William Gray aka Famiily Man reguarly travels with his children (William Gray)
Article Words : Dr Jane Wilson-Howarth | 01 January

Health and travelling with children

Reckless or rewarding? Is travelling with children a danger to their health or inspiring? Dr. Jane decides...

I’ve lost count of the number of times when preparing to set out on a trip that I’ve been asked, “Who is looking after the kids while you are away?” But the boys have always come with us – trekking, on safari, whatever.

They enhance travel in the developing world and introduce us to people we’d never have met without them. Some think we are reckless taking our children to remote places, and there are certainly some families who take unacceptable risks – like the Japanese father who took his one-year-old to the top of Island Peak in Nepal, which is over 6,000m.

So are there destinations that are just too dangerous? What are the main issues for families to consider? And when is the best time to travel?

Things to consider

When planning a trip to a less-developed destination, it is worth thinking about your own travel experience, how relaxed a parent you are, and how likely you are to panic if something unpleasant befalls you or your kids. If you are a worrier it might be best to head for places with good health facilities until children are older.

If you are likely to feel under control, and especially if you know your destination or can speak the local language, things will go easier.

When to travel

A good age to take children travelling is when they are very small – before they crawl and when they are taking nothing by mouth except breast milk. At this time they do not risk stomach problems from dodgy food and they are not yet mobile so can’t crawl into trouble. However, many new parents won’t be ready to travel so soon, especially if the new babe isn’t sleeping – adding jet-lag to already sleepless nights is a recipe for an unhappy trip.

Children over the age of about two are prone to motion sickness: a nauseated, miserable child makes for miserable parents. Dosing kids with an antihistamine – eg, cinnarizine, marketed as Stugeron – three to four hours before travel works well, and if it’s a long journey then extra tablets can be given every eight hours. You need to dose children the night before if you are setting out early.

Children under the age of three seem to be more susceptible than older people to becoming significantly ill when they get any kind of gastroenteritis. They lose fluids quickly and can become very strange when feverish. My youngest, at the tender age of two, awoke distressed and screaming in a hotel in Thailand after having feasted on chicken sausages from the breakfast buffet. He had a high fever and was hallucinating: snakes were chasing him around the bed. He had bacillary dysentery.

Cooling him in a tepid bath, giving him paracetamol to get his fever down and lots of drinks to replace what was pouring out into his nappy meant that we got through this alright; however, it was quite scary and unpleasant at the time – even though I knew what to do.

Any travel carries a risk of getting diarrhoea and all parents should know about giving clear fluids as treatment for this oh-so-common affliction. It is worth travelling with some kind of squash or cordial that your child likes so that they can be encouraged to drink plenty if they get ill – or indeed if the weather is hot.

The places where tourists are most likely to contract serious forms of gastrointestinal disease (including typhoid, dysentery and hepatitis A and E) are the Indian subcontinent and tropical Latin America (Peru is the worst). Therefore, these destinations might not be such good places to visit if you have a child under three.

Small children who are crawling and putting all sorts of unmentionables in their mouths will be difficult to keep safe from infection. A toddler with fever, bellyache and a sore bottom is no fun… and you could run out of nappies.

It is also important to be aware that immunisation rates are low in many developing countries so, whereas in Europe and North America there is less infectious disease about, in the developing world a small child is more likely to come into contact with infections.

Due to this, most doctors would suggest putting off travel to more risky areas until after the first childhood immunisations at the earliest, and it would be best to avoid malarious regions when travelling with any child under three.

Malaria

Protecting the young against malaria is a challenge but nevertheless crucial, since a baby getting cerebral malaria is likely to become ill very quickly and could die almost before it is obvious that they are unwell. There are still no palatable preparations of antimalarial medicines. In addition, it is very difficult to impose a curfew (to protect the child from the mosquito assault at dusk) until reason starts to descend, around the age of three.

I suggest that families travelling for pleasure should avoid highly malarious regions such as sub-Saharan Africa until the children can manage antimalarial tablets and can be bribed into getting dressed in long clothes and putting on repellent at dusk.

If you are going to live in malarious regions, it is often easier to build a protective environment and routines – and you will know where to find a reliable doctor if things do go wrong.

We only ventured into malarious Africa as a family when my youngest was eight – an age when he could be kept safe but also an age when his attention span was long enough to enjoy the safaris. I sprayed the boys’ dusk and evening clothes with permethrin Bug Proof (from Nomad) to discourage biters, and we all took mefloquine (Larium) antimalarial pills. The doses and latest alternatives for malaria protection for children are to be found on www.bradt-travelguides.com in the ‘Resources for Travelling Parents’ section.

Safety

Travelling with small children is fun but it’s definitely much harder than travelling unaccompanied. The biggest worry for travelling parents should be safety. For instance, once the brood becomes mobile, it is remarkably easy to lose one – especially in busy, unfamiliar places. It is best if little ones have some form of contact address in their pocket like a card from the hotel in which you are staying or – when at the airport – a note of your flight and destination. However, labels should not be visible to casual passers-by.

When the family is in a strange, exciting environment is it easy to make mistakes – like stepping out in front of a car because the traffic is going the ‘wrong’ way. Or a curious and intrepid child might fall from a window that, in a first-world hotel, would be secure. Or the toddler could toddle off the edge of a flat roof, or fall into an open fire. Regulations to keep people safe are different overseas and there may be no warnings about hazards, or if the warnings exist you may not be able to read them.

Also, accidents are more likely to befall you if you are at the limit of your ability to cope, so it may be unwise to try some completely new activity when in the company of your little ’uns. If you are in a reasonably familiar environment then the experience will be more fun and unlikely to end in tears.

If you are intending to do anything for which safety equipment is needed then make sure you sort this out. Child car seats can sometimes be arranged along with a hire car, but book this ahead and take your own if there is any doubt. And if you will be doing any water sports, be aware that an adult-sized life-jacket is more likely to drown a small child than protect them – get your intrepid kids swimming early.

We’ve had some great adventures with children, and their company has almost always enhanced our trips, yet travel with the family takes a little more planning. With some extra preparation – which should involve the kids themselves – you’ll have a marvellous trip and will come home safe and sound, with lots of cute photos to prove that you’ve done it.

Dr Jane Wilson-Howarth is co-author of 'Your Child’s Health Abroad' (Bradt). Jane and her husband have travelled intrepidly with their three children – the youngest’s first Himalayan trek was aged just four months.