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Traveling Safely with Infants and Children

The number of children who travel by air or live outside their home countries has increased dramatically. An estimated 1.9 million children air travel overseas each year. Health issues related to pediatric international air travel are complex, reflecting varied activities, exposures, and age-specific health risks. While some travel health concerns are similar for children and adults, international pediatric travelers have unique problems because of variable immunity and different age-based behavior. Furthermore, many travel-related vaccinations and preventive medications used for adults are not licensed or recommended for pediatric use.



Injuries and deaths can occur in children held on adult laps during air travel turbulence and nonfatal crashes. The American Academy of Pediatrics recommends that children should be placed in a rear-facing Federal Aviation Authority (FAA)-approved child-safety seat until they are at least 1 year old and weigh at least 20 pounds. Children older than 1 year of age and 20-40 pounds in body weight should use a forward-facing FAA-approved child safety seat, while children weighing more than 40 pounds can be secured in the aircraft seat belt. Air travel is safe for healthy newborns and infants; however, children with chronic heart or lung problems or with upper or lower respiratory symptoms at the time of air travel may be at risk for hypoxia during flight, and a physician should be consulted before air travel.

Ear pain can be very troublesome for infants and children during descent. Equalization of pressure in the middle ear can be facilitated by swallowing or chewing; infants should nurse or suck on a bottle. Older children can try chewing gum. Antihistamines and decongestants have not been shown to have benefit. There is no evidence that air travel exacerbates the symptoms or complications associated with otitis media.

Air travel to different time zones, “jet lag,” and schedule disruptions can disturb sleep patterns in infants and children, as well as adults. Attempts to adjust sleep schedules 2-3 days before departure may be helpful. After arrival, children should be encouraged to be active outside during daylight hours to promote adjustment. Sedative medications may cause oversedation or paradoxical agitation, and melatonin may have effects on sexual development in infants and children. In general, these medications should be avoided in infants and children. Diphenhydramine can be useful for some children but, similar to any medication for sedation, should be administered as a test dose before air travel to determine the effect on the individual child.



Motion sickness can present as ataxia, dizziness, and nausea in infants and children. Other symptoms include pallor and cold sweats. For symptomatic treatment of children, dimenhydrinate, 1-1.5 mg/kg per dose, or diphenhydramine, 0.5-1 mg/kg per dose, up to 25 mg, can be given 1 hour before air travel and every 6 hours during the trip. Because some children have paradoxical agitation with these medicines, a test dose should be given at home before departure. Scopalamine causes potentially dangerous adverse effects in children and should not be used; prochlorperazine and metoclopramide should be used with caution in children.

SOURCE: US Department of Human Health and Services
Centers for Disease Control and Prevention