The indispensable
- Travel with very young infants, especially in tropical or precarious environments, is generally discouraged due to their high vulnerability.
- In children, prevention relies on protection against heat, cold, mosquitoes, sun, drowning, animals, domestic accidents and rigorous hygiene.
- Specific risks related to transport must be anticipated, with appropriate safety measures in place, particularly for children with special needs.
- Children with chronic conditions (respiratory, cardiac, immune, sickle cell disease, diabetes) require a specialist assessment before departure and personalized measures.
- The risk of female genital mutilation or forced marriage should be addressed when travelling to certain countries.
- In the event of a prolonged stay or expatriation to a tropical area, vaccination preparation, enhanced vector prevention and on-site medical monitoring are essential.
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General recommendations
Travel with very young infants to tropical countries, in precarious conditions, is not recommended.
In children, increased vigilance should be exercised regarding:
- The use of repellents (see link to vector control)
- Exposure to sunlight and high temperatures:
- protect the child from the sun (high protection factor creams to be renewed frequently and after each swim, wide-brimmed hat, long, light, cotton clothing, wearing a t-shirt or lycra for water activities);
- avoid long journeys to very hot countries, which can lead to dehydration and heatstroke;
- give water or oral rehydration solutions to drink frequently;
- dress children in light, easily washable, breathable clothing (cotton and non-synthetic fabrics) to avoid the risk of sudamina (prickly heat).
[Sumanida = A word from scientific Latin, derived from sudare, "to sweat." Small, clear vesicles that appear when one sweats profusely and are caused by the retention of sweat in the sweat ducts. Sudamina are common in infants.]
- Exposure to extreme cold, as children have several factors that reduce their resistance to cold:
- Dress the child warmly: several layers of clothing with an outer layer that is windproof and waterproof;
- cover the head, hands and feet warmly;
The larger head volume in children results in significant heat loss without protection. Frostbite in children carries a specific risk of growth disorders and subsequent deformities due to destruction of the epiphyses or growth plates;
- Avoid using baby carriers in cold weather because the child's immobility promotes hypothermia and carrying promotes compression of the limbs, which can cause frostbite.
- The risk of drowning, in the absence of a safety device.
- Contact with animals, to prevent the risk of bites or transmission of pathogens.
- Rigorous personal hygiene, especially for young children, including a daily shower (with soaping), finished with careful drying of the folds.
- The risks of domestic accidents: parents must be made particularly aware of the risk of burns from falling into a fireplace placed directly on the floor and of the risk of ingesting petroleum or caustic products, pesticides that have been unpacked or stored within reach of children.
- The risk of female genital mutilation (FGM, excision, infibulation) or forced marriage during the stay exists (see link page FGM).
Approximately 21% of young women worldwide were married before their 18th birthday. Female genital mutilation (FGM) affects 230 million women and girls globally, including 144 million in Africa, 80 million in Asia, and 60 million in the Middle East. Traveling to a country where female genital mutilation (FGM) is practiced carries a risk. This issue should be systematically addressed during consultations.
Prevention relies on identifying countries or ethnic groups practicing these mutilations and on informing families about the risks (infections, pain, fertility and sexual disorders, death) and the legal prohibition of these acts (punishable by fines and imprisonment in France).
Information can be found on the toll-free number 3919 or on the HAS website.
In cases where there is suspicion of imminent risk to a minor, a report of concern may be sent to the prosecutor.
In the event of travel without suspicion of imminent danger but with an existing risk, a report can be made to the CRIP:
Land vehicle transport
During transport by land vehicles, it is it is necessary to apply the security measures (belt, car seat, child placed in the back, wearing a helmet for two-wheelers) as much as possible.
In some cases, adaptations are necessary. These mainly concern children who have neuromuscular diseases that alter their tone (hypotonic children must travel in a rear-facing seat), a tracheostomy (which can become blocked or dislodged due to friction with the crossbelt), a gastrostomy or severe gastroesophageal reflux (the lap belt may be difficult to position or increase abdominal pressure), or mental or developmental disorders.
Harnesses, seats, and vests exist to secure children in vehicles with properly adjusted seat belts, but in many countries, these devices are either unavailable or vehicles do not allow for such adjustments. If a child seat must be installed in the front passenger seat facing rearward (to allow the driver to monitor the vehicle), the airbag function must be able to be deactivated.
In addition, the use of adapted wheelchairs for transport and seat transfers may be necessary.
Children with special needs
Traveling with a newborn or a small, premature infant is not recommended :
These children, even without a prior perinatal history, are vulnerable: they are more sensitive to environmental conditions (heat, cold), more at risk of digestive problems and dehydration, or respiratory distress in the event of a viral respiratory illness. Adherence to general and food hygiene rules and the reduction of social interactions that can transmit pathogens are even more important for them.
The vaccinations recommended in the immunization schedule are numerous during the first six months of life. They should be started before departure if possible, sometimes even earlier, in accordance with their marketing authorizations, considering that they often cannot be administered during the trip or stay. Not all travel-specific vaccinations are possible at this age, but the BCG vaccine is recommended for stays in areas at risk of tuberculosis, and the quadrivalent meningococcal ACWY vaccine is available from six weeks of age.
