Children

Introduction

Travelling with children poses some challenges but can also he very rewarding. Children usually adapt better to time and climate changes than adults. The resistance of children to illness, however, is generally lower than that of adults. A child can be overcome by dehydration within a few hours. But although children may become ill with alarming speed, their recovery is often also impressively rapid. Travel-related illness in children is more likely to be due to common problems such as skin infections, injuries, respiratory infections and diarrhoea, than to exotic tropical diseases. Malaria is an important exception, and it tends to be more frequent and severe than among adults.

Immunisations

All children whether they travel or not should receive basic immunisations. Measles, Diphtheria and Poliomyelitis are still common in many countries and travel in densely populated areas may favour transmission.

1. Hepatitis A is the commonest vaccine preventable disease of travellers. However Hepatitis A in children under 5 is a very mild illness and vaccination is not essential. However it is often given to prevent asymptomatic children spreading the disease to others on return from overseas. (virus excreted for as long as 3 months) The safe, effective, long-lasting hepatitis A vaccine (Havrix or VAQTA) is recommended for children over the age of 2 years.
2. Typhoid vaccine is recommended for children over the age of 2 years travelling to endemic regions for more than 1 week. Clinical disease is uncommon in children under the age of 2 years but vaccination can be given down to the age of 12 months if stay in an endemic area is longer.
3. Yellow fever. In general, children should not be immunised below the age of 9-12 months. with an absolute lower limit of six months.
4. Hepatitis B. Children who will be in close contact with local people should be immunised. Infected children rarely develop acute disease, BUT 25-90% become chronic carriers. Approximately 25% of carriers will die from liver cirrhosis or primary liver cancer. Child to child transmission is very common. (page 67 “International Travel and Health” WHO year book 1998).
5. Tuberculosis. TB is more commonly severe in young children and BCG vaccine should be considered for any child going for 6 weeks or longer to an endemic area. BCG does not prevent infection with tuberculosis and is listed as providing only 50% protection against clinical disease. However it appears to have a higher protective rate against disseminated TB and Tuberculous meningitis which are the more serious infections. Also Tuberculosis is becoming multi-drug resistant world wide and BCG is the best preventative we have at the moment.
6. Meningococcal, Rabies, Japanese encephalitis vaccination may be indicated for children over 1 year of age staying for 6-12 months or more in developing countries.

Diarrhoea

Diarrhoea is unfortunately common, for children and adults alike. But children, especially babies. are much more susceptible to dehydration. Prevention involves eating and drinking safely and attention to personal hygiene, especially handwashing (use Dermasoft available at Travel Vaccination Health Care) after bowel movements and before eating.

Breast-fed infants are at substantially less risk of food or water-borne infections. Most diarrhoeal illnesses are acute and self-limited. The main complication of dehydration can be avoided in the great majority of cases by adequate fluid intake.

Mild diarrhoea:- give extra fluids such as water (Boiled or Bottled) oral rehydration solution (ORS eg Gastrolyte) or dilutions of drinks as follows:

• Gastrolyte - As per instructions.
• fruit juice (not concentrated) - 1 part to 4 parts water.

Severe diarrhoea: give one cup of Gastrolyte for every watery stool. Adults travelling with children should carry a supply of Gastrolyte sachets in the Gastro Kit. If the child is hungry give a normal diet.

The most reliable signs of dehydration are weight loss and a fall in urine output. A dehydrated child will drink ORS avidly and should be given as much as he/she will drink. A child who vomits will retain some ORS if given frequent small sips. Feeding, particularly breast feeding, should be continued. Solids should be stopped for no longer than 24 hours and preferably not at all. Starvation delays recovery.

Antidiarrhoeal drugs (lomotil and loperamide), and anti-nausea drugs such as prochlorperazine (Stemetil) and metoclopramide (Maxolon) should not be used in young children because they can cause serious problems. Medical help should be sought if;

• there is blood in the stool.
• a high fever is present.
• diarrhoea persists for more than 3 days in a child or 1 day in a baby.
• any other cause for concern is present.

Malaria

• Because young children are at increased risk of severe malaria, you should reconsider your travel plans.
• In a young child, medical advice (including a blood smear examination) should be sought within 24-36 hours of the onset of fever while in or after being in a malarious area.
• The risk of malaria (and the multitude of other insect-borne diseases) can be substantially reduced by minimising mosquito exposure, particularly at night (see malaria pamphlet). DEET, the active ingredient of the most effective repellents, can be dangerous in children however used appropriately, it is quite safe. Preparations containing more than 20% DEET(Rid) should be avoided, and repellent should be applied sparingly at recommended intervals.
• Breast-fed babies are not protected by their mother's preventive medication, and require their own. Overdose of antimalarial drugs, even chloroquine, can be fatal ( see Children's dosage). Store medication in childproof containers out of reach of children.

Other Hazards

• There is concern about oxygen desaturation in neonates on long haul air flights. Also young children with bronchiolitis are best to delay air travel.
• Ear ache occurs in approx 15% of children during airplane descent and a dose of a paracetamol/ promethazine mixture before flight is reasonable and use of Earplanes (available at Travel Vaccination Health Care).
• Altitude sickness is more common in children especially under the age of 2 years. Royal Children's Hospital, Melbourne does not recommend children under 2 years sleeping above 2,000 metres. NB. Sedatives will increase the danger of hypoxia (low oxygen).

Information mostly extracted from:- Fairfield Hospital Travel information pamphlet: - Travelling with Children 1994