Hitting the dirt road: How to prep families for travel to developing countries

DR. LAUFER is assistant professor of pediatrics, division of infectious diseases and tropical pediatrics at the Center for Vaccine Development, University of Maryland School of Medicine, Baltimore. She has nothing to disclose in regard to affiliations with, or financial interests in, any organization that may have an interest in any part of this article.

Travel to countries outside the United States is increasing: An estimated 50 million people travel between industrialized countries and developing countries each year.¹ Parents who bring their children with them when they travel, live, or work in developing countries offer the children a mind-opening, life-enriching experience. But as pediatricians know, children are not small adults, and caring for youngsters who travel internationally requires special attention. Pediatricians who are not familiar with pretravel counseling should recommend that their patients attend a specialized travel clinic before visiting countries that might pose increased health risks-keeping in mind, however, that most travel clinic physicians are trained in internal medicine, not pediatrics. This two-part review considers the unique health concerns of pediatric travelers and how you can use your expertise in anticipatory guidance and preventive medicine to meet those needs.

Young children have less reserve than older children and adults. They tolerate heat, dehydration, and decreased food intake poorly, and they may not understand the need for behavioral restraint to prevent exposures to unsafe food, contaminated water, or dangerous animals. When traveling with children, parents should actively prepare to meet their children's health needs, plan to observe their children more closely, and be especially equipped to deal quickly with common health problems that arise while the family is away from home.

Identifying travelers: Not as simple as it seems

Some parents planning an exciting, exotic trip will turn to their child's pediatrician for travel advice. But many parents who travel overseas are returning home. Travelers who visit friends and relatives (so-called VFRs) in developing countries are at particularly high risk of travel-related illnesses and seldom seek medical advice before the trip.² VFRs are more likely to travel with very young children, to travel despite underlying medical illness, and to exercise less restraint in avoiding unsafe situations. If you have children in your practice who are from immigrant families, you can discuss the possibility of travel back to the family's country of origin at routine well-child visits so that you can begin to prepare the children for travel.

Groups with special concerns

Adolescents, children with a disability, and children with chronic diseases have specific travel needs and concerns that need to be addressed.

Adolescents. From the standpoint of medication and vaccination, adolescents can be treated as adults. Whether an adolescent is traveling with his or her parents or more independently, be sure to communicate behavioral and safety advice directly to the teenager. Keep in mind that in a new place, inhibitions and level of supervision are reduced. Adolescent travelers have many opportunities to engage in potentially hazardous behavior, including sexual activity, drug and alcohol use, tattoo and body piercing, and travel in unsafe motor vehicles. Encourage parents to address these issues explicitly with their teenagers to prepare them to deal with exciting and tempting opportunities when they leave home.

Children with a disability.Developing countries are physically challenging even for the most nimble person; navigating the terrain may be extremely difficult for a child whose mobility is impaired. Several Web sites offer specific information about wheelchair-accessible hotels and activities as well as written material for disabled travelers ( http://www.access-able.com/; http://www.miusa.org/; http://www.mossresourcenet.org/travel.htm).