Objectives. Travelling with Children: Making it Safe & Enjoyable for All. 1. Become familiar with the risks to children who travel internationally,

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1 Travelling with Children: Making it Safe & Enjoyable for All Dr. Susan Kuhn Departments of Pediatrics & Medicine University of Calgary Objectives 1. Become familiar with the risks to children who travel internationally, 2. Learn what can be done prior to / during travel to reduce these risks, 3. Determine where and how to find travel health services.

2 Movement of People Spatial mobility has increased 1000-fold since million people crossed international borders in 2003 Increasing by 5% annually Travel Facts > 50M people travel from developed to developing countries per year 4% go to developing countries/yr Number going to Africa increases by 10% per year Canadians made 4.7 million non-us international trips in 2002 (Statistics Canada) Children comprise 7% of travellers In Calgary 12% of travellers attending 2 large clinics were children (1998) What is the most likely cause of death in a traveller to Africa (<50 yrs)? 1. Malaria 2. Charged by a hippopotamus 3. Cholera 4. Motor vehicle accident 5. African sleeping sickness 6. Hepatitis 7. HIV/AIDS

3 Non-Infectious Risks Bites & Stings Safety Altitude Exposure to sun / temperature General Travel Issues Infectious Risks

4 Travel Broadens the Mind and Loosens the Bowels. Children < 2 twice as likely to get diarrhea, and for a much longer time Hepatitis A More likely if Self-organized Asia Less likely if > 55 yrs Visited travel clinic Typhoid Fever Majority of cases < 18 yrs and (children of) immigrants 1/3 of cases from trips of 2 wks Indian subcontinent is highest risk sk1

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6 Children are not just baggage to be carried on the trip! A trip from a child s perspective.. Painful vaccinations Disgusting medication Long, tiring journey Constantly changing surroundings Strange people Unknown language Unfamiliar food

7 Travel Medicine Is the promotion of health and the prevention of disease or other adverse health outcomes in the international traveller. Pre-Travel Individual Risk Assessment Trip Where: Country & itinerary Why: Purpose of travel When: Season, time until departure,duration How:Type of accommodation & transportation What:Activities Pre-Travel Individual Risk Assessment Traveller Allergies and medications Underlying health status & special needs Immigration status Immunizations Age & developmental stage Personality and behaviors Family factors: preparation, past experience with travelling

8 Children are NOT just small-sized adults! (Although the reverse may apply ) Essential Differences Between Children and Adults Size and shape Regulation of heat Immune system General health Developmental stage and behavior Highest Risk Pediatric Traveller: Immigrants / Children of Immigrants

9 Immunizations for Travel measles Routine Any due soon? Fast-tracking needed? Give early e.g. measles? Recommended Required Travel Vaccines In Children Vaccine Min. Age Comments Hepatitis A 1 2 yrs Hepatitis B Birth Twinrix at 1 yr; given as routine (10 yr) Typhoid 2 yrs (inj) 6 yrs (oral) Yellow Fever 9 months 6 mos. if high risk Japanese Encephalitis 1 yr ½adult dose (1-3 yr) Rabies No limit See comments Meningitis (quadrivalent) 2 yrs See comments Rabies Vaccine in Children More likely to be bitten than adults Bites to head and face more common Shorter distance for virus to reach CNS Unreliable to report contact CONSIDER for affected areas if: Remote or long-term travel If safe & effective products unavailable Currently in short supply

10 Insects and Diseases Mosquitoes Sandflies Ticks Flies Fleas so emphasize the protective measures. Malaria Dengue Leishmaniasis Distribution of Malaria

11 Risk of Malaria by Region Clin Infect Dis 2004;39:

12 Personal Protective Measures Adjust itinerary or activities to limit exposure Accommodation with A/C, screens, nets Long sleeves/pants Bug shirts Avoid dark colours & fragrances Repellent <35% DEET Permethrin-treated clothing and nets for beds, strollers, playpens PPM are only effective if used! DEET in Children See: & Can Med Assoc J 2003;169(3): Use of Repellents in Children Maximize other forms of cover-up Application of DEET Only when needed and wash off when not With care on face and hands Other repellents Autan 2 in Europe & US Herbal products: short acting, toxic if ingested

13 Malaria Medications Myths: Children are too young / too small to take most medications Children have more side effects than adults Realities: Few available as liquids Difficult to cut tablets accurately Taste awful Potentially fatal if overdose A Spoonful of makes the medicine go down.

14 Antimalarials on the Road Never discuss malaria chemoprophylaxis with someone who speaks with a British accent! Managing Traveller s Diarrhea Fluids, fluids, and more fluids...ors (e.g. Gastrolyte) Then consider antibiotics, possibly Imodium in older children. Medical Kit Items Medications Tylenol Antihistamine ± Anaphylaxis kit Motion sickness rx Antibiotic ointment Antifungl ointment Antimalarial rx Antibiotics: diarrhea Other Items Insect repellent Sunscreen First aid supplies Oral rehydration solution packets Hand sanitizer Thermometer

15 Well-being of child depends on the commitment of their adult care-taker Snake Farm in Bangkok Canopy Tours in Costa Rica* Company # Locations Minimum age Comments A 5 2 or 5 Different ages on different websites! B 3 5 Via C 1 8 Direct discussion D 1 4 As young as 2, strapped to parent, via *Information compiled from websites and responses to request for information

16 /2007/12/08/common-sense/&usg= QVXcGOjEm4FYpc1kJlUKeSrPL50=&h=729&w=576&sz=67&hl=en&start=1&um=1&tbnid=n7KGKy3SN4MCyM:&tbnh=1 1&tbnw=111&prev=/images%3Fq%3Dcommon%2Bsense%26um%3D1%26hl%3Den

17 Resources Travel with Children (Lonely Planet) Children Abroad: A Guide for Families Travelling Overseas Take the Kids Travelling: Survive and Enjoy Your Child s Health Abroad: A Manual for travelling Parents. Culture Shock. Successful Living Abroad. Where There is No Doctor

18 Pre-Travel Care Not an insured service Most vaccines and medications covered by extended health benefits Some family physicians comfortable for low-risk destinations Travel Clinics See Yellow Pages Clinics subheading Travel Clinics Providers vary: RNs, MDs, combination Vaccines on site; check for YF if relevant