Travel Tips updated

It's that time of the year again when many of my patients and families are  traveling.

Therefore, it is time to dust off, tweak and rerun the travel post. Fully half of the calls I took this week were from folks who were calling from a trip. After listening to the list of symptoms and concerns, I would be all set to say "Gee, it sound like you need to be seen for that" and the caller would answer "but I am in Delaware/ Minnesota/ Timbuktu"

 

TRAVEL TIPS

"When is my baby old enough to fly?" is a question that we hear all the time. There are  many different factors to consider, so there is no one simple answer. Adopted babies might fly within the first few days on their way to their new home. Other folks make the valid choice to fly earlier than we are really comfortable with in order to see an aging relative or deal with a family crisis.

In ordinary circumstances, I would prefer to have the babies wait until they are over 2 to 3 months of age and have had their first set of immunizations (keep in mind that the first shot does NOT give full protection against some serious illnesses, but it is a start.) The size of the baby as well as the time of year are also factors. If there is some kind of crazy flu epidemic, I would think long and hard before taking a young baby on a plane. A few months ago we had that crazy measles outbreak. Last fall we has the Enterovirus D68. Right now, (June 2015) unless you are heading to South Korea, things seem reasonably quiet (knocking on wood as I type this.) Regardless of how old your child is, if you are planning a trip here are some tips and things to keep in mind.

Before you leave

I get calls from all over planet from parents who are dealing with a sick child during their trip.

Prior to the trip, check with your insurance company to see what the best method is for having out of state or international doctor visits covered. Some plans are much easier to deal with than others. Whether the visit is covered or paid for out of pocket, you also need to figure out what your actual options are. Is there an urgent care facility near by? Do you have a friend or relative with a pediatrician who is willing to see patients who are not in their practice? Does your insurance only cover an emergency room visit?

Hopefully you won't need to use this info, but if you are dealing with a sick child away from home it is nice to have a "Plan B" in place. If your child has a history of wheezing, it is wise to bring the meds along even if they haven't needed them in a while.

Surviving the flight

A few years ago I sat next to a mom with a very young baby. She was so worried about the possibility of getting evil looks from the other passengers that she had actually brought ear plugs to hand out to the people sitting around her. What she didn't have was anything to soothe her baby. Please always make sure that you have Tylenol or Motrin with you on the plane (not packed away in your suitcase). It is okay to bring small bottles through security. They need to be smaller than 3.5 ounces.I don't tend to give it ahead of time, but I am quick to medicate during the first sign of fussiness.

I often get questions about the use of Benadryl. This is an option for a child who is over 8 months with a long flight ahead. It helps dry up any congestion and makes 90% of kids who take it deliciously sleepy. Aha, but what about the other 10% you might ask? It turns those little darlings into hyperactive, wild hooligans. You do not want to find out on the plane that you are the parent of the 10%. There is no such thing as infant Benadryl, We use the children's liquid generic name diphenhydramine.

Many labels will warn not to give to children under 4. We routinely ignore that. You may want to give a test dose a few days prior to the trip to make sure it is a viable option for you.

I want parents to have the tools with them to deal with an unhappy child. Don't give any medication unless it is necessary. While I would usually err on the side of less medication, Benadryl and Tylenol/Motrin can be given at the same time.

Many babies and children can have trouble with their ears . For the younger ones, try to nurse or have them feeding during takeoff and landing. Sucking on a pacifier may be helpful as well. Have a lollipop or chewing gum for older kids. Ayr saline gel is a nice thing to have along. A dab at the base of the nostrils can moisturize the dry air and make the breathing easier (use it for yourselves as well.)

If you have a child with a history of ear trouble, have some of the little gel heat packs in your bag. You can activate them as needed and the warmth feels great to a sore ear.

Take WAY more diapers with you than you think you need for the trip. I was on another flight not too long ago when we sat on the tarmac for three hours. There was an unfortunate family behind me who had planned on a short little trip and was out of diapers long before we took off. It wasn't pretty. Plan accordingly.

Many folks automatically bring a change of clothes for their baby. It is also worth bringing an extra outfit for yourself. If you have a long flight ahead of you with a child on your lap, it may come in handy (I learned that one the hard way and sat for several hours covered with poop.)

Changing your baby on the plane can be a challenge. It is helpful to have little changing packs, with a diaper and some wipes, in individual zip lock bags. This will prevent you from having to take the entire bulky diaper bag with you into the tiny bathroom.

