Women and children only

Travelling with children

It’s worth doing a bit of advance planning and preparation to make the holiday more enjoyable for everyone. Usually, before you go, take the opportunity to check that the childhood immunisation schedule has been completed and enquire about whether your child needs any further immunisations.

It can be difficult getting malaria tablets into babies and small children and there are no children’s formulations of most varieties. It is often a matter of breaking tablets and persuading the child to take repeated doses of bitter tablets while you’re away and for four weeks after your return. It can easily turn into a battle of wills, so you might be wiser to opt for holidays outside malarial areas for the time being at least.

Try to book your airline seat well in advance for longer journeys with a young baby to make sure a ‘sky cot’ is available. Babies can suck a bottle and children can suck a sweet on take off and landing to help them equalise pressure in their ears, which otherwise is uncomfortable. Crying has the same effect. ‘Blocked’ ears caused by infection should be medically checked before travel and sometimes flying may have to be delayed.

Motion sickness is rare in very small children but common between three and twelve years of age. A vomit bag may be a sensible precaution and the chemist can provide mild medication for those known to suffer. Being able to see the view outside to the horizon might help. Reading or doing puzzles may not. Don’t forget to pack toys or amusements for the journey in your hand baggage, bearing in mind that there’ll probably be limited play space.

Simple medicaments should also be in your hand luggage and so available at all stages of the journey. Children’s painkillers, nappies, antiseptic creams, a few plasters plus the oral rehydration salts and a children’s thermometer need to be included, together with supplies of any regular medication taken already by your child. You might like to discuss with your doctor whether to carry a mild paediatric sedative to have in reserve for an exceptionally long journey.

Wet or antiseptic tissues for cleaning their hands after the lavatory and before handling food are also useful.

Pack suitable clothes in your hand luggage, bearing in mind any likely changes in temperature between home and your final destination. When packing for hot climates, do not take only short-sleeved clothes but remember that you’ll probably need to be able to cover your child’s arms, legs and head against the sun (and sometimes to reduce the area of skin exposed to insect bites).

You’ll need to allow for unforeseen delays on the journey when packing supplies of suitable food and drink. If possible check the availability of baby foods at your destination particularly in tropical or developing countries. Bought milk can be a source of infection and breast-feeding has obvious advantages. If you are breast-feeding, you must be sure to drink adequate quantities of water yourself in hot climates. Children can dehydrate quickly and especially if they develop diarrhoea or vomiting.

Plenty of safe drinks should always be available and you should take packets of oral rehydration salts, which can be mixed with boiled or bottled water. These help to restore the balance of salts and help the body to retain fluids. They must be reconstituted exactly according to the manufacturer’s instructions (particularly for babies) so don’t be tempted to make them up any stronger. Small children shouldn’t take tablets designed to stop diarrhoea, so food and water hygiene is especially important for very young children. Always seek medical attention earlier rather than later for young children with diarrhoea, particularly if they have a temperature.

Don’t use too much insect repellent or apply it too frequently to young children’s skin – in other words, don’t exceed the quantities recommended on the pack. You shouldn’t put it on their hands either as they may then rub it into their eyes or mouth. Spraying it directly on to collars, cuffs and trouser legs will cut down the amount that you need to apply to their skin.

Where insects are a real problem and you’ve had to put repellent on all exposed areas of skin, wash it off once you go indoors.

You will have to make an effort to ration the amount of time children spend out in hot sun, and always use a high protection factor sunscreen for them.

Accidents can happen in new environments and you’ll need to take particular care close to the sea or swimming pool. Children have disappeared or been drowned when their parents have been distracted for only a few minutes. Any animal bite or scratch must be seen by a doctor in a country where rabies exists. This should be done especially quickly for any injury to the face or head, which is more likely where children rather than adults are concerned.

As always, medical insurance is important for overseas travel and children may be included free.

