traveling with children

43
http://www.fitango.com/categories.php?id=420 Fitango Education Health Topics Traveling with children

Upload: fitango

Post on 13-Jul-2015

86 views

Category:

Documents


0 download

TRANSCRIPT

Page 1: Traveling with children

http://www.fitango.com/categories.php?id=420

Fitango EducationHealth Topics

Traveling with children

Page 2: Traveling with children

1

Overview

The number of children who travel or live outside their home countries has increased dramatically. An estimated 1.9 million children travel internationally each year.

Page 3: Traveling with children

2

Overview

Although data about the incidence of pediatric illnesses associated with international travel are limited, the risks that children face while traveling are likely similar to the risks that their parents face. The most commonly reported health problems among children are:

-- Diarrheal illnesses

-- Dermatologic conditions

Page 4: Traveling with children

3

Overview

-- Systemic febrile illnesses, especially malaria

-- Respiratory disorders

Motor vehicle and water-related accidents are also major health problems for child travelers. In assessing a child who is planning international travel, clinicians should:

Page 5: Traveling with children

4

Overview

-- Review routine childhood and travel-related vaccinations. The pre-travel visit is an opportunity to ensure that children are up to date on routine vaccinations.

-- Assess all travel-related activities.

Page 6: Traveling with children

5

Overview

-- Provide preventive counseling and interventions tailored to specific risks, including special travel preparations and treatment that may be required for children with underlying conditions, chronic diseases, or immunocompromising conditions.

Page 7: Traveling with children

6

Overview

-- Give special consideration to the risks of children who are visiting friends and relatives in developing countries. These conditions may include increased risk of malaria, intestinal parasites, and tuberculosis.

-- Consider counseling adults and older children to take a course in basic first aid before travel.

Page 8: Traveling with children

7

Diarrhea

Diarrhea and associated gastrointestinal illness are among the most common travel-related problems affecting children. Infants and children with diarrhea can become dehydrated more quickly than adults. The etiology of travelers’ diarrhea (TD) in children is similar to that in adults.

Page 9: Traveling with children

8

Diarrhea**Prevention**

For infants, breastfeeding is the best way to reduce the risk of foodborne and waterborne illness. Infant formulas available abroad may not be the same as in the United States; if parents are feeding their child formula, they should consider whether they need to bring formula from home.

Page 10: Traveling with children

9

Diarrhea**Prevention**

Water served to young children, including water used to prepare infant formula, should be disinfected. In some parts of the world, bottled water may also harbor germs and should be disinfected before consumption.

Page 11: Traveling with children

10

Diarrhea**Prevention**

Similarly, food precautions should be followed diligently. Foods served to children should be thoroughly cooked and eaten while still hot; fruits eaten raw should be peeled immediately before consumption. Additionally, caution should be used with fresh dairy products, which may not be pasteurized and may be diluted with untreated water. For short trips, parents may want to bring a supply of safe snacks from home for times when the children are hungry and the available food may not be appealing o

Page 12: Traveling with children

11

Diarrhea**Prevention**

Scrupulous attention should be paid to handwashing and cleaning bottles, pacifiers, teething rings, and toys that fall to the floor or are handled by others; water used to clean these items should be potable. Parents should be particularly careful to wash hands well after diaper changes, especially for infants with diarrhea, to avoid spreading infection to themselves and other family members.

Page 13: Traveling with children

12

Diarrhea**Prevention**

When proper handwashing facilities are not available, an alcohol-based hand cleaner can be used as a disinfecting agent. However, because alcohol-based hand cleaners are not effective against certain types of germs, hands should be washed with soap and water as soon as possible. Additionally, alcohol does not remove organic material; visibly soiled hands should be washed with soap and water.

**Management**

Page 14: Traveling with children

13

Diarrhea**Prevention**

Adults traveling with children should be counseled about the signs and symptoms of dehydration and the proper use of oral rehydration salts (ORS). Medical attention may be required for an infant or young child with diarrhea who has:

-- Signs of moderate to severe dehydration

-- Bloody diarrhea

Page 15: Traveling with children

14

Diarrhea**Prevention**

-- Temperature >101.5°F (38.6°C)

-- Persistent vomiting (unable to maintain oral hydration)

Page 16: Traveling with children

15

Diarrhea**Prevention**

The biggest threat to the infant with diarrhea and vomiting is dehydration. Fever or increased ambient temperature increases fluid loss and speeds dehydration. Parents should be advised that dehydration is best prevented and treated by use of ORS, in addition to the infant’s usual food. ORS should be provided to the infant by bottle, cup, oral syringe (often available in pharmacies), or spoon while medical attention is obtained.

