Keeping your child happy on the long flight

child on flight

One of things that I think about often when I take a trip with my child is how to keep her happy and entertained on a long flight.  We have all read recent headlines about flights getting diverted due to disruptive passengers or people getting kicked off of flights. There was a recent news article early May 2015 about a teenager with autism who was kicked off a United airlines fight. She apparently just wanted a hot meal instead of a cold one. What was disturbing was that she was not being disruptive to others at all according to the passengers who were sitting near her.  The pilot and flight attendants diverted the airplane and had an “emergency landing”  because of this non-disruptive autistic teenager. Scary for the rest of us mothers to think about our loud and very disruptive toddlers.  Here are some helpful tips to help make your flight a better experience with children.

1.  Bring a FAA approved car seat if your child is under 2.  The airlines do not require it but it is the safest and most comfortable way to fly for your infant or toddler.  It is also best if your child can sit in his/her own seat.  For international flights, you can also reserve a bassinet for your infant.  For kids ages 2-4, there is great product called CARES harness system that is FAA approved.

2.  Do not have your young child sit in the aisle seat.  You don’t want any hot liquids accidentally spilling on your child.  You will also have a harder time keeping those little arms and legs out of aisle.

3.  Bring your child’s favorite stuffed animal, doll, or toy.  You may also want to bring your child’s favorite blanket or pacifier, if he/she uses one, to help your child sleep on the flight.

4.  Bring a bag of new small toys that your child has not seen before and that you can whip out every 15 minutes. Before my trip, I went to the dollar store, Michael’s, Target, and  ToysRUs and bought a whole selection of inexpensive coloring and sticker books, activity packs, play dough, pipe cleaners, small children’s books, finger puppets, and new crayons.  I also asked all my mommy friends which new apps their kids like and uploaded them on to my ipad.   I brought along some kid-friendly head phones.   All of these items helped immensely with my long international flights.  When my daughter was 18 months, she also loved playing with the paper cups the stewardess would give out for drinks.  A happy child is a happy mommy!

5. Healthy snacks for your child, like fruit, crackers, and cheese sticks.  Avoid sugary and salty snacks.  You may also want to bring a few special treats, like gummy fruit snacks or sugar-free lollipops, for those “emergencies” and to help your child chew or suck on something when your plane is descending.  A busy mouth is a quiet mouth.

6. Formula and purified water if your infant needs it.  However, if you are breast feeding, I strongly encourage you to not give up and to keep breastfeeding throughout your trip for several reasons.  Not only will your child be more likely to stay healthy and avoid diarrhea, your child will be more comfortable on the flight descent if you breastfeed at that time.  And you don’t have to worry about keeping those bottles clean and disinfected!

7. Infant carrier, if your baby likes to sleep in it and your hands are free.

If anyone else has any other useful tips, please comment!

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What you should put in your travel health kit for your child

Every international traveler should pack a good travel health kit in their carry-on luggage.  But what should you pack if you have kids?  I get asked this question very frequently from parents at my pediatric practice.  Many parents who ask me are either going abroad to visit friends and relatives or going on an international vacation to a tropical destination.  Here is a list of what I think should be in your travel health kit, with your child in mind.

1.  Prescription medications.  Keep these in their original bottles or packaging.  It is also a good idea to bring a copy of your prescriptions.  Your pharmacist can print this out for you.  For certain countries, like Japan and UAE, certain medications, like stimulants or other controlled substances, are limited or prohibited.  Check the U.S. Department of State website, travel.state.gov  for up to date information on country specific restrictions.  You may need a letter from your prescribing doctor stating what medications (include generic name) you will be bringing and how much medication you will need if you are bringing controlled substances.  For injectable medications, like insulin, a letter from  your doctor will also be helpful.  If you are bringing an Epi-pen or Auvi-Q on board the flight, a physician’s letter will not be necessary.

2. Special travel prescriptions, like antibiotics and malaria prophylaxis medication. Many medications purchased abroad can be completely fake or falsely packaged.  Do not buy these medications overseas!

3. Acetaminophen or ibuprofen medication.  These medications will be good for fever or pain.  Remember to buy small bottles (less than 3.4 oz) or chewable tablets for kids over 2. Again, do not buy these medications overseas. A travel medicine specialist told me that even paracetamol (which is like acetaminophen) purchased in developing countries can be fake or with false doses.

4. Antihistamines, like diphenhydramine (Benadryl) if your child is over 6 or has a history of allergies. These medications come in fast melt tablets or liquid that are easy for small children to take.  Be careful to use the correct dose for your child since overdose of antihistamines can be dangerous!  Ask you doctor if you have any questions.  Diphenhydramine can be helpful for motion sickness and allergy symptoms, like hives, sneezing, nasal congestion, or itchy eyes.  Many parents ask me about using diphenhydramine to help their kids sleep on the long plane ride.  Boy, do I wish there was something that was safe and works for young children! About 5% of young children have a paradoxical agitation reaction to antihistamines.  This reaction would be far worse on the airplane.  For most children, this medication simply just does not work unless your child is already super tired.  Despite this information, many parents still want to try using diphenydramine. In fact, I know many physician parents, who have also tried it with limited success. In summary, I do not recommend sedating your child with antihistamines on the airplane due to the possible risks.

