Air travel and children's health issues

Question 1

What measures are present to prevent spread of infection on planes?

Answer 1

1. High-efficiency particulate filters remove 99.9% of bacteria and virus from cabin air
2. Air exchange 15-20 times per hour
3. Air flow occurs from top to bottom with little front to back flow

Question 2

Which patients are recommended for evaluation of potential hypoxemia before air travel?

Answer 2

1. known or suspected hypoxemia
2. known or suspected hypercapnia
3. known chronic obstructive or restrictive lung disease
4. who already use supplemental oxygen
5. with a history of previous difficulty during air travel
6. patients with recent exacerbation of chronic lung disease
7. with other chronic conditions that may be exacerbated by hypoxemia

Question 3

What is the oxygen content in a commercial flight?

Answer 3

15%

Question 4

Which children are at risk for developing DVT aboard planes?

Answer 4

1. Thrombophilia
2. Previous thromboembolism
3. malignancy
4. major surgery w/in 6 weeks of the flight

Question 5

What should be available for children with sickle cell anemia?

Answer 5

Oxygen therapy available on aircraft at altitudes over 2135m especially if they have splenomegaly and relatively higher blood viscosity

Question 6

What is barotitis media?

Answer 6

Inflammatory change (acute or chronic) of the middle ear secondary to barotrauma characterized by sudden ear pain, impaired hearing, and occasionally vertigo and ruptured TM

Question 7

How do you prevent barotitis?

Answer 7

Teach children to perform a valsalva manoeuvre, by T-tubes, or by treating nasal congestion or a sinus infection before a flight

Question 8

What is true of children with recurrent otitis media and adenoidal hypertrophy?

Answer 8

They have a harder time equilibrating the pressure of the middle ear

Question 9

What can be helpful for otalagia if used at least 30 min before takeoff and landing?

Answer 9

Nasal decongestant

Question 10

When are children safe to fly post AOM diagnosis?

Answer 10

Two weeks usually, but try to clinically evaluate prior to air travel. If diagnosis is within 48h of flight that cannot be postponed then provide analgesia

Question 11

What should parents of children with food allergies do?

Answer 11

Inform flight crew and the airline of the allergy

Carry epipen and antihistamines on the flight

Question 12

What precautions should be taken for air travel?

Answer 12

If a day is shortened by more than 2h decrease insulin and if it is lengthened by more than 2h than increase insulin as needed

Question 13

What should parents with epileptic children do?

Answer 13

Inform flight attendant and airline

Anti-epiletic medication should be readily available

Question 14

What are measures to combat air sickness?

Answer 14

1. Dimenhydrinate
2. directing cool ventilate air to the face
3. gazing at the horizon
4. selecting seat away from the rear of the cabin

Question 15

What should be used for behavioral control?

Answer 15

1. Show books about air travel
2. Explain steps needed for travel
3. Take practice trips to the airport
4. Practice relaxation techniques
5. Do not use dimenhydrinate, chloral hydrate or promethazine as risk of oversedation and paradoxical irritation

Question 16

What is jet lag?

Answer 16

Daytime fatigue, sleeping difficulties, irritability, and decreased mental efficiency that occur when there is an imbalance between the body’s internal clock and the external environment

Question 17

What are risk factors for jet lag?

Answer 17

1. Crossing multiple time zones, especially eastward

2. Poor sleep

Question 18

Is melatonin recommended for use in children with jet lag?

Answer 18

No as side effect profile is not well studied and recent meta-analysis did not show any benefit

Question 19

What should be done to all feeding and infusion tubes during takeoff and landing?

Answer 19

Capp them off

Question 20

What should be done for children with recent fractures (48h)?

Answer 20

1. Plaster or fibreglass cast should be bivalved
2. Provide adequate analgesia
3. Engage in proper limb elevation
4. Pneumatic splints are usually not allowed

Question 21

What is recommended regarding child restraints in aircrafts?

Answer 21

Recommended by the US but inconclusive safety and economic data
Holding an infant or child on a caregiver’s lap is improper restraint and has the potential to contribute to injury on an aircraft

Question 22

What should physician provide to air travellers?

Answer 22

A medical letter briefly describing the patient’s medical status, and if necessary, the need for medical equipment, supplies and medications