Page 17: Traveling with children

16

Diarrhea**Prevention**

Low-osmolarity ORS is the most effective in preventing dehydration, although other formulations are available and may be used if they are more acceptable to young children. Homemade sugar-salt solutions are not recommended. Adults traveling with children should be counseled that sports drinks, which are designed to replace water and electrolytes lost through sweat, do not contain the same proportions of electrolytes as the solution recommended by the World Health Organization for rehydration dur

Page 18: Traveling with children

17

Malaria

Malaria is among the most serious and life-threatening diseases that can be acquired by pediatric international travelers. Children who are visiting friends and relatives are at particularly high risk for acquiring malaria if they do not receive chemoprophylaxis. Children with malaria can rapidly develop a high level of parasitemia. They are at increased risk for severe complications of malaria, including shock, seizures, coma, and death.

Page 19: Traveling with children

18

Malaria

Initial symptoms of malaria in children may mimic many other common causes of pediatric febrile illness and therefore may result in delayed diagnosis and treatment. Clinicians should counsel adults traveling with children in malarious areas to use the appropriate preventive measures, be aware of the signs and symptoms of malaria, and seek prompt medical attention if they develop.

**Antimalarial Drugs**

Page 20: Traveling with children

19

Malaria

Pediatric doses for malaria chemoprophylaxis are provided in Table 3-11. Pediatric doses of medications used for treatment are included in Table 3-09. All dosing should be calculated on the basis of body weight. Medications used for infants and young children are the same as those recommended for adults, except under the following circumstances:

Page 21: Traveling with children

20

Malaria

-- Doxycycline should not be given to children aged <8 years because of the risk of teeth staining.

-- Atovaquone-proguanil should not be used for prophylaxis in children weighing <5 kg (11 lb) because of lack of data on safety and efficacy.

Page 22: Traveling with children

21

Malaria

Chloroquine, mefloquine, and atovaquone-proguanil have a bitter taste. Before departure, pharmacists can be asked to pulverize tablets and prepare gelatin capsules with calculated pediatric doses. Mixing the powder in a small amount of food or drink can facilitate the administration of antimalarial drugs to infants and children.

Page 23: Traveling with children

22

Malaria

Additionally, any compounding pharmacy can alter the flavoring of malaria medication tablets so that they are more willingly ingested by children. Assistance with finding a compounding pharmacy is available on the International Academy of Compounding Pharmacists’ website (). Because overdose of antimalarial drugs, particularly chloroquine, can be fatal, medication should be stored in childproof containers and kept out of the reach of infants and children.

Page 24: Traveling with children

23

Malaria**Personal Protection Measures**

Children should sleep in rooms with air conditioning and screened windows, or under bed nets, when available. Mosquito netting should be used over infant carriers. Children can reduce skin exposed to mosquitoes by wearing long pants and long sleeves while outdoors in areas where malaria is transmitted.

Page 25: Traveling with children

24

Malaria**Personal Protection Measures**

Clothing and mosquito nets can be treated with insect repellents such as permethrin, a repellent and insecticide that repels and kills ticks, mosquitoes, and other arthropods. Permethrin remains effective through multiple washings. Clothing and bed nets should be retreated according to the product label.

Page 26: Traveling with children

25

Malaria**Personal Protection Measures**

Permethrin should not be applied to the skin. Although permethrin provides longer duration protection, recommended repellents that can be applied to skin (DEET [N,N-diethyl-m-toluamide], picaridin, oil of lemon eucalyptus [OLE] or PMD, and IR3535) can also be used on clothing and mosquito nets.

**Repellent Use**

Page 27: Traveling with children

26

Malaria**Personal Protection Measures**

CDC recommends the use of DEET, picaridin, OLE or PMD, and IR3535, which are repellents containing active ingredients registered with the US Environmental Protection Agency, according to the product labels. Most repellents can be used on children aged >2 months, with the following considerations:

-- Products containing OLE specify that they should not be used on children aged <3 years.

Page 28: Traveling with children

27

Malaria**Personal Protection Measures**

-- Repellent products must state any age restriction. If none is stated, the Environmental Protection Agency has not required a restriction on the use of the product.

