Wellness tips for travelers

Your wellness is important to us. During this time of year, seasonal flu and infections (such as gastroenteritis, norovirus, travelers’ diarrhea and other stomach ailments) are common in the United States and other countries. Club Med takes the safety and security of its guests as its highest priority. The resorts have in place numerous measures to reduce the spread of illness, including stringent protocols for cleaning and disinfecting, regular inspections by independent laboratories to ensure food quality and safety, numerous training programs on safety and hygiene, onsite medical staff, and other measures.
When traveling, there are several steps you can take to reduce the possibility of contracting an illness. The United States Centers for Disease Control (www.cdc.gov) and the Public Health Agency of Canada (www.phac-aspc.gc.ca) provide excellent recommendations for travelers.

For your convenience, we have excerpted some of the suggestions from the CDC site that we thought you might find useful:

Diarrhea and Dehydration

Diarrhea and associated gastrointestinal illness are among the most common travel-related problems affecting children. Young children and infants are at high risk for diarrhea and other food- and waterborne illnesses because of limited pre-existing immunity and behavioral factors such as frequent hand-to-mouth contact. Infants and children with diarrhea can become dehydrated more quickly than adults. Prevention:
• For young infants, breastfeeding is the best way to reduce the risk of food- and waterborne illness.
• Travelers should use only purified water for drinking, preparing ice cubes, brushing teeth, and mixing infant formula and foods.
• Scrupulous attention should be paid to handwashing and cleaning pacifiers, teething rings, and toys that fall to the floor or are handled by others.
• When proper handwashing facilities are not available, an alcohol-based hand sanitizer can be used as a disinfecting agent. Alcohol does not remove organic material; visibly soiled hands should be washed with soap and water.
• Fresh dairy products in developing countries may not be pasteurized and may be diluted with untreated water.
• For short trips, parents may want to bring a supply of safe snacks from home for times when the children are hungry and the available food may not be appealing or safe.

Insect and Other Arthropod Precautions

Personal protection against mosquitoes and other biting insects is an important part of prevention of disease, particularly for such diseases as yellow fever, Japanese encephalitis, and dengue, for which no treatment is available.

General Protective Measures
• Children should sleep in rooms with air conditioning, screened windows, or under bed nets, when available.
• Mosquito netting should be used over infant carriers.
• Children can wear clothing that covers more skin, such as long pants and long sleeves, while outdoors.
• Clothing and mosquito nets can be treated with permethrin, a repellent and insecticide that repels and kills ticks, mosquitoes, and other arthropods. Permethrin remains effective through multiple washings. Clothing and bednets should be retreated according to the product label. Permethrin should not be applied to the skin.
• For more information on protecting against insect and other arthropod bites, see the Protection Against Mosquitoes, Ticks, and Other Insects and Arthropods section in Chapter 2.

Repellent Use
CDC recommends the use of repellents, with active ingredients registered with the United States Environmental Protection Agency (EPA), according to the product labels.

• Most repellents can be used on children >2 months of age, with the following considerations:
o Products containing oil of lemon eucalyptus specify that they should not be used on children under the age of 3 years.
o Repellent products must state any age restriction. If there is none, EPA has not required a restriction on the use of the product.
o The American Academy of Pediatrics (AAP) recommends that repellents with DEET should not be used on infants <2 months old.
• Protect infants <2 months of age from biting mosquitoes by using an infant carrier draped with mosquito netting with an elastic edge for a tight fit.
• Apply repellents only to exposed skin.
• Never use repellents over cuts, wounds, or irritated skin.
• Do not allow young children to handle the product.
• When using repellent on a child, an adult should apply it to his or her own hands and then rub them on the child. Avoid the child’s eyes and mouth, and apply sparingly around the ears.
• Do not apply repellent to children’s hands. (Children tend to put their hands in their mouths.)
• Do not apply repellent under clothing.
• Heavy application and saturation are generally unnecessary for effectiveness. If biting insects do not respond to a thin film of repellent, then apply a bit more.
• After returning indoors, wash treated skin with soap and water or bathe. This is particularly important when repellents are used repeatedly in a day or on consecutive days.
• Keep repellents out of reach of children.
Products that contain repellents and sunscreen are generally not recommended because instructions for use are different, and the need to reapply sunscreen is usually more frequent than with repellent alone. Mosquito coils should be used with caution in the presence of children to avoid burns and inadvertent ingestion.

Air Travel

Although air travel is safe for healthy newborns, infants, and children, a few issues should be considered in preparation for travel.

