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Bring one pair of comfortable walking shoes as well as a pair of sandals or Tevas. Before you leave home, break in your new shoes so you're not uncomfortable on the road.

Health On the Road: Part 2 (of 4)

Health Tips

Compliments of: "Travel With Children" by Maureen Wheeler (Lonely Planet Publications, 155 Filbert Street, Suite 251, Oakland, CA 94607. $11.95)

MEDICAL PROBLEMS & TREATMENT

Potential medical problems can be broken down into several areas. First there are the climatic and geographical considerations-problems caused by extremes of temperature, altitude or motion. Then there are diseases and illness caused by either poor environmental sanitation, insect bites or stings, and animal or human contact. Simple cuts, bites or scratches can also cause problems.

Self-diagnosis and treatment can be risky, so wherever possible seek qualified help. Although we do give treatment dosages in this section, they are for emergency use only. Medical advice should be sought where possible before administering any drugs.

An embassy or consulate can usually recommend a good place to go for such advice. So can five-star hotels, although they often recommend doctors with five-star prices. (This is when that medical insurance stuff really comes in handy!) In some places standards of medical attention are so low that for some ailments the best advice is to get on a plane and go somewhere else.

FEVER

Children often have high fevers for little apparent reason and recover from them remarkably quickly. Carry a digital thermometer and, if your children are very young, fever strips (those little strips which will tell you immediately if your child does have a fever). I find it easier to use these in the first instance as most small children are not too cooperative when having to sit still with a thermometer in their mouths for the required time. If the strip does indicate fever, use the thermometer to find out just how hot your child is. As you would normally do, try to get medical help if the temperature is abnormally high. Fevers in small children can be quite dangerous.

The general rule with treating fevers is to get the child cool as quickly as possible. Remove all their clothes, sponge the child down with tepid water, place close to a fan, and try to get them to drink something cool. If the temperature is high, place them in a cool bath. The child won't want to go, and may shiver because they are hot, but you must bring the temperature down. Administer paracetamol (e.g. Panadol). Treat fevers seriously, and always call in medical help if you are at all concerned.

Children often run temperatures without ill effect: my most frightening experience was Kieran running a high fever when we were in Africa. We were all sleeping in a rather small tent while a herd of elephants grazed outside. One male elephant was acting quite aggressively towards our camp. Since I found the sound of elephants grazing right by my head rather unsettling to say the least, I was not sleeping very well. In the middle of the night Kieran woke up, delirious and very feverish. Trying to calm him, get his fever down and keep him quiet so as not to alarm the elephants while remaining calm myself was not easy. I was sure he had malaria, meningitis, sleeping sickness, etc. Next day, a rather tired but otherwise totally healthy Kieran awoke; I was a complete wreck.


CLIMATIC & GEOGRAPHICAL CONSIDERATIONS:


SUNBURN

In the tropics, the desert, or at high altitudes you can get sunburned surprisingly quickly, even through clouds. Use a sunscreen and take extra care to cover areas which don't normally see sun, such as your feet. A hat provides added protection, and you should also use zinc cream or some other barrier for your nose and lips.

Apart from sunburn, there is evidence that damage from overexposure to the sun can lead to skin cancer in later life. Small children burn easily so always use sunscreen, even if you are only taking them for a five-minute walk around the corner to get lunch. Remember the sun is at its strongest around noon, but for most of the day in many countries it is strong enough to burn a baby very severely. Early morning and late afternoon are fine times to take the children to the beach; it is usually warm enough to really enjoy the water and the sand, but not hot enough to do any harm. Still, an umbrella may be a good idea to take to the beach to use as a sunshade, especially if you have a small baby who is not yet crawling or walking.

Cover your children with a complete sunscreen anytime they are in the sun (water-resistant if they will be in the water). A T-shirt or light cotton caftan will also give protection and can be worn in the water. It is possible to burn through the T-shirt, especially when it is wet, so be careful. The danger of sunburn is greater at the beach than anywhere else as the sun reflects off the sand and water.