Page 29: Traveling with children

28

Malaria**Personal Protection Measures**

-- Many repellents contain DEET as the active ingredient. The concentration of DEET varies considerably among products. The duration of protection varies with the DEET concentration: higher concentrations protect longer. Products with DEET concentration above 50% do not offer a marked increase in protection time. The American Academy of Pediatrics recommends:

- ?30% DEET should be used on children aged >2 months.

Page 30: Traveling with children

29

Malaria**Personal Protection Measures**

- Repellents with DEET should not be used on infants aged <2 months.

Repellents can be applied to exposed skin and clothing; however, they should not be applied under clothing. Repellents should never be used over cuts, wounds, or irritated skin.

Page 31: Traveling with children

30

Malaria**Personal Protection Measures**

Young children should not be allowed to handle the product. When using repellent on a child, an adult should apply it to his or her own hands and then rub them on the child, with the following considerations:

-- Avoid the child’s eyes and mouth, and apply sparingly around the ears.

Page 32: Traveling with children

31

Malaria**Personal Protection Measures**

-- Do not apply repellent to children’s hands, since children tend to put their hands in their mouths.

-- Do not apply repellent under clothing.

-- Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, then apply a bit more.

Page 33: Traveling with children

32

Malaria**Personal Protection Measures**

-- After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days.

Page 34: Traveling with children

33

Malaria**Personal Protection Measures**

Products that contain repellents and sunscreen are generally not recommended, because instructions for use are different and the need to reapply sunscreen is usually more frequent than with repellent alone. In general, apply sunscreen first, then apply repellent. Mosquito coils should be used with caution in the presence of children to avoid burns and inadvertent ingestion.

Page 35: Traveling with children

34

Other conditions**Infection and infestation from soil contact

Children are more likely than adults to have contact with soil or sand, and therefore, they may be exposed to diseases caused by infectious stages of parasites present in soil, including ascariasis, hookworm infestation, cutaneous or visceral larva migrans, trichuriasis, and strongyloidiasis.

Page 36: Traveling with children

35

Other conditions**Infection and infestation from soil contact

Children and infants should wear protective footwear and play on a sheet or towel rather than directly on the ground. Clothing should not be dried on the ground. When traveling in countries with a tropical climate, clothing or diapers dried in the open air should be ironed before use to prevent infestation with fly larvae.

**Animal bites and rabies**

Page 37: Traveling with children

36

Other conditions**Infection and infestation from soil contact

Worldwide, rabies is more common in children than adults. In addition to the potential for increased contact with animals, children are also more likely to be bitten on the head or neck, leading to more severe injuries. Children and their families should be counseled to avoid all stray or unfamiliar animals and to inform adults of any contact or bites. Bats throughout the world are considered to have the potential to transmit rabies virus.

Page 38: Traveling with children

37

Other conditions**Infection and infestation from soil contact

Mammal-associated injuries should be washed thoroughly with water and soap (and povidone iodine if available), and the child should be evaluated promptly to assess the need for rabies postexposure prophylaxis. Because of the potential unavailability of rabies vaccine and rabies immune globulin in certain destinations, families should seriously consider purchasing medical evacuation insurance.

**Air travel**

Page 39: Traveling with children

38

Other conditions**Infection and infestation from soil contact

Although air travel is safe for healthy newborns, infants, and children, a few issues should be considered in preparation for travel. Children with chronic heart or lung problems may be at risk for hypoxia during flight, and a physician should be consulted before travel. Making sure that children can be safely restrained during a flight is a safety consideration. Severe turbulence or crash can create enough momentum that a parent cannot hold onto a child:

Page 40: Traveling with children

39

Other conditions**Infection and infestation from soil contact

-- Children should be placed in a rear-facing Federal Aviation Authority-approved child-safety seat until they are aged ?1 year and weigh ?20 lb.

-- Children aged ?1 year and 20–40 lb should use a forward-facing Federal Aviation Authority-approved child-safety seat.

-- Children who weigh >40 lb can be secured in the aircraft seat belt.

Page 41: Traveling with children

40

Other conditions**Infection and infestation from soil contact

Ear pain can be troublesome for infants and children during descent. Pressure in the middle ear can be equalized by swallowing or chewing:

-- Infants should nurse or suck on a bottle.

-- Older children can try chewing gum.

Page 42: Traveling with children

41

Other conditions**Infection and infestation from soil contact

-- Antihistamines and decongestants have not been shown to be of benefit.

There is no evidence that air travel exacerbates the symptoms or complications associated with otitis media. Travel to different time zones, “jet lag,” and schedule disruptions can disturb sleep patterns in infants and children, as well as adults.

Page 43: Traveling with children