MD Travel Health

Traveling with infants and children

Medical facilities

Before you leave, make sure you have the names and contact information for physicians, clinics, and hospitals where you can obtain emergency medical care if needed. It is preferable to avoid bringing infants and young children to countries where medical resources are limited.

Yellow fever

Children less than nine months of age should not be brought to areas where yellow fever occurs, which includes most of equatorial Africa and many parts of South America, because yellow fever vaccine is not approved for use in this age group.

Malaria

The recommendations for malaria prophylaxis are the same for young children as for adults, except that (1) dosages are lower; (2) Malarone is not recommended for children weighing less than 25 pounds; and (3) doxycycline should be avoided. DEET-containing insect repellents are not advised for children under age two, so it's especially important to keep children in this age group well-covered to protect them from mosquito bites.

Measles

Children who are 12 months or older should receive a total of 2 doses of MMR (measles-mumps-rubella) vaccine, separated by at least 28 days. Children between the ages of 6 and 11 months should be given a single dose of measles vaccine before international travel. MMR vaccine may be given if measles vaccine is not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress. If measles vaccine is given before 12 months of age, revaccination with two doses of MMR, separated by at least 4 weeks, is recommended after the first birthday.

Food and water precautions

When traveling with young children, be particularly careful about what you allow them to eat and drink (see food and water precautions), because diarrhea can be especially dangerous in this age group and because the vaccines for hepatitis A and typhoid fever are not approved for children under age two. Baby foods and cows' milk may not be available in developing nations. Only commercially bottled milk with a printed expiration date should be used. Young children should be kept well-hydrated and protected from the sun at all times.

Routine immunizations

Make sure that all children are up-to-date on routine immunizations (see the American Academy of Pediatrics). If traveling with a child who is less than one year old or who is behind in his immunizations, see the "Accelerated immunization schedule" below. If visiting a country where an outbreak is in progress, it may be appropriate to give the relevant vaccine ahead of schedule.

Medical kit

Be sure to pack a medical kit when traveling with children. In addition to the items listed for adults, bring along plenty of disposable diapers, cream for diaper rash, oral replacement salts, and appropriate antibiotics for common childhood infections, such as middle ear infections.

Air travel

Air travel is not recommended for infants less than 7 days old.

Accelerated immunization schedules

The following are the minimum acceptable intervals for immunizations, intended for children who require immediate protection because they may be exposed to infectious diseases while traveling abroad. For further information, see "Drugs and Vaccines for Pediatric Travelers: An Integrated Table" by Caroline S. Zeind and Mary E. Wilson (J Travel Med. 2001 Sep-Oct;8(5):274-5).

Children less than one year of age

Polio vaccine

First dose may be given as early as six weeks of age. The next three doses may be given at 4-week intervals thereafter, although the preferred interval between the second and third doses is two months.

Diphtheria-tetanus-pertussis vaccine

First dose may be given as early as six weeks of age. The next two doses may be given at 4-week intervals thereafter. Children who have not received at least three doses of vaccine may not be fully protected. Two doses may offer partial protection. A single dose provides no significant benefit.
Fourth dose should not be given before 12 months of age.

Hemophilus influenzae vaccine

First dose may be given as early as six weeks of age. The next two doses may be given at 4-week intervals thereafter.
Booster dose should be given at age 12-15 months.

Measles vaccine

First dose should be given at 6-11 months of age. MMR (measles-mumps-rubella) vaccine may be given if measles vaccine not available, though immunization against mumps and rubella is not necessary before age one unless visiting a country where an outbreak is in progress.
If measles vaccine is given before 12 months of age, revaccination with two doses of MMR, separated by at least 4 weeks, is recommended after first birthday.

Varicella vaccine

Not necessary before 12 months of age, due to protection from maternal antibodies

Hepatitis B vaccine

Follow routine immunization schedule.

Children older than 6 weeks who are behind in their immunizations

Polio vaccine

First dose should be given immediately, if child has never received polio vaccine. The next three doses may be given at 4-week intervals thereafter, although the preferred interval between the second and third doses is two months. The fourth dose is unnecessary if the third dose is given at age four or older.

Diphtheria-tetanus-pertussis vaccine

First dose should be given immediately, if child has never received diphtheria-tetanus-pertussis vaccine. The next two doses may be given at 4-week intervals thereafter. The fourth dose may be given 6 months after the third, but not before 12 months of age.

Hemophilus influenzae vaccine

First dose should be given immediately, if child has never received Hemophilus influenzae vaccine. The next two doses may be given at 4-week intervals thereafter. The fourth dose may be given 2 months after the third, but not before 12 months of age.

Varicella vaccine

Follow routine immunization schedule.

Hepatitis B vaccine

Follow routine immunization schedule.

From the Centers for Disease Control (CDC)

Traveling Safely with Infants and Children

Vaccine Recommendations for Infants and Children

Breastfeeding and Travel

From "Health Information for Overseas Travel" (U.K.)

Travel with children