Keeping Kids Well in Remote Places

Before leaving on sabbatical last year, UCLA anthropologists Robert Boyd and Joan Silk were careful to find out how best to stay healthy in Botswana. In particular, they wanted to be sure their son Sam, now 7, would return home with them as healthy as when he left.

Taking children along to remote locations like the "baboon camp," where Joan Silk studied primate behavior, or on vacation treks through the Amazon can make pediatricians and parents nervous. Not every trip is medically appropriate for children, experts agree.

Before taking a trip to an exotic locale, travel medicine experts recommend researching the potential health hazards and, if necessary, taking action to minimize them. It is also vital to know when it is simply safer and saner to postpone a trip until a child is older and stronger.

The Boyds took that advice to heart. First, they found out that no special vaccinations are required for entry into Botswana, but that precautions against malaria are recommended. So they took anti-malarial drugs. They also found out that there was some risk for schistosomiasis, a parasitic disease acquired from bathing in contaminated water. So they carefully avoided stagnant water, where the parasites are most often found.

In addition, they took along a good first aid kit. They found out how they could get quick access to a small plane that could transport them to the nearest town with medical services. And for extra peace of mind, they bought a special insurance policy that would pay to airlift them to the nearest large city, Johannesburg, South Africa, should medical evacuation become necessary.

"What we worried about more than diseases were snakes and scorpions," Boyd said, although their fears proved groundless.

The decision to take children to developing countries should be based partly on a child's age, travel medicine experts say. "If someone calls and wants to take a 3-month-old to the Amazon, I'd say no," said Dr. Victor Kovner, a Studio City physician who specializes in travel medicine. He cites the risks of malaria, dengue fever (a viral disease transmitted by mosquitoes) and food-borne illnesses, such as gastroenteritis or inflammation of the lining membrane in the stomach and intestines. "The child is not going to remember being in the Amazon," Kovner tells parents, so why endanger him or her? In fact, he would say no to a trip to Brazil for a child less than 4 months old because a child that age would be too young for a yellow fever vaccine, which is required for older children.

Likewise, parents who dream of taking a toddler trekking in Nepal would likely get a veto from Dr. Loraine Stern, a Newhall pediatrician and spokeswoman for the American Academy of Pediatrics. "There are too many hazards, and they can't walk very long," Stern said. In wilderness areas children can be subjected to physical hazards such as poisonous snakes and other creatures they don't encounter at home. "You can childproof your house," Stern tells parents, "but there's no way to childproof the jungle."

Decisions to take children to undeveloped or remote locales should be made on a case-by-case basis. Consider the mode of transportation, Stern suggested, and the environment where children will stay at the destination. Children visiting family members are probably at less risk for health problems than others, Stern said. Whether the location is remote or urban is also of prime importance, since good medical care is generally more available in cities.

Parents planning adventure vacations in developing countries should be experienced enough to handle it, Kovner suggested. Families going camping in a remote location, for example, should have plenty of camping experience.

Sometimes parental fears are misplaced, Kovner said. Some worry the destination location is too far from a hospital, when an airlift would be easy to arrange. Yet parents may pay too little attention to what their children are eating and drinking.

Stern recommends that parents find out what medical facilities are available before a trip and whether English-speaking physicians or other health care providers are available.

Once you've made the decision to go, be sure your child's routine immunizations are up to date, Stern advised.

Depending on destination, certain vaccine schedules should be accelerated, said Rosamond Dewart, chief of the travelers' health section for the federal Centers for Disease Control and Prevention.

For example, infants who will be taken to areas where diphtheria and/or pertussis are prevalent should receive three doses of the vaccine before a trip, according to CDC recommendations. Generally, the first three doses are given at two, four and six months. But CDC guidelines suggest the first dose can be administered to infants as young as four weeks, with the remaining two doses given at four-week intervals.

Stern, the Newhall pediatrician, tells parents to take along medication such as acetaminophen for fever, along with any medication the child has taken in the past. If a child has ever taken asthma medicine, for instance, pack a supply. If he or she is prone to ear infections, pack an antibiotic that doesn't need refrigeration and some eardrops. And Dr. Victor Kovner reminds parents not to forget anti-diarrheal medicine.

The Healthy Traveler appears the second and fourth week of every month.

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