Have children, will travel

Dr Jane Wilson-Howarth explains what families should pack to keep their little ’uns safe, healthy and occupied when travelling independently
We first ventured overseas as a family when our first-born was three months old. After the long flight, we checked into a palatial hotel in Karachi and were greeted with free warm samosas and thick mango juice bobbing with ice cubes. About 36 hours later, Pakistan’s welcome started pouring out of my bottom, and I spent much of the next two days becoming familiar with the tiles on the bathroom floor. I paid dearly for ignoring the traveller’s mantra: ‘peel it, boil it, cook it or forget it.’

I was breast-feeding my baby at the time, but the diarrhoea compromised my milk supply and he soon became hungry, unsettled and demanding. I bought a feeding bottle with a stinky rubber teat, which he declined, so we struggled until my gastroenteritis burned itself out and my milk started to flow again. I hadn’t thought about a backup and wasn’t aware of the well-established technique of feeding him with a cup and spoon. The episode demonstrated both how protective breast-feeding is (my baby remained well throughout) and that lukewarm snacks and ice cubes are high risk when travelling where not everyone has access to a toilet.

Before leaving Britain, we had prepared for our first family trek by buying a flat-packable baby carrier. It fitted neatly into a suitcase and seemed comfortable for him and us. We checked the manufacturer’s instructions, as guilt-ridden new parents are wont to do, and noted a dire warning that the child could fall out and be harmed. A restraining harness was recommended. We searched, and finally a salesman – himself a parent – reassured us that a harness wasn’t necessary. Our reaction hadn’t been atypical. We were heading up into the Karakoram and, as new parents, we were edgy and keen to do the best forour precious progeny. Inexperienced parents – like inexperienced travellers of all kinds – tend to take too much gear. It often turns out that you need very little special equipment, and it can be profitable to buy or improvise from local markets.

Keep it steady

Families new to travelling often fall into the trap of spending too much time searching out fancy kit. Those hours might be better spent trying out solutions with gear you already own and researching the destination. In this planning stage, it’s also important to take a cold, hard look at whether the trip will suit all members of the family. Some children get dragged along by over-eager parents when the youngsters would rather hunker down in a sandpit or arrange pebbles on a beach.

A successful family trip often isn’t goal-driven and allows plenty of flexibility so that the whole family can just relax by a river for a couple of days if that’s what spontaneously appeals. A toddler carried all day in a backpack will want out and will be frisky and mischievous at the end of the day, when the parents want to rest. A child who has been allowed to potter and explore will be tired at sundown, too, and nights will be more restful for everyone. Clearly, there are times when, for safety reasons, an infant must be carried: the route to Kangchenjunga Base Camp in the Nepalese Himalaya, for example, involves negotiating high paths with potential for a 1,000-metre fall into the river below, and valley-bottom paths punctuated with temporary bamboo bridges over raging glacial meltwater that would swallow the strongest of swimmers, let alone a child.

Trekkers keep warm through exertion, so it’s easy to forget that the baby or toddler in the carrier can get seriously cold, as well as bored. Indeed, there are several deaths each year in the Alps where mountaineering or skiing parents don’t notice that their child has become hypothermic. A Japanese father took his infant to the 6,189-metre Himalayan summit of Island Peak, despite the fact that it’s unwise to ascend above 3,000 metres with a child who can’t describe their high-altitude headache. Fortunately, the child survived. Children carried on parents’ backs are also at risk of sunburn; some child carriers feature sunshades, but a cheap umbrella often suffices.

The best time to travel with kids is after they reach three years of age. Most will have then left the ‘terrible twos’ behind them and bribery and negotiation become possibilities. Three-year-olds will have begun to develop a sense of danger, and it’s also the age when children can communicate if they’re ill. Travel consequently becomes much less scary for the parents.

With a child’s increasing age comes – with luck – an extended attention span and the need for less variety in any trip. Nevertheless, consider how your brood will react to the activities you want to do: even jungle trips on elephant-back can quickly bore small children. My boys have warm memories of one trip to southern Africa where they wandered on foot in a reserve in the Drakensberg. They could stalk and try to get close to warthog, gazelle, giraffe and rock hyrax. This was much preferred to the rather serious outings in crowded jeeps to spot the ‘Big Five’, during which they couldn’t see out and weren’t allowed to speak. Tellingly, the crazy golf and snooker in the Drakensberg resort is their most abiding memory.

