International Travel & Teens: Know Before
by Dr. Ann L. Engelland
scoop ice cream if you can throw snowballs in the Yukon?
Each year there are more and more teen adventure travel
options available. While envious parents juggle the myriad
forms, bills and plane reservations required to ship their
kids out for the summer, they are surely feeling a certain
amount of unease and uncertainty about sending kids off
to foreign and remote lands. Security concerns (terrorism
where you don’t expect it), diseases (malaria is
making a comeback) and natural disasters have us wondering
how to help kids make the most of these wonderful opportunities.
Preparation, common sense and luck are the key ingredients
Let’s keep in mind that the more common calamities
are still common.
Unsafe road, vehicle and driving conditions contribute
to accidents at a rate that may be as much as 80% higher
in some foreign countries than at home.
Risky teen behaviors, sometimes in the presence of alcohol,
contribute to drowning and motor vehicle accidents.
about the blazing tropical sun sears the skin of many
with chronic conditions need to remember to take a
supply of their medications so that they avoid emergency
or clinic visits as much as possible.
What about immunizations?
There are six immunizations to consider:
Tetanus. By age fifteen most teens have had a tetanus
booster. Better to have one within the last five years
if students are engaging in activities that put them at
risk for puncture wounds (e.g. construction projects in
Hepatitis B. Most teens are up to date and have had the
three part series by the time they are old enough to travel
Hepatitis A. This two part immunization series is important
to protect against hepatitis A, which is a viral illness,
transmitted by contaminated food and water.
Typhoid. Frequently recommended for international travelers,
this is an oral vaccine that needs to be taken over the
course of a week, finishing the course at least a week
Meningococcal vaccine. Although not specifically required
for all international travel, this vaccine is now highly
recommended at most college campuses for freshman and sometimes
for visiting high school students.
Tuberculosis testing (PPD). It’s a good idea to
have a PPD (Skin test) done before and within a few months
after a trip to any impoverished place where close contact
with potentially infected people has occurred (e.g. volunteering
with young kids or in hospitals in the developing world).
How do I know if I need to take malaria pills? And which
The best source of information on this is www.mdtravelhealth.com
where travelers can find a wealth of information on malaria
in all countries of the world. The site is exhaustive and
well organized about all aspects of travel and will tell
you if the county or province you are planning to visit
requires malaria prophylaxis. There is also a discussion
of the different types of medications that are currently
used. I recommend this site to all of my travelling patients
and their families. I ask them to do the research and bring
it to me so we can make decisions together. The website
has links to all sorts of interesting maps and resources,
including the Center for Disease Control in Atlanta.
What is the best advice on preventing insect bites?
Some places will provide mosquito nets for sleeping. If
the nets are not pre-treated, it’s not a bad idea
to spray some insect repellent on the netting each night.
Insect repellents with 5-50% DEET will repel mosquitoes,
chiggers, ticks, fleas, and biting flies. It is useless
to buy anything more concentrated than 50%, as there is
no added benefit. If repellents are used daily, it is best
to apply them to collars, socks, hair and pant cuffs rather
than directly on the skin. Despite early negative reports,
DEET appears to be quite safe, even in younger children.
What about traveler’s diarrhea?
“Montezuma’s revenge” or E.coli diarrhea
is common. However, there are a number of other viral,
bacterial and parasitic organisms that can cause GI upset.
The best advice to give kids is to prevent it in the first
place by practicing good hygiene and hand washing and by
avoiding water if it is not bottled and sealed. Even tooth
brushing should be done with clean water. All uncooked
and unpeeled vegetables, unpasteurized milk or dubious
foods should be avoided.
Prophylactic antibiotics for traveler’s diarrhea
are not recommended. However, it’s not a bad idea
to send some along with the traveler so that if a severe
(more than 3 loose stools in 8 hours or more than 5 in
24 hours accompanied by nausea, vomiting, fever, cramps
or bloody diarrhea) attack occurs, medication is handy.
Imodium, sold over the counter, is also good to have in
the travel bag, accompanied by instructions on when and
how to use it. Remind your child to stay hydrated-before,
during, and after any diarrheal illness.
Does medical insurance cover services when travelling
It depends. It is probably worth inquiring before your
child goes abroad. Some teen travel organizations also
insist on Evacuation Insurance, a scary thought when nothing
is going on, but a comforting one should relocation for
sophisticated medical care become necessary.
What about motion sickness and long plane rides?
If a traveler is prone to motion sickness it is prudent
and safe (and considerate of others travelling) to send
her with Dimenhydrinate (Dramamine), which is available
over the counter and works well for most people.
Parents sometimes ask about “sleeping” or “anxiety” pills
for long plane rides. I discourage their use because staying
up and jet lag are part of the group experience. And it
sends a message about taking drugs for “normalizing” extraordinary
activities, which is not a good one for young people to
hear. Overcoming jet lag is best managed with plenty of
daylight and exercise upon reaching destination. Short
naps, if necessary, may help ease the transition.
Following is a starter list of basic medications and equipment
that one might include in a youngster’s travel kit.
Traveling Medical Kit
Sunscreen (spf 30 is plenty)
Topical cortisone cream (OTC)
Antibiotics for diarrhea (by prescription only)
Antibiotic ointment (eg Neosporin)
Dental floss (Ya never know)
Dressings for severe blisters
security and terrorism issues and natural disasters?
website noted above has links to the State Department
and other sources which are continuously updated if activity
arises in the country where your child is destined to
travel. Addresses of embassies and local contacts are also
Finally, it is important to remember once the bags are
packed that the kids are going off to adventures they
(hopefully) cannot get at home. All of these do carry
some risk--risk of illness, risk of trauma and risk
to safety. But, they also carry the risk of discovery and
growth. Good preparation and planning will ensure that
the memories will be good ones even if there is some
hardship along with the adventure.
Engelland has a practice in Mamaroneck devoted to
Adolescent Primary Care. She can be reached at 914 698-5544. Use the form below
to submit a question to Dr. Engelland.
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