Staying Healthy Abroad by Christopher Sanford M.D

Author:Christopher Sanford, M.D.
Language: eng
Format: epub
Publisher: University of Washington Press
Published: 2018-03-12T16:00:00+00:00

SCHISTOSOMIASIS

Any child who has fresh water exposure in an area endemic for schistosomiasis (bilharzia)—such as a lake in Africa—should have screening for this illness. This screening is a blood test performed a minimum of six to eight weeks after the most recent potential exposure.

GI PARASITES

For those returning after lengthy stays abroad, consider a stool exam, even in those without symptoms.

Kids Abroad Q&A

Q Are there some itineraries for which we should leave the kids at home?

A You bet.

High altitude: There is no reason to take a child to high altitude. Studies have not been performed on the effects of high altitude on children. It would not be ethical to march a thousand children up to 20,000 feet (6,100 meters) and see how they do. The travel medicine community is split on the issue of children’s sensitivity to altitude illness. Some providers feel kids are about as sensitive to altitude illness as are adults; some think they are a little more prone. The problem is that the signs of acute mountain sickness in children—irritability, fussiness, fatigue—are identical to the early signs of more serious problems, including high-altitude pulmonary edema and high-altitude cerebral edema, which are also identical to the signs of a crabby or tired kid who is having no problem whatsoever with altitude. With preverbal children, it’s impossible to tell if they only want a nap or if they are feeling short of breath or confused. I would advise that you leave your children with relatives or a sitter at low altitude.

Those with Down syndrome are more susceptible to high-altitude pulmonary edema.

In 2001 a committee of twenty-five experts on high-altitude illness published a consensus statement which concluded, “Drug prophylaxis [e.g., Diamox—generic name: acetazolamide—commonly used by adults] to aid acclimatization in childhood should usually be avoided.” The authors also pointed out the following:

• There are no data about safe absolute altitudes for ascent in children.

• The risk of acute altitude illness is for ascents above about 8,200 feet (2,500 meters), particularly sleeping above that elevation.

• Intercurrent illness might increase the risk of altitude illness.

• Effects of long-term (weeks) exposure to altitude hypoxia on overall growth and brain and cardiopulmonary development are unknown.

Security risks: If for some reason you are going somewhere with a high risk of civil turmoil or crime, leave the wee ones at home. Yellow fever: Babies under age 9 months should not receive the vaccine for yellow fever; hence, they should avoid travel to regions in tropical South America and tropical Africa that are endemic for yellow fever. (Babies under age 9 months have a risk of encephalitis, a life-threatening condition, if they receive this vaccine.)

Q What about taking a child to an area with malaria?

A Although malaria may be more severe in children than in adults, I think that as long as the child takes an appropriate antimalarial drug, and parents are conscientious in their use of personal protection measures (DEET or picaridin to exposed skin, permethrin to clothes, bed net) for the child, children should not be barred from regions in which malaria is present.

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