Beating the Travel Blues!

Traveling with infants & Toddlers

Let’s start by simply stating, it is best not to travel with an infant. However, as with anything, there will be necessary exceptions to the rule. I usually recommend trying to avoid any substantial travel in the first two months. Babies need this time to get well established in a nice routine at home. We all function better if we are on some sort of routine. Most pediatricians agree that traveling with an infant less than two to three weeks of age is most undesirable since the babies need to get adjusted to life in the real world. There is significantly increased risk of infection while exposed to a lot of people in places that are not very clean. No matter how you slice it, traveling with an infant is going to be stressful for both the parents and the baby. You can bet that if you are having a hard time with traveling, your baby will feed off of that and contribute to everyone’s stress. It is often easier (and nicer for the baby) to use snugly type sling to free up your hands as you’re carrying the baby around during travel. The better you plan ahead the better your trip is likely to be. Be Flexible!

Short trips by car are usually the easiest to take. Never travel without your child being securely fastened in a proper car seat. Did you know that 70% of car seats are NOT fastened properly? Do it right! Try to schedule the travel at times when your child will not need to eat. If you must feed your baby, it is safest to pull off to the side of the road, take the child out of the car seat and take care of the feedings, changings, etc. Whenever I traveled with my smaller children over a longer period of time, like to visit relatives, I would start the trip in the middle of the night so that the children would sleep while I drove a number of hours without having to entertain two toddlers the same time.

Most of us encounter the greatest problems if we have to travel great distances, especially by airplane. Always contact the airlines well in advance to help plan the trip. The airlines often have a limited supply of equipment for babies, such as slings and traveled beds, so get your name on the list early. Many people prefer bulkhead seats because they give small children greater room to squirm without bothering the person in the seat in front of them. It is also easier for the parents to feed and entertain the children in the bulkhead area. Please do not change the diapers at your seat or in the aisle! That is likely to really offend a lot of people and you will reduce the chance of someone offering to help you. I generally don’t recommend that you let a lot of strangers play with your baby, but if you need help and some kindly traveler offers – take it without hesitation. Diaper changes should be done in the bathrooms only. Call the airline to make sure they have changing facilities in their bathrooms. Most airlines do, but some do not, so plan ahead. Many parents have told me that they prefer rear seats because they’re closer to the bathrooms, stewardesses, and there is less bustle and activity from other passengers. The downside to the back of an airplane is that it is likely to give you a bumpier ride. The Academy of Pediatrics as well as most airlines prefer that infants be placed in a rear facing car seat that is no wider than 16in. This recommendation applies to children up to a year of age and less than 20lbs. in weight. Twenty to 40lb. children should have a forward facing seat. Inquire of the airline if they have something like that available. Children over 40lbs. can use normal adult seat belts.

Bring a soft bag full of necessities and goodies. As necessities I would consider having the following:
A few small water bottles
Travel pack of Kleenex
Wet wipes
Hand sanitizer
Diaper ointment
Pacifiers
A few 1qt. zip lock bags
Three times as many diapers as you think you’ll need
Multiple snacks in small containers or zip lock bags
Tylenol or Motrin
Band-Aids and a little duct tape

Bring something like link rings or strings that you can attach to the seat or to your wrist on one end and bottles, toys, etc. on the other. Your back will be very grateful that you don’t have to become a pretzel and fish under the seats for dropped items. Most infants can be entertained with soft animals, plastic mirrors and keys, pop-up toys, teething rings, puppets, etc. For toddlers bring puzzles, colored paper, non toxic crayons, action figures, story books, hand puppets. I like to bring new goodies for the toddlers, while most infants seem to prefer “old favorites.” DO NOT bring squeaky toys!
I generally do not like to recommend giving drugs to make children sleepy. Although Benadryl occasionally works well, some children get very hyper from it while other children get very cranky because they feel overtired and fight the effect of the Benadryl in a stimulating environment. However I will give you the dosages of two medications that are commonly used to help relax or reduce motion sickness. Benadryl is used at 0.5-1mg per kilo per dose; the typical dose for a 2-6yr old child would be 6.25mg every four to six hours. If you wish to use Dramamine the dosage is 1-1.5mg per kilo per dose every six hours, but Dramamine is not approved for children less than two years of age. A typical dose for a 2-6 yr. old would be 12.5 to 25mg. every six hours, with a daily maximum of 75mg. You can double that for the 6-12 year age range. You can approximate at 2lb=1Kg, so Benadryl would be given at 1-2 mg. per pound. Never use scopolamine for children. Test these medications once or twice on the children before traveling to avoid unpleasant surprises.

