What do we know about travel for children with special health care needs? A review of the literature
Section snippets
Background
Most children are healthy, yet the proportion of children with chronic disease has been steadily increasing over the past few decades [1]. Children with chronic illness comprise 12-15% of the US pediatric population, which is similar to The World Health Organization (WHO) prevalence of children with disability [2,3]. Children and youth with special health care needs (CSHCN) have a chronic physical, developmental, behavioral or emotional condition that needs health care services [4]. Although
Methods
An Online search of the PubMed, CINAHL and Google databases of English language literature was conducted June 2016, October 2017, June 2018 and April 2019 using the terms children and travel and air travel, travel health, disabled child, children with special healthcare needs, parents of disabled children, vacations, recreation, international, wheelchairs, planning techniques, asthma, diabetes, altitude, cystic fibrosis, inflammatory bowel disease, sickle cell disease, depression, food
Results
185 papers were examined for travel health related outcomes for children and adults with chronic diseases. Articles were excluded if they addressed the educational needs of students with disabilities traveling abroad, did not directly address travel health (e.g. travel skills, travel itineraries), contained outdated policy statements, or were case reports of a single patient. The remaining 84 papers were organized by organ systems. The articles were primarily descriptive and thus did not lend
Motor vehicle safety
Seat belts and car safety seats (CSS) are recommended for proper restraint of children when traveling. Alternative harnesses are available for children whose height and weight qualify them for CSS but their medical equipment, such as a halo head brace, hip spica cast, tracheostomy or omphalocoele interfere with the straps [23]. Children who need support for their head and neck may require a medical CSS for safe transportation. Specialized medical CSS and travel vests are available for larger
Asthma
Asthma is the most common chronic disease of childhood. In the US 8.4% of children suffer from asthma [37,38]. Managing asthma while traveling includes minimizing triggers, treating typical flare-ups and working with families to identify when and where to seek treatment. Common triggers associated with travel include low humidity air in airplanes, passive smoke, pollution, mold, pollen, animal dander and respiratory infections. Asthma attacks are one of the top pediatric in-flight emergencies;
Congenital heart disease
Congenital heart disease affects 1% of babies worldwide [51]. A pre-travel consultation with a cardiologist is recommended to determine the need for in-flight oxygen. Families are adept at adjusting schedules to accommodate their child's activity tolerance, which they can extend to travel. Children with complex congenital heart disease are often in various stages of repair; consultation with a pediatric cardiologist is advised to review flying, exercise restrictions, and the need for ongoing
Immunosuppression
Significant advances in the care for children with underlying inflammatory and autoimmune diseases have created a large group of children who feel well, but are partially immune suppressed either as a result of their underlying illness or treatment. Travel medicine providers will need to assess unique risk of acquiring infections at the destination as well as the effectiveness of immunizations and/or prophylactic medications for their immune suppressed travelers [54]. The Infectious Disease
Sickle cell anemia
Sickle cell disease (SCD) is a heterogeneous inherited disorder of hemoglobin. Many children with SCD have families who have migrated from Africa, Arabia or India. Pediatric patients with sickle cell disease (SCD) who travel are susceptible to infection with encapsulated bacteria (e.g. meningococcus, pneumococcus), malaria and salmonella [[68], [69], [70]]. Two sickle cell centers analyzed their center's data on ill-returned travelers with differing results. Ten to 59% of pediatric travelers
Diabetes
Type 1 diabetes affects 0.24% of Americans under age 20 [72]. A large retrospective study showed that young adults18-32 years of age with Type 1 diabetes with good glycemic control prior to departure do not suffer increased travel-related illness over their healthy peers. Additionally, they maintain good glycemic control when traveling [73]. Similar findings were supported in a large prospective study of adults [74]. An older study noted that hypoglycemia occurred in 10% of type 1 diabetic
Hearing and visual impairments
Communication barriers and unfamiliar environments associated with international travel are compounded for children with hearing and/or vision impairment. Travel skills for children with vision impairments should be taught early in childhood, often well in advance of planned travel. Families of children with low or no vision can describe the environment to the child, pointing out traffic, landmarks and give the child responsibility for planning routes. Ideally orientation and mobility skills
Intellectual and behavioral health problems
Careful preparation for a child with a developmental or behavior disorder is essential to successful travel. Many of the experiences involved in travel such as tolerating loud noises, long waits in line, unfamiliar foods and altered sleep habits can cause a deterioration of a child's behavior. Data are not available about travel-related health outcomes for children with Autism or ADHD despite their high prevalence (2.5% and 9.4% respectively) [85,86].