Women on holiday

Women may have more concerns about the standards of hygiene and lavatories that they are likely to encounter on holiday, especially in developing countries and away from the major holiday centres. As a woman, you may also have specific queries, for example, about travel and the contraceptive pill and about personal safety concerns.

In places where washing your hands properly may not always be practical, it is worth carrying some packs of moist tissues. Your hands need to be clean before you insert a tampon as well as after using the lavatory. A roll of loo paper may be useful in countries with different customs such as India. It may not be available except in major westernised hotels. Tampons are not available in many developing countries apart from main tourist centres.

For camping, sailing or other situations where you might prefer to postpone a menstrual period, your GP or family planning clinic can often prescribe the contraceptive pill or suggest how you could adapt the way that you take your present one. Should you have a gastrointestinal upset causing you to vomit a few (probably up to three or four) hours after taking a pill, you can take another one.

With travellers’ diarrhoea it is more difficult to estimate how much protection has been lost. You should keep on taking your pill, but also use an additional form of contraception such as a condom because you cannot rely on the pill again until the next cycle.

The same applies if you’re taking some types of antibiotic, except that the extra precautions are advisable for 14 days after the course. One malaria tablet called doxycycline may make the pill less effective for the first month that you are taking doxycycline. Before travelling, it is wise to check current advice in these situations for your individual contraceptive pill. As missed pills can cause problems, always pack them in your hand luggage.

A new contraceptive patch applied once weekly will avoid the problems of the daily pill being forgotten and is a very convenient method for women travellers. Another method of avoiding daily pills is to arrange for depo-injected contraception from your GP or family planning clinic. However, this method would be unsuitable for use just before travel because it is not reversible in the case of side effects. It should be tried out well in advance of departure. An implant (Implanon) lasting several years could be attractive for long-term travellers. It can, if necessary, be removed, but only by a doctor trained in the technique. Another point about contraceptive hormones and hormone replacement therapy (HRT) is that the small risk of deep vein thrombosis (DVT) with these products may be increased by long-haul flights (see section on DVT).

Some women find that their periods stop on longer trips and this can be quite convenient so long as you have no reason to think that you might be pregnant. Some women may like to carry condoms, which also help to prevent sexually transmitted infections – in some countries it can be difficult for women to buy condoms. In an emergency you can ask a doctor to prescribe the ‘morning-after’ pill, which you can take up to 72 hours after unprotected intercourse. In the UK this pill is available over the counter from a chemist.

Thrush is more common in hot climates because the yeast organism that causes it multiplies faster in warm, humid conditions. Your genital area should be kept clean, avoiding irritation by soap. Cotton underclothes are a good idea but tight trousers aren’t because they prevent circulation of air. If you know that you’re prone to thrush, especially if on doxycycline antimalarial tablets, you may find it useful to carry some clotrimazole or econazole, which you

can buy from the chemist or get on prescription from your doctor. Even more convenient is the ‘over-the counter’, single capsule, fluconazole.

Urine infections can also be common in hot climates especially in those who are prone to them at home. They can be very inconvenient because you feel that you have to pass urine more often and, when you do, there is a burning sensation.

Drinking plenty of fluids, especially in hot climates, is worthwhile, both as a preventive and also because it helps to relieve symptoms once they have occurred. The burning may be relieved by taking potassium citrate, available from the chemist.

Cranberry juice is a popular remedy in the USA and it is widely available in supermarkets. If the symptoms do not settle, and particularly if you have a temperature or back pain, then you should see a doctor as antibiotics may be needed.

Women travelling alone may encounter more problems than men in the same situation, although the risk of being attacked exists for either sex. No written advice can replace common sense and caution. Planning the journey so that hitch-hiking and long waits in bus or train stations are unnecessary is a sensible precaution.

Always make sure that someone knows your expected itinerary and times of arrival. Obviously keep cameras, mobile phone and valuables out of sight and dress modestly. This is particularly important in Muslim countries where exposing a lot of female skin or wearing tight, figure-hugging clothes can be equated with loose morals. The same judgement may be made of women travelling without a male ‘protector’. It may be necessary to cover your head and/or arms to visit holy places in various countries. The Foreign and Commonwealth Office (FCO) website and telephone line (see ‘Useful information’) provide advice on security and some local customs in individual countries.