• Children with chronic heart or lung problems may be at risk for hypoxia during flight, and a physician should be consulted before travel.
• Making sure that children can be safely restrained during a flight is an important safety consideration. Severe turbulence or a nonfatal crash can create enough momentum that a parent cannot hold onto a child.
o Children should be placed in a rear-facing Federal Aviation Authority (FAA)-approved child-safety seat until they are at least 1 year old and weigh at least 20 pounds.
o Children >1 year of age and 20 – 40 pounds in body weight should use a forward-facing FAA-approved child safety seat, while children weighing more than 40 pounds can be secured in the aircraft seat belt.
• Ear pain can be very troublesome for infants and children during descent. Equalization of pressure in the middle ear can be facilitated by swallowing or chewing.
o Infants should nurse or suck on a bottle.
o Older children can try chewing gum.
o Antihistamines and decongestants have not been shown to be of benefit in this situation.
• There is no evidence that air travel exacerbates the symptoms or complications associated with otitis media.
• Travel to different time zones, “jet lag,” and schedule disruptions can disturb sleep patterns in infants and children, as well as adults. After arrival, children should be encouraged to be active outside during daylight hours to promote adjustment.

Accidents

Vehicle-Related

Vehicle-related accidents are the leading cause of death in children who travel.
• While traveling in automobiles and other vehicles, children weighing <40 pounds should be restrained in age-appropriate car seats or booster seats, as described above. These seats often must be carried from home, since availability of well-maintained and approved seats may be limited abroad.
• In general, children are safest traveling in the rear seat; no one should ever travel in the bed of a pick-up truck.
• Families should be counseled that in many developing countries cars may lack front or rear seatbelts.

Drowning and Water-Related Illness and Injuries
Drowning is the second leading cause of death in young travelers. Children may not be familiar with hazards in the ocean or in rivers. Swimming pools may not have protective fencing to keep toddlers from falling into the pool.
• Close supervision of children around water is essential.
• Appropriate water safety devices such as life vests may not be available abroad, and families should consider bringing these from home.
• Protective footwear is important to avoid injury in many marine environments.

Schistosomiasis is a risk to children and adults in endemic areas. While in schistosomiasis-endemic areas (see Map 5-7), children should not swim in fresh, unchlorinated water.

Altitude

Children are as susceptible to altitude illness as adults.

Young children who cannot talk can show nonspecific symptoms, such as loss of appetite and irritability. They may present with unexplained fussiness and change in sleep and activity patterns. Older children may complain of headache or shortness of breath.

If a child demonstrates unexplained symptoms after an ascent to altitude, it may be necessary to descend to see if they improve. Acetazolamide (Diamox) is not approved for pediatric use for altitude illness, but it is generally safe in children when used for other indications.

Sun Exposure

Sun exposure and particularly sunburn before age 15 are strongly associated with melanoma and other forms of skin cancer. Exposure to UV light is highest near the equator, at high altitudes, during midday (10 am to 4 pm), and where light is reflected off water or snow

• Sunscreens are generally recommended for use in children >6 months of age. Sunscreens (or sun blocks), either physical (e.g., titanium or zinc oxides) or chemical, at least SPF 15 and providing protection from both UVA and UVB, should be applied as directed, and re-applied as needed after sweating and water exposure.
• Babies <6 months of age require extra protection from the sun because of their thinner and more sensitive skin; severe sunburn for this age group is considered a medical emergency. Babies should be kept in the shade and wear clothing that covers the entire body; a minimal amount of sunscreen can be applied to small exposed areas, including the infant’s face and hands.
• There are sun-blocking shirts available that are made for swimming and preclude having to smear sunscreens over the entire trunk.
• Hats and sunglasses also reduce sun injury to skin and eyes.
• If both sunscreen and insect repellent are applied, the efficacy of the sunscreen is diminished by one third, and covering attire should be worn or time in the sun decreased accordingly.

Other General Considerations

Travel Stress

Changes in schedule, activities, and environment can be stressful for children. Including children in planning for the trip and bringing along familiar toys or other objects can decrease these stresses. For children with chronic illnesses, decisions regarding timing and itinerary should be made in consultation with their health-care provider(s).

Insurance
As for any traveler, insurance coverage for illnesses and accidents while abroad should be verified before departure. Consideration should be given to purchasing special travel insurance for airlifting or air ambulance to an area with adequate medical care.

Identification
In case family members become separated, each infant or child should carry identifying information and contact numbers in their own clothing or pockets.

Because of concerns about illegal transport of children across international borders, if only one parent is traveling with the child he or she may need to carry relevant custody papers or a notarized permission letter from the other parent.

Pediatric Travel Health Kit
In addition to the travel health kit items listed in Chapter 2, parents with children may also consider the following items:

• Safe water and snacks
• Child-safe hand wipes
• ORS packets
• Oral syringes for administration of medications and ORS
• Diapers and diaper rash ointment—if the child still wears diapers. Parents should try to ascertain whether reliable supplies of disposable diapers are available at their destination. If not, they will need to carry enough for the duration of their trip.
• Any medications the child takes regularly, bringing enough for the entire trip
• Other medications occasionally used (e.g., acetaminophen) if illness develops (Locally purchased medications and health products may not be available or may be counterfeit.)