Traveling with Children

New! Dr Karl Neumann a Pediatrician  that specializes in Travel medicine for children has put together a website for parents about travel concerns

Vaccinations For Children

Children and Bugs

Preventing insect bites is very important in preventing many diseases. The following are recommended:

1. Placing nets over baby carriages and cribs.
2. Eliminating standing water around living quarters to decrease the opportunity for insects to breed close to peoples homes.
3. Stay inside between dusk and after dark, as this is when Malaria mosquitoes bite. Other infectious bugs may bite during the daytime.
4. Dressing children carefully in long sleeved clothing over neck, wrists, and ankles.
5. Not allowing children to go barefoot as parasites can enter the body through the feet.
6. Covering skin with DEET 20-35% - This is higher than what many other recommend. (DEET is safe to use on children when used correctly. Apply on exposed skin, but not on irritated skin and wash it off after use.)
7. Use a flying insect spray in living and sleeping quarters
8. Sleep in air-conditioned area when possible

Malaria Medication and Children
Chloroquine is self and well tolerated but has a bitter taste. Eating adult strength doses can harm children. Chloroquine should be kept in safe place away from children.

Mefloquine is very safe in children. Neurological agitation from Mefloquine is not seen in children as with adults.

Malarone is a new medication and is more expensive. It is taken daily according to weight.

10-20 kg 1 Pediatric strength tablet
21-30 kg 2 Pediatric strength tablet
31-40 kg 3 Pediatric strength tablet
40+ kg 1 Adult strength tablet

Safe for ages 9+. Also safe in lactating mothers, but not in pregnant woman.

Travelers Diarrhea
No vaccine exists yet but antibiotics can be taken for self-treatment abroad. Children may take Pepto-Bismol providing no allergy to ASA. Pepto-Bismol is useful for treating mild Travelers Diarrhea but also can prevent it if taken while traveling.

Pepto-Bismol: Self-Treatment:

Children may take Pepto-Bismol providing
no allergy to ASA
9-12 yrs 1tbs (15ml)
6-9 yrs 2tsp (10ml)
3-6 yrs 1tsp (5ml)
0-3 yrs tsp (2.5ml)

Each dose may be taken every 4hrs to a maximum of 6 doses/ 24 hrs.

Vaccines for Children Traveling
Children traveling with their parents may need their vaccinations adjusted, because of the decreased availability of pediatric follow-up where they are going or because of the increased visit of the new area.

Changes in Schedule for Routine Immunization due to Travel

Vaccine Age Routinely Given Accelerated Schedule
DTaP - Diphtheria, Tetanus, Pertussis 2,4,and 6 months 6wks, 10wks, and 14wks
Hepatitis B (note: Hep B is given much earlier in U.S than in Canada) Birth, 1, 6-12 months 0,1 month, 2 months, booster-12 months (Hep B is given much earlier in U.S than Canada.
MMR - Measles, Mumps, Rubella 12-15 months 6 months
Polio 2, 4, and 6 months 6wks, 9wks,and 12 wks

Note: When vaccines are given younger than routinely recommended or intervals are shortened, vaccinations may need to be repeated at a later date.

Special Notes on Vaccines in Children
Cholera Vaccine-
Is no longer available in North America. Risk of Cholera to travelers is very low. Breast-feeding protects children. In older children, close attention to food and water will protect.

Hepatitis A- Is given to children over 1 yrs old. Breast-feeding protects small infants with passive immunoglobins from mother's milk.

Japanese Encephalitis Virus- Is given to children over 1yrs old traveling to rural areas endemic in this infection during the peak transmission season. Japanese Encephalitis is recommended only if staying in areas around rice paddies or pig farms, where the risk of JEV mosquitoes is high.

Measles- Infants younger than 6 months are protected from Measles by maternal antibodies. If 6-11 months he\she should have MMR or separate measles. If a child is 12 months and traveling to an area of high risk, a first does should be administered and a second in 28 days.

Mumps and Rubella- Not needed for infants less than 12 months.

Varicella (Chicken pox)- recommended if 12 months or older.

Haemophilis Influenza Type B (Hib)
-Never given less than 6 weeks old. Begin series at 2 months.
-If previously not vaccinated, children under 15 months should have 2 doses of Hib before travel (there should be 4 weeks between doses).
-Unvaccinated children 15-59 months should have a single dose.

Hepatitis A
-Recommended for children over 1 year old.
-(The U.S recommends Hep A for over 2 years old but Havrix has been licensed for children over 1 year old)

Hepatitis B
-Vaccination may begin at birth or by 2 months.
-Second dose should be given after 1-2 months.
-Third dose should be given at least 2 months later and not before 6 months of age.

-Breastfeeding children are likely to protect infants.
-Vaccine is recommended for children 2 years or older.

Yellow Fever
- Never given under 4 months, rarely given to children 4-6 years of age.
- 6-9 years of age are vaccinated only if traveling to areas of ongoing Yellow Fever epidemic.