Travel in pregnancy

Pregnant women often want to have a holiday before their lives become more restricted by the arrival of a baby. Many enjoy travelling and suffer no problems; however, there is no doubt that, if something goes wrong, most would have preferred to be at home.

Your choice of destination and time of travel can be important, so it is wise to think carefully and perhaps discuss the possibilities with your doctor before booking your holiday. Try to find out about the likely standard of medical facilities in the destination country. Malarial areas should be avoided because, although some tablets can be taken in pregnancy if necessary, it is not an ideal situation. Most women would prefer not to take medication during pregnancy and no tablets can provide complete protection. Malaria is more serious in pregnancy. Furthermore, women should ideally avoid becoming pregnant for about three months after leaving a malarial area in case they are incubating malaria, which would then be more difficult to treat.

It is also ideal to avoid immunisations, although again, if the risk of disease is high enough, some may be given. It is preferable not to be put into that position, so choose somewhere outside the yellow fever belt (Africa and the north part of South America – see earlier maps) and away from the areas of higher risk from food- and water-borne diseases. Be prepared to stay in hotels where the catering hygiene standards are likely to be relatively high or where you can cater for yourself and take special care.

The most common time for a miscarriage to happen is at around 12 weeks and some women need a minor operation if it is not complete. This is straightforward with modern medical facilities, but would not be ideal in a developing country. Morning sickness and nausea are also usually more of a problem early in pregnancy. In the last three months, the possibility of early delivery means that you should be close to high standards of medical help. By this stage anyway, your size and general discomfort may also make long journeys and holidays in a hot climate uncomfortable. Airlines may refuse to carry pregnant women after 36 weeks.

Malaria – BETTER SAFE …

If you can, opt for the less risky areas, and you’ll have a more relaxing holiday SAFEST DESTINATIONS WHEN PREGNANT (i.e. good medical treatment available)

• Europe (except eastern)
• USA and Canada (but expensive if you need treatment)
• Australia and New Zealand (but a long way from home)

EXAMPLES OF TROPICAL CLIMATES WITH LITTLE OR NO MALARIA RISK

• Caribbean islands (except Haiti and the Dominican Republic)
• Singapore
• Penang and most of peninsular Malaysia
• Seychelles
• Bangkok, Pattaya, Phuket (Thailand)
• Queensland (Australia)
• Florida, Hawaii (USA)

HIGH RISK OF MALARIA (AVOID IF POSSIBLE WHEN PREGNANT) East, West and Central Africa Amazon basin areas of South America Burma (Myanmar) Vietnam

Cambodia and Laos Sabah

Papua New Guinea, Vanuatu, Solomon Islands Rural far south China (Yunnan and Hainan provinces) Northern and border areas of Thailand

ALWAYS CHECK THE UP-TO-DATE SITUATION WITH YOUR DOCTOR OR A TRAVEL CLINIC

This leaves the middle three months (especially 18 to 24 weeks) as the best choice for those who want to get away. Check your airline’s policy with regard to pregnancy and read the small print on your travel insurance.

When making your plans, remember that pregnancy can increase fatigue, hunger and how often your bladder needs to be emptied. Your ankles can swell more during flights and hours of travel can leave you with backache, so try to allow for all this when planning your schedule. In any case it is important to try to move around during the flight and consider the use of travel socks to reduce the risk of DVT, which can be higher in pregnancy.

Key points

• Plan your destination carefully, checking local facilities

   

• Avoid malarial areas in pregnancy and when travelling with small children

   

• Keep essential supplies for your baby close to hand

   

• Don’t delay seeking medical help if a young child develops diarrhoea, especially if accompanied by a fever

   

• Women travellers should be particularly aware of personal safety