Back Off, Montezuma!
Top pediatricians and medical specialists answer the 10 questions traveling families always ask
1. My child has a cold; can I take him on a plane? If it's simply a case of the sniffles, flying shouldn't be a problem, says Dr. Mika Hiramatsu, attending physician at Children's Hospital & Research Center, in Oakland, California. With a bad cold, however, there's a risk of ear infection, which can occur if high cabin pressure traps mucus in the eustachian tube. (Kids who already have ear infections definitely should not fly—the pressure could rupture their eardrums.) To make sniffly babies more comfortable on the flight, use a bulb syringe just before you board ("Kids hate it, but it really does work," says Hiramatsu). Child-sized earplugs and over-the-counter decongestants, such as Sudafed and Benadryl, can help older kids. But, cautions Hiramatsu, although Benadryl makes most kids drowsy, it causes some to get hyper, "and you don't want to find that out on the plane."
2. If we need a pediatrician while we're on vacation, how do we find one? If you're traveling in the United States, get the name of a doctor at your destination before you leave home (ask your insurance company or regular pediatrician). Also keep in mind that many city hospitals have urgent-care clinics that treat patients with non-emergency conditions, such as ear infections and stings, seven days a week (check the local Yellow Pages under Hospitals). High-end hotels and resorts often have doctors on call around the clock. The concierge (or the local medical association) can also give you the name of a pediatrician. In busy cities, agencies such as HouseCalls USA (www.hoteldocs.com) and InnHouse Doctor (www.inn-housedoctor.net) will connect you with practitioners who cater to tourists. If you're traveling abroad, check the Web site of the U.S. State Department's Bureau of Consular Affairs (www.travel.state.gov) to see if the American Embassy or consulate in the country you're visiting lists local hospitals and English-speaking doctors. And if you're heading somewhere remote or want to be extra cautious, consider signing on with a health assistance company, such as International SOS (www.sosinternational.com), which has worldwide contacts and will get you first-rate medical care wherever you are.
3. We want to go on a safari in Kenya. Are antimalarials really safe for children? Yes, as long as a child weighs more than 30 pounds. Lariam, the antimalarial commonly prescribed by pediatricians, is only to be avoided if your child has epilepsy or suffers from depression. (Warning: It occasionally causes people of all ages to have nightmares.) Children over eight are also eligible for doxycycline (a prophylactic antibiotic taken before, during, and after the trip), though rashes and sun sensitivity sometimes occur. Because mosquitoes in different parts of the world carry different types of malaria, discuss your itinerary with a doctor and consult the Web sites of the American Academy of Pediatrics and Centers for Disease Control and Prevention (www.aap.org and www.cdc.gov/travel/mal_kids_pub.htm) for more information.
4. I'm off to Europe with my children. What can I do to help them adjust to the time change? On each of the several days preceding your trip, gradually move their schedule closer to what it will be in the new time zone—for example, putting them to bed and waking them a half-hour earlier, says Mary Rimsza, professor of pediatrics at the Mayo Clinic College of Medicine in Scottsdale, Arizona. On the first full day abroad, fight the urge to dive into bed. Because light influences circadian rhythms, you can help your kids acclimate by getting them outside.
5. How do I treat a kid with Montezuma's revenge? If it's really bad (20 trips to the toilet a day), you might have to see a doctor for an antibiotic, says Lois Hoornstra, a nurse practitioner and director of the pediatric travel clinic at the University of Wisconsin Hospital in Madison. But you can usually take care of mild diarrhea on your own, with clear liquids (bottled water, apple juice, and caffeine-free soda or tea), bland food (bananas, rice, applesauce, and toast—best remembered by the acronym BRAT), and rest. Pepto-Bismol, which reduces irritation in the intestines, is fine for children, except those under three or any who might have, or be recovering from, chicken pox or influenza. Don't worry, by the way, if the pink stuff turns your child's tongue and stools black; it's a temporary, harmless side effect.
6. What's the latest on Lyme disease? The disease doesn't seem to be on the rise (about 21,273 cases were reported in 2003, down from 23,763 in 2002), but it is spreading geographically. Still most prevalent in the Northeast, mid-Atlantic, and upper north-central states, it has also shown up in northwestern California. People of all ages are thought to be equally susceptible, but children are among the most frequently diagnosed—presumably, says Dr. Phillipa Gordon, a pediatrician in Brooklyn, New York, because they get exposed while playing outdoors and because parents have learned to be on the alert for the telltale bull's-eye rash and achy joints. The good news is that Lyme disease is highly treatable. "Especially in children, it responds well to antibiotics," says Gordon, "and long-term problems are extremely rare." For more information, including what to do to reduce the risk of infection, log on to www.cdc.gov/ncidod/dvbid/lyme/.
7. Is it okay for someone with a mild peanut allergy to fly on an airplane where peanuts are served? Yes—if you're vigilant. In recent years, many airlines have stopped serving peanuts (for a list, see www.foodallergy.org). But often passengers bring their own snacks, so don't be lulled into a false sense of security, warns Dr. Marianne Neifert, clinical professor of pediatrics at the University of Colorado Health Sciences Center in Denver. As always, parents should be prepared for emergencies—and make sure the EpiPen is packed in a carry-on.
8. We're heading to the Rockies. How can we prevent altitude sickness? About 25 percent of people (young and old) who travel to typical Rocky Mountain altitudes (about 8,000 feet above sea level) experience the flulike symptoms caused by lower levels of oxygen in the air. To minimize discomfort, take it easy the first day you arrive, advises Neifert, and, most important, drink eight ounces of water every couple of hours to avoid dehydration, a common cause of altitude headaches. For a wealth of information, see the International Society for Medicine Web site, www.ismmed.org. Bottom line: If symptoms persist, head to lower ground.
9. Should kids at dude ranches wear helmets when they're out riding?Almost everyone just wears cowboy hats. Definitely insist that your children wear helmets, our experts say. About 70,000 people require medical attention for horseback-riding head traumas every year, according to the Brain Injury Association. Many ranches have helmets on hand, or you can bring your own; www.horsehelmets.com is one source. Make sure to pick models with an American Society for Testing & Materials logo: they'll have adequate chin straps, puncture-resistant shells, and supportive neck padding.
10. What's the newest, best way to combat motion sickness? Unfortunately, there's still no perfect remedy. While Dramamine, an antihistamine, works for some children, it makes most kids drowsy and isn't approved for those younger than two. Scopolamine, a drug delivered through a patch, is an anticholinergic agent that suppresses the central and peripheral nervous systems to reduce nausea, says Gordon, but it's approved only for children 12 and older and occasionally results in constipation. As for crystallized ginger and acupressure wristbands, there is no hard data supporting their effectiveness, though many swear by them. Others rely on the time-honored tricks—soda crackers, no reading in the car, and distraction.
LOUISA KAMPS is a contributing writer for Elle.