5. Antibacterial ointment, like bacitracin, for those cuts and scrapes you or your child may get.

6. Basic first aid items, like bandages, gauze, antiseptic, tweezers.

7. 1% Hydrocortisone cream, for itchy insect bites or itchy rashes.

8. Diaper rash cream, if your child still uses diapers. And don’t forget to pack a LARGE supply of diapers in your carry-on luggage.  When my daughter was 2, I almost ran out of diapers on my flight from Mexico.   Talk about a stressful experience!

9.  Anti-motion sickness medication, like Dramamine.  This medication can be especially helpful if you know your child already gets motion sickness or if you will be going on a cruise. There is an OTC Dramamine for kids >2 years.  Since this medication is an antihistamine, remember what I said about the possibility of paradoxical reactions in young children? It may happen in your child.

10. Digital thermometer, if you don’ trust your “mommy touch” or if you have a very young infant with you.

11. Oral rehydration solution (ORS) packets, which will be very important if your child gets diarrhea. You can also buy these in pharmacies in developing countries.  Or you can buy them/order them online before your trip.  Make sure you get the yummy flavored ORS salts!

12. Antibacterial hand wipes and hand sanitizer.  I may be a little germophobic but I usually wipe down the area around my child’s airplane seat and table when we first sit down after boarding our flight.  I also recommend washing hands frequently and thoroughly during the flight and always before eating.  Hand sanitizer is helpful but doesn’t kill all the viruses, including the dreaded Norovirus, a.k.a “No want this virus.”

13. Sunscreen, at least SPF 30.  I really like the new sunblock sticks, that have zinc or titanium oxide as the main ingredient.

14. Insect repellant.  Buy the kind with 20-30% DEET.  OFF makes these really convenient DEET wipes, that are handy for travel.  DEET repellant is safe for infants >2 months of age.

15.  Emergency contact and health insurance card.  Write down your emergency contact’s information, health insurance info, and travel health insurance/medical evacuation info.  If your child has an allergy or a chronic condition, like diabetes or asthma, write this down on the card as well.

16. Extra change of clothes for you and your child. You just never know if your child is going to have an accident or spill juice all over you.  When we went to Cancun, Mexico, my daughter was 2 years old at the time. She spilled juice all over herself twice. I felt embarrassed when other people on the airplane noticed that she was no longer wearing pants.  I wish airlines believed in lids for their cups.

These are the basic essentials of a travel health kit.  For children, who have chronic health conditions, like asthma, diabetes, or severe food allergies, talk to your doctor about other emergency medications you may need.

Preparing for the big trip

 

 

Arriving in Chengdu, China

 

No matter how well you think you have packed and prepared for your trip, something unexpected will happen.  When we left for our 3 month trip around the world, I decided to bring our beloved BOB jogging stroller with us.  The picture above was taken after a 15 hour flight from Seattle to Chengdu, China connecting through S.F.O.  This was the only way that I thought I could make it through all of our flight connections and layovers with a 3 year old.  My daughter loved being in this stroller and most importantly of all, she loved napping in it.  How hard could it be for my husband and I to lug around all of our luggage and a 3 year old through airports, customs, subways, and local streets?

Our family had traveled many times to California, Boston, and Hawaii with this BOB stroller and I did not think anything would happen to this stroller…until the airline lost it in Singapore when we were going to New Zealand. With this stroller, we were able to pull around 3 carry-on luggages, 3 backpacks, and get our 3 year old through customs and to the gate. We decided to pack light for our 3 month trip and not pay extra money for check-in luggage. We were determined to save money where we could.  We had also purchased travel insurance before we left for our trip so we thought we were well prepared.  However, we were not prepared to lose our stroller or to wait 3.5 months for compensation from the airline.  In fact, we did not have any resolution from the airline until we were back home in Bellevue from our journey.

What was the lesson I learned from this?  I learned to expect the unexpected when traveling. I learned not to bring anything of high value, like our BOB stroller, on our trip.  I learned that I could just use an inexpensive $25 folding umbrella stroller for my toddler at the airport and be okay.  And another important fact is that many international airlines outside of the U.S. now charge a significant amount of money to bring a stroller on the airplane.  It is a good idea to call your airline or check their website before you go on your trip so you know their carry-on luggage restrictions.  In the U.S., a carry-on luggage cannot exceed 22 pounds.  Many international airlines now have a weight restriction of 15 pounds for carry-on luggage.  And if you arrive at the airport without purchasing check-in luggage, you may be charged 3 times more money for check-in luggage!  We made this mistake in Singapore. They charged us $75 for one piece of luggage.  Knowing how much you can pack in your carry-on luggage is important, especially when you are traveling on a long international flight with a child. It is always a good idea to check the TSA website http://www.tsa.gov for carry-on luggage rules.

