or other surface. Bedding should be washed regularly using detergent and hot water.

Immunizations

Immunizations have a limited role in preventing disease in children younger than 6 months of age. Vaccines that are not recommended for these children include measles-mumps-rubella, varicella, typhoid, influenza, yellow fever, hepatitis A, meningococcal and Japanese encephalitis. An accelerated vaccine schedule can be provided that includes two doses of hepatitis B, at least four weeks apart. In addition, the following routine vaccines can be initiated at 6 weeks of age, with subsequent doses given at four-week intervals: rotavirus; diphtheria, tetanus and acellular pertussis; Haemophilus influenzae type b; 13-valent pneumococcal conjugate; and inactivated poliovirus. For infants who travel for an extended period of time, vaccines may be given at age-appropriate times in the destination country. For information on measles vaccine schedules, see article on page 11.

Other considerations

For children with chronic conditions, appropriate arrangements should be made for medications and necessary medical follow-up. Insurance coverage for international travel is variable. Infant car seats should be used consistently during vehicular travel to minimize the risk of injury.

For more information regarding travel, you can visit http://www.cdc.gov/travel/ or as always, if you have any questions, feel free to contact the office!

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