Bring some disinfectant wipes along and give the tray table and any surfaces a nice wipe down before you use them.

You can't count on airlines giving you any reasonable snacks, so it is important to bring along enough provisions in case of delays.

Download some activities or shows ahead of time for your laptop or tablet. While I am dreading the day when cell phone use is okay in flight, technology has certainly made it much easier to keep your child entertained during the journey. Don't forget about the old fashioned low tech options!

If you are visiting family, print out a bunch of photos of the people you are going to see. You can use these for all sorts of art projects on the plane. Make a paper doll family! This can help your kids recognize folks that they don't see too much of. Wikki sticks are also a great activity to bring along. They are lightweight and not too messy. Reusable stickers will stick on the window.

Once you get to where you are going, make sure the place is adequately child proofed (this is also a discussion that it is worth having with your hosts before you get there). I had one situation just last year, where a 3 year old opened a drawer and got into grandma and grandpa's medications.

Is there a pet where you are going? Make sure that any dogs are safe with children.

If you are staying in a vacation home, do a quick safety check. Do they have working smoke detectors? A fire extinguisher?

Time zones are tricky. My best suggestion is eat when you are hungry, sleep when you are tired and just do your best. Staying hydrated and getting fresh air are essential. Sunshine is a bonus.

http://www.reflexandmore.com/en/articles-heb/25-english/articles/21-jetlag 

The link above has wonderful information for dealing with jet lag. Even the best sleepers may have a period of needing a sleep training tune up when you get home.

You can have lots of fun while you are away and it is wonderful to see family. But, in my opinion, if you are traveling with children under the age of seven, don't call it a vacation. It's not. It is a TRIP (we used to call our visits to the various grandparents the "bad bed tour.")

A little preparation goes a long way and remember that some of the more challenging moments make for the best stories!

Here is one of mine..

Many years ago when my daughter Lauren was two, I got creative as I was planning for an upcoming flight as a solo parent. I had seen a craft in a magazine (long before pinterest existed) where a necklace had been made of cereal and I thought that that seemed like a fabulous thing for an airplane trip. Unfortunately, not all ideas turn out to be good ones. Lauren and I strung some Cheerios onto elastic and she proudly wore her new necklace onto the plane. Soon after take-off Lauren decided to eat some of the Cheerios. I noticed with some dismay that as she bit off a Cheerio, some would go into her mouth while other parts would shoot off like little spitty projectiles. They were landing (unnoticed by anyone but me) on just about everyone within three rows of us. As soon as I realized what was happening, I tried to see if there was a way for her to nibble them off without making a mess. When that didn't work, I tried to take the necklace off to make it easier or to have her stop eating them at all. But as mentioned, she was two. My choices were clear... tantrum on the plane or unsuspecting fellow passengers having little pieces of spitty Cheerios in their hair.

I opted for peace (besides, ignorance is bliss, right?)

Have safe travels and make great memories

Headaches/Migraines

Headaches are very common in children and adolescents. In one study, 56% of boys and 74% of girls between the ages of 12 and 17 reported having had a headache within the past month. By age 15, 5% of all children and adolescents have had migraines and 15% have had tension headaches. Does your child tend to head off to a quiet, dark room when there is too much going on? It could be migraines.

While headaches are more common in children once they reach 9 or 10, some children as young as 2-3 can articulate that their head hurts.

Migraines, tension and cluster are called primary headaches because they are neurological disorders not caused by an underlying medical condition. There is no specific medical test for migraines, so diagnosis is usually based on symptoms. Some of the classic symptoms include:

*A moderate to severe throbbing pain for 24-72 hours. Often this is on one side of the head. (for those of you who enjoy knowing its etymology,  the word migraine comes from the Greek hemicranios, meaning half a head.)

*nausea (they may or may not actually vomit)

*Sensitivity to light, noise or odor

Roughly 15-20% of migraine sufferers experience visual disturbances about 15 minutes before the headache sets in. This is known as an aura.

The drawing up at the bottom was drawn by one of my favorite people, Rachel, when she was seven years old  in an attempt to describe to her doctor what an aura felt like.

Migraines don't always manifest as headaches. Some children also have abdominal migraines. If your child is having frequent tummy aches and or complaints about nausea, ask them if they have any visual symptoms.