 

Welcome! Bonjour! Ni hao!

I have been a primary care pediatrician in Redmond, WA for 10 years. My pediatric practice recently gave me the luxury of a 3 month sabbatical.  Ever since I was a teenager, I have loved to travel.  Having a toddler was not going to stop me from fulfilling my dream of  traveling  the world with my family.  My husband was fortunate to get time off from his job also so we took this once in a lifetime opportunity to visit 6 countries in 3 months.  We traveled through China, Bali, Singapore, New Zealand, Australia, and the Philippines.   I returned from this incredible trip with an even stronger passion for travel but also a new interest in pediatric travel health.   I want to help other families be safe and healthy during their travels. I was inspired to start this blog after attending the CISTM14, a travel medicine conference in Quebec.  I will be sharing some personal stories as well as helpful pre-travel health information to families with children.

As I currently sit in a room with about a thousand healthcare practitioners from all over the world dedicated to travel health, I keep thinking about all the families that I know who are traveling abroad.  Over the last 2 weeks in clinic, I must have met at least 15 families that told me that they were taking trips overseas this summer to places like India, China, Philippines, and South America.  I shared their excitement since I absolutely love travelling.  Yet, only 1 of these families actually made a pre-travel health appointment to discuss their risks overseas.  All of the other parents brought up their summer travels during their child’s well child checks or sick visits.  Most of these families were traveling abroad to visit friends and relatives and staying abroad for a month or more.   There is so much information that families need to know about how to keep themselves safe and healthy while traveling abroad.

Travel medicine is not just about giving vaccines or prescribing medications although those issues are very important.  Parents need to be educated about issues like what to bring in a medication kit, road safety, avoiding bug bites, staying away from wild or stray animals, safe foods and drinks, and how to avoid diseases that they may never even heard about, like schistosomiasis, strongyloides, chikungunya, or zika virus (what is that?).   People going back to their home country and staying longer are at a significantly higher risk of getting serious illnesses, like typhoid fever, malaria, or Japanese encephalitis. In fact, people visiting friends and relatives are 8x more likely to get malaria than other tourists.  These diseases kill and are preventable!  Did you know that 1/3 of travelers get traveler’s diarrhea while abroad?  And children are particularly at high risk of getting dehydrated or even hospitalized.  That would surely be a trip ruiner!

In addition,motor vehicle accidents and accidental injuries, including drowning, are the leading killers of travelers.  Parents need to be extra vigilant with their young children.  I remember trying to cross the road in Guilin, China, with my 3 year old. Drivers in cars and motorcycles did not care that I was in the crosswalk with my daughter.  Many would honk or just continue to drive towards us while I was frantically running across the road.

So why are most parents bringing their children abroad to visit friends and relatives not seeking pre-travel health advice?  Is it because they could not get access to that care?  Is it because they refused care?  Is it because they are not concerned about the health risks abroad?  Do they think they are immune?  Studies show that the vast majority are not concerned about the risks abroad.  The primary purpose of this blog is to educate parents and healthcare providers that getting pre-travel health advice is good preventive medicine.  Many of us buy travel insurance before a major international trip to prevent us from losing money in case unexpected issues or delays arise.  However, only a third of people get pre-travel health advice to prevent major illness or even death when visiting  developing countries.

For people who do seek pre-travel advice, studies show that most ask their primary care provider first.  Now I am proud to say that I work with a fantastic group of pediatricians, who were educated in some of the best medical schools and residency training programs in the country.  Travel medicine, however, was rarely taught in my education.   Pediatricians need to be more up to date  with pediatric travel medicine, especially since most of our patients will not end up going to a specialized travel clinic for various reasons.  Not only do most pediatricians not have enough training in this field, but they also do not have enough time during the visit to discuss it.  Before reading the CDC’s Yellow Book and attending the ISTM conference, I admit that the pre-travel advice I gave to patients who asked me was limited and very rushed.  Many parents ask about travel as a “by the way” question during a visit for a different reason.  And even though I encourage parents to make a separate appointment to discuss their trip, many parents tell me that their trip is next week or that they don’t have time to come back.  This common scenario has compelled me to start an online pre-travel consultation service for my pediatric practice. When is the ideal time for a pre-travel consult?  About 4-6 weeks before your trip.  But if your trip was arranged last-minute or you just simply forgot, it’s never too late to get your pre-travel consultation before you leave.

Through this blog, I am excited to combine my love for travel and my passion for child health.  I am looking forward to sharing my personal stories and educating my fellow travelers.  I will be sharing important health information to families who want to explore other countries with their children and keep them safe and healthy.