Twenty-seven million people from the United States travel internationally per year; one-third of them travel to developing nations. Approximately 50%–70% of travelers become ill during their travel overseas. The number of children traveling with families continues to increase. Children who travel are especially susceptible to infectious diseases, trauma, and other health problems, which vary with the destination. Preparation for travel with children and infants includes consideration of destination-specific risks, underlying medical problems, and administration of both routine and travel-related vaccines. Pretravel counseling should ideally take place at least 1 month prior to travel, given the need to develop an effective immune response from any travel-associated vaccinations. The physician involved in pretravel counseling should focus on the issues listed in Table 45–1.
Table 45–1.Preparing for travel—issues specific to travel as indicated. ||Download (.pdf) Table 45–1. Preparing for travel—issues specific to travel as indicated.
Vaccinations (indications, safety, and tolerability)
Insect precautions (use of protective clothing, repellants, bed nets, insecticides)
Malaria chemoprophylaxis (benefits of a particular regimen vs potential adverse reactions)
Food and water precautions and environmental risks from waterborne disease
Traveler’s diarrhea and self-treatment
Health insurance/evacuation insurance
Trauma prevention and car seats
Access to medical care during travel
Disease outbreaks in destination
Animal exposure, trauma from animals
General health and routine illness
Clothing and footwear
Copies of prescriptions, vaccination documentation, physician’s letter, list of medications
Safe sex counseling
Crime and safety
PREPARING CHILDREN & INFANTS FOR TRAVEL
Parents and care providers should be advised that travel with children and infants is much more enjoyable when the number of journeys in a single trip is limited, travel time is kept relatively short, and travel delays are anticipated. Planning for delays and other problems should include bringing new or favorite toys or games for distraction and carrying extra food and drink, changes of clothing, and fever medications.
Medical Care During Travel
It is useful to obtain names and addresses of local health care providers at the family’s destination. This is available from travel medicine practitioners or from the membership directory of the International Society of Travel Medicine. The International Association for Medical Assistance to Travelers website (www.iamat.org) is another useful resource with a worldwide directory of providers proficient in English. Travel insurance, which is highly encouraged, should not only cover medical care at the destination but also provide 24-hour helplines with information regarding English-speaking physicians and hospitals, and arrange and pay for evacuation to a medical facility that provides necessary treatment that is not available locally. In emergencies, parents and caretakers should take their children to the largest medical facility in the area, which is more likely to have a pediatric unit and trauma services.