If your children do get burned, calamine lotion is a good standby, but there are other lotions (such as Bepahthin) you can get. Have a pair of sandals or beach shoes on hand as the sand can get hot enough to badly burn little, tender-skinned feet.

Try to get your children to wear a hat - both my children when they were very small promptly ripped hats off as soon as I put them on but it is worth persevering.

PRICKLY HEAT

Prickly heat is an itchy rash caused by excessive perspiration trapped under the skin. It usually strikes people who have just arrived in a hot climate and whose pores have not yet opened sufficiently to cope with greater sweating. Keeping cool but bathing often, using a mild talcum powder or even resorting to air-conditioning may help until your children acclimatize. If the rash is very bad check with a local pharmacy. If there is a history of hives or other allergic reactions in your family, ask your doctor's advice before you leave. Sometimes an antihistamine cream or medication is useful in severe cases.

HEAT EXHAUSTION

Dehydration or salt deficiency can cause heat exhaustion. Take time to acclimatize to high temperatures and make sure your kids get sufficient liquids. Salt deficiency is characterized by fatigue, lethargy, headaches, giddiness and muscle cramps and in this case salt tablets may help. Vomiting or diarrhea can deplete their liquid and salt levels. Anhydrotic heat exhaustion, caused by an inability to sweat, is quite rare. Unlike the other forms of heat exhaustion it is likely to strike people who have been in a hot climate for some time, rather than newcomers.

HEAT STROKE

This serious, sometimes fatal, condition can occur if the body's heat-regulating mechanism breaks down and the body temperature rises to dangerous levels. Long, continuous periods of exposure to high temperatures can leave you vulnerable to heat stroke. Children are particularly susceptible to heatstroke and you should avoid excessive activity when you first arrive in a hot climate.

The symptoms are feeling unwell, not sweating very much or at all and a high body temperature (39 to 41 degrees Celsius). Where sweating has ceased the skin becomes flushed and red. Severe, throbbing headaches and lack of coordination will also occur, and the sufferer may be confused or aggressive. Eventually the victim will become delirious or convulse. Hospitalization is essential, but meanwhile get victims out of the sun, remove their clothing, cover them with a wet sheet or towel and then fan continually.

FUNGAL INFECTIONS

Hot weather fungal infections are most likely to occur on the scalp, between the toes and fingers (athlete's foot), in the groin (jock itch or crotch rot) and on the body (ringworm). You get ringworm (a fungal infection) from infected animals or by walking on damp areas, like shower floors.

To prevent fungal infections wear loose, comfortable clothes made from natural fibers such as cotton, wash frequently and dry carefully. If you do get an infection, wash the infected area daily with a disinfectant or medicated soap and water, and rinse and dry well. Apply an anti-fungal powder like the widely available Tinaderm. Try to expose the infected area to air or sunlight as much as possible. Wash all towels and underwear in hot water and change them as often as possible.

Babies wearing diapers provide the perfect conditions for fungal infections such as thrush. In hot climates avoid using plastic pants and try to leave the diaper off as much as possible. If you are breast-feeding and your baby gets thrush be extremely careful to wash your hands thoroughly after diaper changes so that you don't transfer the infection to your breasts through the baby's mouth.

COLD

Too much cold is just as dangerous as too much heat, particularly if it leads to hypothermia. If you are trekking at high altitudes or simply taking a long bus trip over the mountains, particularly at night, be prepared. In some countries (e.g. Tibet, Chile) you should always be prepared for cold, wet or windy conditions even if you're just out walking or hitching.

Hypothermia occurs when the body loses heat faster than it can produce it and the core temperature of the body falls. Children are particularly susceptible to extreme temperatures. It is surprisingly easy to progress from very cold to dangerously cold due to a combination of wind, wet clothing, fatigue and hunger, even if the air temperature is above freezing. It is best to dress in layers: silk, wool and some new artificial fibers are all good insulating materials. A hat is important, as a lot of heat is lost through the head. A strong waterproof outer layer is essential, as keeping dry is vital. Carry basic supplies, including food containing simple sugars to generate heat quickly and lots of fluid to drink.