Personal protection against vectors using impregnated mosquito nets is essential for stays in countries at risk of arboviral disease or malaria, as skin repellents are not recommended for infants under 6 months, and malaria chemoprophylaxis can only be prescribed for children weighing less than 10 kg outside of the approved indications.
For children at risk of hypoxia, air travel should be discouraged and restricted to essential reasons only. A consultation with their doctor is recommended before departure, and their respiratory condition must be stable before leaving. It is helpful to bring a copy of their most recent test results.
Risk related to relative hypoxia during air travel
Healthy children under 15 years of age may experience small, asymptomatic, and harmless decreases in transcutaneous oxygen saturation (SpO2). Children with chronic respiratory disease may compensate for the relative decrease in FiO2 through hyperventilation. British Thoracic Society issued recommendations in 2022, some of which concern children:
It is advisable to postpone travel beyond the first week for full-term newborns to ensure their good health. Premature infants (born before 37 weeks of gestation) but less than 41 weeks of corrected gestational age at the time of travel, whether or not they have had a neonatal respiratory problem, are at risk of respiratory distress during the flight. It is recommended to postpone air travel until they have reached 41 weeks of corrected gestational age. If this is not possible, oxygen therapy at 1-2 L/min should be administered during the flight.
Infants under one year of age with a chronic respiratory problem warrant an evaluation by a pediatric pulmonologist to discuss a hypoxia test before departure.
Children with chronic respiratory disease such as cystic fibrosis or ciliary dyskinesia should have spirometry before departure if their age allows and receive oxygen during the flight depending on the results.
Children who have had routine oxygen supplementation in the six months prior to travel should have an evaluation with a pediatric pulmonologist and a hypoxia test.
Children with asthma must have their condition well-controlled before flying and should carry their asthma medication with them in the cabin. Those with severe asthma (persistent symptoms or frequent exacerbations despite optimal treatment) should undergo a hypoxia test.
Children with a history of pneumothorax, like adults, should not travel by plane for 7 days after the pneumothorax has cleared on X-ray. If there is a risk of recurrence, specialist advice should be sought.
In case of asthma:
- Have an action plan drawn up by the attending/referring doctor during exacerbations;
- Keep in the cabin the treatment for the exacerbation (bronchodilator with spacer if necessary, oral corticosteroids) and the maintenance treatment (if it needs to be administered during the flight);
- If a stay at altitude is planned during the trip, be informed about Acute Mountain Sickness and altitude pulmonary edema, the symptoms of which can be similar to those of an asthma exacerbation.
In the case of cystic fibrosis:
- Protection against respiratory infections must be strengthened (hand washing, physical distancing, wearing a suitable mask – possible beyond 3 years old);
- The prevention, identification, and early treatment of traveler's diarrhea must be understood, due to the altered perception of thirst and difficulties in regulating sodium balance in people with cystic fibrosis.
A consultation with your referring cardiologist is recommended before departure. It is helpful to bring a copy of your latest test results (ECG, echocardiogram).
Children with implantable devices must undergo manual inspection at airports and not go through automatic security gates.
Children with a right-to-left shunt or pulmonary arterial hypertension (PAH) should not stay at an altitude above 2500 m. Those with a left-to-right shunt should not stay for extended periods at an altitude above 1500 m to avoid the risk of PAH. Children with simple or surgically repaired congenital heart disease have no altitude restrictions.
Children with cyanotic congenital heart disease without severe activity limitations or resting symptoms (NYHA class I to II) can travel without oxygen. Those with resting symptoms (NYHA class III) or severe functional impairment (NYHA class IV) should receive oxygen therapy at 2 L/min. If hypercapnia is present, a hypoxia test should be performed.
A consultation with the referring specialist or an international vaccination and travel advice center is advisable before departure, to adapt the vaccination prevention or drug prophylaxis.
Knowing the address of a suitable referral center in the destination country is helpful.
Vaccinating individuals who are contacts travelling with the child is important to prevent intrafamilial transmission of certain infectious diseases.
A consultation with the referring hematologist or an international vaccination and travel advice center is recommended before departure for:
- Check hemoglobin levels, and possibly perform a blood transfusion;
- Check for essential additional vaccinations (pneumococcus, Haemophilus influenzae, meningococcus, influenza, typhoid…);
- Discuss antibiotic prophylaxis during the trip and anticoagulation for the flight;
- Prepare an action plan in case of suspected vaso-occlusive crisis (VOC) or infection;
- Write a medical certificate to be able to have oxygen on board in case of bone or chest pain, or in case of dyspnea.
The prevention, identification and early treatment of traveler's diarrhea should be emphasized, due to the risk of CVO in cases of hypovolemia or dehydration, which is more common in children.
The measurements are comparable to those for adults (see link). Consulting the online guide from the Aid for Young Diabetics (AJD) on travel may be helpful.
Expatriation to tropical environments increases health risks, particularly infectious diseases. However, adherence to health recommendations is insufficient for children in this situation, hence the need to:
- Optimize malaria chemoprophylaxis and vaccination preparation, particularly against rabies, tuberculosis and specific epidemiological risks;
- Emphasize hygiene measures, vector control and general prevention (sun…);
- Plan for an on-site follow-up consultation, then regular monitoring to adapt preventive or curative treatments for chronic disease to weight, and to administer booster vaccinations.
Source: Guide to Health Recommendations from the High Council for Public Health for Travellers