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Sick to the stomach

In my experience, the farther you venture from Britain, the more child-friendly you’re likely to find people. It’s unusual to find notices in hotels saying ‘no children’. However, if your destination is tropical or otherwise bug-infested, this will have health implications and influence the amount of precautions, potions and equipment you’ll need to carry.

Disease avoidance isn’t merely a matter of deciding which antimalarial drug the children need to swallow (the choices are Malarone, Lariam or very unpalatable chloroquine syrup). Malarious mosquitoes and other insects that spread diseases typically bite at night, so a cot net will help the kids avoid bites, and should stop big centipedes and snakes climbing into bed with them. I’d counsel caution if you’re thinking of going to malarious Africa with small children, and the advice of a travel clinic should be sought. Under-threes can get sick incredibly quickly if an infectious disease strikes, and it may be difficult to find a doctor you can communicate with and trust.

Gastroenteritis is a big concern for travelling families. The destinations that pose the highest risk are South Asia and tropical Latin America. The under-threes are, once again, at the biggest risk of getting seriously ill from a brisk, dehydrating bout of diarrhoea. It also plays havoc with your careful budgeting of nappies. It pays to pack some washables so that half your baggage allowance doesn’t get taken up by disposables.

Wherever there’s a high risk of tummy troubles, there’s also a risk of other filth-in-the-mouth infections, including vaccine-preventable hepatitis A and typhoid. However, the hepatitis A vaccine isn’t licensed for use in children under one, typhoid vaccines are ineffective in kids younger than 18 months, and there’s no vaccine for the similar – but more common – paratyphoid fever. Parents need to understand the life-saving properties of rehydrating drinks, what they are, and how and when to give them.

Little health essentials

Travel sickness pills or bands
Sunscreen (water resistant); SPF 15–25 is recommended
Insect repellent: Permethrin spray to insect-proof clothes
Cot net (also insect-proofed)
Paracetamol and/or ibuprofen syrup
Digital thermometer (with low reading to diagnose hypothermia at altitude)
A drying antiseptic such as Savlon Dry spray
Colourful sticking plasters
Sore throat pastilles
Water bottle of known volume (for example, one litre) with a good seal
Glucose powder (to make energy drinks and to rehydrate children)
Sudocrem for healing post-diarrhoea bottom and nappy rash
Pointed tweezers (to remove splinters and coral pieces)
Crepe bandage (for sprains, snakebite, bleeders and extensive lacerations)
Knowledge from a first-aid course and/or a book

Accidents waiting to happen

While all travelling children should be protected from tropical diseases with immunisations, the biggest threat to their health is accidents. Travel with safety equipment, including helmets and car seats (check if the hire car will have seatbelts to secure them). If going on the water, find out whether the activity organiser provides child lifejackets.

Children who aren’t fully occupied are at risk of wandering into danger, especially if the parents are at the limits of their ability to cope. It’s important to carry a few emergency bribes, and also have new games up their sleeves. In some destinations, health and safety regulations are non-existent or not enforced: a toddler could fall from an upstairs window, off a flat roof, or through a barrier. And kids are more likely than adults to get pushed off mountain paths by pack animals, attacked by village dogs, or threatened by temple monkeys.

Motion sickness plagues many trips. Travel bands – which press on acupuncture points – help reduce motion sickness in some. The evidence that bands work isn’t strong, but there’s so much suggestibility in motion sickness that they may help. There are essentially two sorts of motion sickness pills: hyoscine (branded as Joy-rides or Kwells) and antihistamine (such as Stugeron or Sea-legs; respectively available in generic form as cinnarizine or meclozine). Hyoscine relieves nausea more quickly, but the effect only lasts four hours. Antihistamines need to be taken more than three hours before travel; the dose can be repeated every eight hours.

However, ginger is about as effective in preventing motion sickness as these medicines. It can be administered as ginger biscuits; dose as required.

More than a thirst quencher
Drinks containing solutes (for example starch or sugars and/or salt) are absorbed into the body better than water alone. This has been known in India for generations, where rice water has been used traditionally to rehydrate people with diarrhoea. The idea was imported into Britain during the Victorian cholera outbreaks, but it wasn’t until the 1970s that this message, together with therapeutic rehydration sachets, became known globally. Rehydration drinks have now saved countless millions of lives.

DR JANE WILSON-HOWARTH–is a GP who raised three sons in Nepal. Her memoirs, A Glimpse of Eternal Snows (published by Pier 9), describe the family’s treks. For more information, visit www.wilson-howarth.com

July 2009

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