It is generally a very good idea to nurse your baby or offer small sips of a beverage during takeoff and landing. Don’t just hand them the bottle, offer sips. This will help prevent plugged up ears from causing pain and discomfort. Some people like to pretreat with Tylenol or Motrin just to ease any discomfort during the flight. Benadryl can be given with Tylenol or Motrin. If you are traveling overseas have a separate passport for your child, have an ID securely attached to your child and a notarized note from your spouse if you are traveling alone that you have his or her permission to take the child by yourself. Because of the concern of familial kidnappings most airlines will require some kind of statement from the non traveling spouse. Dress your child in bright colors to make them easier to spot. Having that prepared can save you a lot of hassle.

SIDS: New info from the Academy of Pediatrics

The Academy of Pediatrics is the "governing body" for us pediatrician. They are the ones who review data and issue guidelines and recommendation on health care for infants and children.
Sudden Infant Death Syndrome (SIDS) has decreased substantially (about 50% drop) since around 1994 when we started recommending the "back to sleep" position. Since then, we have accumulated more information that is important to share. The riskiest period seems to be between 2 and 4 months of age, with very few reports of SIDS after 6 month. Nothing is absolute and there will be exceptions to this general rule.
There are a few things that reduce the chances of SIDS that moms can do before delivery. Studies show an increased risk for SIDS if mom has no prenatal care or smokes. Don't do that. Increased risk means something is more likely to happen, not a guarantee that it will. There is a greater risk for a drunk driver to have an accident than a sober one. Both types will have accidents. Both types will not have accidents. BUT, the drunk drivers will have many more accidents (increased risk) than the sober ones.
Nothing guarantees your child will not die of SIDS, but you can do a number of things that will lessen that risk.
Back to Sleep is the only recommended position, not on the side or tummy. Do not use any items to prop the baby in any position, just lay them on their backs. They should be on their back for all sleeping times, although a brief nap in your arms seems safe enough. When babies are not sleeping, they do not need to be on their backs. They can be in any reasonable position. I used to see lots of babies with very flat heads and a stiff neck from laying in one position from infancy. Currently I recommend that babies be put to bed with their head toward the head of the crib one day/night and the next day/night their head toward the foot of the crib. That way you can help position the head so it is turned toward one shoulder one day and the opposite shoulder the next. That will prevent the head from flattening and exercize the neck muscles.
Firm mattress is another important recommendation. Soft mattresses, water beds, etc. Are not a good idea. There should not be any additional soft items in the bed, like comforters, stuffed animals, pillows, sheepskins, etc. because they can cover the baby's face.
Co-sleeping, that is, having the baby sleep in the bed with mom is not a good idea. About 150 babies die each year in the USA from a parent rolling onto the infant and smothering them. Beside the bed, in a separate sleeper is OK. Bringing the child into the bed to breast feed at night is fine, but not to sleep.
Pacifier use seems to also reduce SIDS to a substantial degree. The recommendation is to use a pacifier only once breast feeding has been well established (3-4 weeks). Some babies do need it even sooner (that's probably OK), but I have never liked to push a pacifier on a baby that refuses it. The recommendation is to put the baby to sleep with the pacifier, but if it falls out, not to replace it. To be honest, I don't understand that, but, for now, it's probably safer to use it than not.
Gadgets are not useful. No monitors, etc. will prevent SIDS. There is no need to buy other things to position the baby. Simply lay them flat on their back. Those gadgets are not only a waste of money, but give you FALSE security that you're doing something beneficial.
These are the latest recommendations. Please follow them. Your comments are welcome.