Parents and therapists have found ways to
General travel preparation
Traveling internationally with children with special health care needs requires pre-travel planning. A summary of an approach to preparing a CSHCN for travel is provided in the Fig. 1. Several authors recommend a practice or ‘trial run’ of travel to a near-by city for a weekend. This ‘mini travel’ gives the patient and family a chance to identify and solve many obstacles such as completing activities of daily living, providing routine medical care and finding safe transportation prior to
Conclusion
Travel health professionals, general practitioners and pediatric specialists all share in the responsibility of caring for children with chronic and complex healthcare needs who travel internationally. General principles of travel health such as providing safe transportation, preventing infections, updating immunizations and managing common travel illnesses are important. In addition, care plans must include day-to-day needs as well as management of flare-ups of illness while away from home.
References (100)
- et al.
Global burden of disease in young people aged 10–24 years: a systematic analysis
The Lancet
(2011) - et al.
Travel-related infections in children
Pediatr Clin
(2013) - et al.
Preparing children for international travel
Trav Med Infect Dis
(2008) Family travel: an overview
Trav Med Infect Dis
(2006)- et al.
International travel by persons with medical comorbidities: understanding risks and providing advice
Mayo Clin Proc
(2013) - et al.
Chronic illnesses in travelers to developing countries
Trav Med Infect Dis
(2014) When travel is a challenge: travel medicine and the ‘dis-abled’ traveller
Trav Med Infect Dis
(2018)- et al.
Definition of cutoff values for the hypoxia test used for preflight testing in young children with neonatal chronic lung disease
Chest
(2008) - et al.
Predicting hypoxia in cystic fibrosis patients during exposure to high altitudes
J Cyst Fibros
(2006) - et al.
The hypoxia challenge test does not accurately predict hypoxia in flight in ex-preterm neonates
Chest
(2008)
Pediatric admissions due to travel-related asthmatic attacks in Japan: a retrospective case series and case-control study
Allergol Int
Cystic fibrosis
The Lancet
Travelling with cystic fibrosis: recommendations for patients and care team members
J Cyst Fibros
Pre-travel care for immunocompromised and chronically ill travellers: a retrospective study
Trav Med Infect Dis
Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease
J Crohns Colitis
High altitude journeys and flights are associated with an increased risk of flares in inflammatory bowel disease patients
J Crohns Colitis
In-flight allergic emergencies
World Allergy Organ J
Global burden of disease in young people aged 10–24 years: a systematic analysis
The Lancet
Dynamics of obesity and chronic health conditions among children and youth | obesity | JAMA | JAMA network
J Am Med Assoc
World report on disability
A New definition of children with special health care needs
Pediatrics
Health challenges of international travel for obese patients
J Travel Med
International tourism results: the highest in seven years | world tourism organization UNWTO n.d
Morbidity among Israeli paediatric travellers
J Travel Med
Pre-travel health preparation of pediatric international travelers: analysis from the global TravEpiNet consortium
J Pediatr Infect Dis Soc
Illness in children after international travel: analysis from the GeoSentinel Surveillance Network
Pediatrics
Profile of travel-associated illness in children, Zürich, Switzerland
J Travel Med
Paediatric travel medicine: vaccines and medications
Br J Clin Pharmacol
Health challenges of young travelers visiting friends and relatives compared with those traveling for other purposes
Pediatr Infect Dis J
Pediatric travelers presenting to an Australian emergency department (2014-2015): a retrospective, cross-sectional analysis
Trav Med Infect Dis
Travel-related morbidity in children: a prospective observational study
J Travel Med
Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic
J Travel Med
Health risks of travelers with medical conditions--a retrospective analysis
J Travel Med
Development of an alternative five-point restraint harness to accommodate children with special healthcare needs in child safety seats
J Pediatr Rehabil Med
Issues and approaches to safely transporting children with special healthcare needs
J Pediatr Rehabil Med
Transporting children with special health care needs
Pediatrics
Getting the right wheelchair for travel: a WC19-compliant wheelchair
Except Parent
Applying basic principles of child passenger safety to improving transportation safety for children who travel while seated in wheelchairs
J Pediatr Rehabil Med
The flight experiences of people with disabilities: an exploratory study
J Travel Res
Hypoxia challenge testing in neonates for fitness to fly
Pediatrics
Commercial airline travel decreases oxygen saturation in children
Pediatr Emerg Care
Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations
Thorax
Pre-flight testing of preterm infants with neonatal lung disease: a retrospective review
Thorax
Predicting hypoxaemia during flights in children with cystic fibrosis
Thorax
CDC - asthma
Chest
Pediatric emergencies on a US-based commercial airline
Pediatr Emerg Care
Asthma in patients climbing to high and extreme altitudes in the Tibetan everest region
J Asthma
Asthma in medium altitude--exercise-induced bronchoconstriction in hypobaric environment in subjects with asthma
Allergy
Incidence and risk factors associated with acute mountain sickness in children trekking on Jade Mountain, Taiwan
J Travel Med
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