Migraines have a big genetic component. There is often a strong family history. A pediatric neurologist at UCSF says, "If you're having trouble finding the family history, the paternal grandmother is often the link.  Because migraine genes are expressed more often in women than in men, dad might pass on the genes to a child without knowing it."

There are also current studies to see if there is a connection between colic in a baby and migraines later on.  

  

Secondary headaches result from another medical condition. These conditions can range from a relatively harmless illness like sinusitis or the flu to more serious conditions. Strep throat is often accompanied by a headache. Simple cold/allergies are also common culprits. As miserable as these headaches are, most parents and practitioners are less concerned if there is an obvious cause like a virus.

Mystery headaches are somewhat more alarming. A red flag that you should contact a doctor about a headache would be one:

*    that wakes the patient out of a deep sleep

*    appears suddenly and is more severe and different from past headaches

*    comes along with weakness or numbness or tingling

*    makes it difficult to think or remember things

*    follows  a recent head injury (within 2 weeks)

Headaches that are associated with vomiting are also worth checking out (if the entire family has the flu and is having similar symptoms, I am much less concerned.)

If there is a headache that is coming more than once a week or with any kind of frequency that has you alarmed,  it is worth getting checked out. It is always worth starting with  your primary doctor, but they may want to do a referral to a headache specialist.

The first step is for the  neurologist to make sure that there isn't something serious going on. Once the scary stuff has been ruled out, they can be an essential part of your team helping to manage chronic headaches moving forward. Headache specialists can help you identify the triggers and explore many non-medical options. The folks at UCSF are on the cutting edge of managing migraines. They are exploring things like CoQ10 and Riboflavin rather than jumping to medication options (you need to see them to discuss dosages.) In fact they are currently looking for teens for a study seeing if melatonin might play an important role in treatment. If you have a teen 12-17 who might be interested in taking part in this check out this link:

 http://brain-m.ucsf.edu/  

The patient will need to only go in for one visit. The rest of the data will be gathered remotely. The participants will also be given a Fitbit that they get to keep!

 

If your child is having headaches, start keeping a journal to see if you can identify the causes. The information that will be most useful to the doctor is the frequency of the headaches and the tracking of the treatment. What did you try? Did it help?

As you think of other things to add to the journal look at this list of some common triggers and see if any obvious one come to mind:

*Irregular sleep habits

*Dehydration

*Skipping breakfast

*Not getting regular exercise

*Change in weather

*Foods with additives/nitrates

*Red wine (hey this info is for you grown ups too)

*Hormone fluctuations

*Recent stress

*Lighting changes e.g., bright fluorescent

*screaming baby? 

My daughter Lauren had very frequent headaches. Our cousin Avi lovingly nagged and nagged her to see if a gluten free diet would help. He was relentless. She finally gave in and agreed to give it a shot. To her delight (and horror) it made a huge difference. She has been gluten free (and headache free) for years. When she gets an accidental exposure to gluten the headaches come roaring back. There is no ignoring the connection.

I get migraines when I drink a certain type of red wines. A glass of Syrah will trigger a headache that knocks me flat. Every step ricochets from my feet up through my head. Not fun. My learning curve on this was almost comical. I couldn't imagine that I was really reacting to only one type of wine and it took about 3 or 4 miserable experiences until I stopped all experiments and simply don't drink any Syrah.

If you or your child are suffering from headaches be a sleuth!

There was a recent study that showed in some cases regular exercise was just as effective as medication in preventing and reducing headaches.  

Some people have also had success with alternative therapies such as gentle chiropractics and or acupuncture.  

  

I will close with some last words of wisdom from the wonderful Dr Gelfand

*    Get regular sleep

*    Stay well hydrated with non caffeinated beverages

*    DON'T skip breakfast

*    Get regular exercise.

*    Chocolate is innocent!! It is no longer on the list of frequent triggers,  

I was very fortunate that Dr Amy Gelfand allowed me to "pick her brain" so to speak about this important topic. Dr. Gelfand is a child neurologist at the UCSF Headache Center. She specializes in diagnosing and treating children who suffer from a variety of headache disorders, as well as children with childhood periodic syndromes such as abdominal migraine that are felt to be precursors to migraine headache later in life.

September 2015 check out this blog from Dr Gelfand
bit.ly/migrainebacktoschool