Symptoms of hypothermia are exhaustion, numb skin (particularly toes and fingers), shivering, slurred speech, irrational or violent behavior, lethargy, stumbling, dizzy spells, muscle cramps and violent outbursts or energy. Irrationality may take the form of sufferers claiming they are warm and trying to take off their clothes.

To treat hypothermia, first get the person out of the wind and/or rain, remove their clothing if it's wet and replace it with dry, warm clothing. Give them hot liquids - not alcohol - and some high-kilo joule, easily digestible food. Do not rub victims but place them near a fire or in a warm (not hot) bath. This should be enough for the early stages of hypothermia, but if it has gone further it may be necessary to place victims in warm sleeping bags and get in with them.

Children are more susceptible to changes of temperature and lose body heat faster than adults, if you are taking them to areas where such rapid temperature changes can occur, make sure you know what you are doing and are completely prepared.

ALTITUDE SICKNESS

Acute Mountain Sickness or AMS occurs at high altitude and can be fatal. The lack of oxygen at high altitudes affects most people to some extent.

Even with acclimatization you may still have trouble adjusting - headaches, nausea, dizziness, a dry cough, insomnia, breathlessness and loss of appetite are all signs to heed. Mild altitude problems will generally abate after a day or so but if the symptoms persist or become worse the only treatment is to descend - even 500 meters can help. Breathlessness, a dry, irritative cough (which may progress to the production of pink, frothy sputum), severe headache, loss of appetite, nausea, and sometimes vomiting are all danger signs. Increasing tiredness, confusion, and lack of coordination and balance are real danger signs. Any of these symptoms individually, even just a persistent headache, can be a warning.

There is no hard and fast rule as to how high is too high: AMS has been fatal at altitudes of 3000 meters, although 3500 to 4500 meters is the usual range. It is always wise to sleep at a lower altitude than the greatest height reached during the day.

Again this is an illness which will affect children more quickly and seriously than adults.

PREVENTING ACUTE MOUNTAIN SICKNESS (AMS)

Ascend slowly - have frequent rest days, spending two to three nights at each rise of 1,000 meters. If you reach a high altitude by trekking, acclimatization takes place gradually and you are less likely to be affected than if you fly direct.

Drink extra fluids. The mountain air is dry and cold and moisture is lost as you breathe.

Eat light, high-carbohydrate meals for more energy.

Adults should avoid alcohol as it may increase the risk of dehydration.

Avoid sedatives.

JET LAG

Jet lag is experienced when you travel by air across more than three time zones (each time zone usually represents a one-hour time difference). It occurs because many of the functions of the human body (such as temperature, pulse rate and emptying of the bladder and bowels) are regulated by internal 24-hour cycles called circadian rhythms. When we travel long distances rapidly, our bodies take time to adjust to the "new time" of our destination, and we may experience fatigue, disorientation, insomnia, anxiety, impaired concentration and loss of appetite. These effects will usually be gone within three days of arrival, but there are ways of minimizing the impact of jet lag.

It takes children even longer to adjust to a new time zone, and you may have a few broken nights at the beginning.

AVOIDING JET LAG

Rest for a couple of days prior to departure; try to avoid late nights and last-minute dashes for travelers' cheques, passport, etc.

Try to select flight schedules that minimize sleep deprivation; arriving late in the day means you can go to sleep soon after you arrive. For very long flights, try to organize a stopover.

Avoid excessive eating (which bloats the stomach) and alcohol (which causes dehydration) during the flight. Instead, drink plenty of non-carbonated, non-alcoholic drinks such as fruit juice or water.

Sit with children in the non-smoking section as cigarette smoke reduces the amount of oxygen in the cabin even further and causes greater fatigue.

Make yourself and your children comfortable by wearing loose-fitting clothes and perhaps bringing an eye mask and ear plugs to help you sleep.

(Remember to check out Parts 1, 3 and 4 of this article.)

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