Keeping Your Children Safe When Traveling Abroad

In a memorable grand rounds lecture recently, the lecturer, a Canadian expert in malaria, playfully summed up how to stay safe when traveling abroad. His advice was "Don't get hit, don't get lit, don't eat (well, let's say food contaminated with fecal matter), and don’t do it." By "hit" he meant to be cautious of motor vehicle-related accidents — a leading cause of death worldwide. "Lit" referred to taking illegal drugs, a surefire recipe for poor decisions. The third — fecal contamination — is pretty self explanatory. And, "it" referred to refraining from sex in order to reduce your chances of contracting HIV or another sexually transmitted disease. Four rules are not hard to follow, and maybe in this case adults have it easy. But, if you're a parent traveling with your children, the rules expand. Here are a few other items you should consider when traveling abroad.

	Dr. Moscona with her sons, Ari and Jacob, in Costa Rica.

"Vehicles and water should be your biggest concern," says Dr. Anne Moscona, the vice chair for research pediatrics, professor of pediatrics, and professor of microbiology & immunology at Weill Cornell Medical College, and an attending pediatrician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "Vehicle-related accidents are the leading cause of death for children who travel, and drowning is the second leading cause."

For vehicles, call ahead to make sure rental car companies or hired drivers can supply a car with seat belts and car seats. In many countries, especially developing ones, not every car will have seat belts, and car seats can be hard to find or of inferior quality. If the vehicle you're considering doesn't have seat belts, find another one that does. And, if car seats aren't available or appear inferior, bring your own.

Dr. Moscona with Jacob in Paris.

"You can't do much about poor road conditions or dangerous intersections," says Dr. Moscona. "But you can prevent your children from being tossed around or ejected from the vehicle if an impact occurs, and this significantly reduces their risk of being hurt or killed."

Around water, don’t assume that lifeguards will be provided, reliable, or properly trained. Remember, a parent's vacation is also a child's vacation, and when your mother said "having kids will change your life," she was right. Supervision, especially around water, really comes down to parents watching over their own.

Also, with regard to life vests or other flotation safety devices, follow the same rule as you did with car seats: if there are none available or what's available seems of inferior quality, bring your own. However alluring the water may appear, it is still dangerous.

	Mom snaps the photos during a hiking holiday with Jacob, top, and Ari, bottom, in the Spanish Pyrenees.

And that brings us to the sun: think about bringing head-to-toe protective clothing — usually like zip-on jumpsuits — for places with strong sun. Parents may find these suits easier than sunscreen, which generally has to be reapplied every few hours. And, don't forget a hat and sunglasses. Babies have particularly thin skin which makes them susceptible to sunburn. Also, the amount of sun exposure children get in their first 15 years of life is believed to be an influential predictor of skin cancer later on.

For nutrition, Dr. Moscona recommends to breast feed young children if you can. They are the most susceptible to water and food-borne illness. And, for children of any age, make sure food is well-cooked and that your youngsters eat only fresh fruit that can be peeled. Be especially careful about drinks. Water should be bottled if possible or filtered and boiled, but also fruit juices or anything prepared locally may contain impure water and should be avoided. Watch out for ice cubes. Putting ice cubes made from contaminated water into pure, bottled water is a common and dangerous mistake.

In case of emergency, be sure to pack the names and contact information of pediatricians in the area you are going to. Many times, your regular pediatrician can recommend someone, and this small measure can save time in an emergency. Along with the list, it might be advisable to pack several syringes, an EpiPen, and needles in your first-aid kit. Some countries still reuse "sharps" to cut expenses and they may not have been properly sterilized.

Be vigilant about malaria. If traveling to areas where mosquitoes carry the disease, make sure your children take medication — typically, chloroquine or mefloquine — to prevent infection. The tablets taste terrible so getting them down can be a challenge. "Cut the pills into pieces using a pill cutter," says Dr. Moscona. "And then put the pieces in pudding. Do three 'practice swallows' with pudding only, and then, on the fourth, include the med in the pudding."

Lastly, if you are a parent traveling alone with your children, it doesn't hurt to bring a letter from your partner giving permission for the travel. Due to fears about abduction or child trafficking, some customs agencies won't allow a parent traveling alone with children to pass through their border without written permission.

For a more comprehensive guide on "Traveling Safely with Infants and Children," please see the Centers for Disease Control's web site.