How parents can protect kids from suffering medical emergencies on flights

The pre-flight checklist for families on vacation often includes making sure the kids have enough snacks and activities to last from takeoff to landing. But now there is another item to include: a first-aid kit.

About 15% of all in-flight emergencies involve children, researchers at Duke University Medical Center found.

In a study published recently in the Annals of Emergency Medicine, researchers looked at about 11,700 in-flight emergencies that involved children and teens from January 2015 to October 2016, flying 77 airlines on six continents. Experts say that, often, such crises can be averted.

“It is important for parents to be mindful of steps they can take to avoid emergencies while traveling,” said lead author Alexandre T. Rotta, chief of the division of pediatric critical-care medicine at Duke.

The in-flight emergencies were similar to the ones pediatricians see in emergency rooms.

About one-third of the in-flight emergencies involved nausea and vomiting, 22% were fever and/or chills, blunt trauma accounted for nearly 7%, and 5% were due to allergic reactions. Other less frequent emergencies included abdominal pain, stomach flu, seizures, and fainting. There were 11 in-flight deaths in the group studied.

Although more than 82% of the cases were resolved during the flight, one in six needed additional care when the plane landed. Emergency diversion of the aircraft was necessary in less than 1% of all cases, the study reported.

What can parents do to avoid joining those statistics?

“It is all about preparation,” said pediatrician Jonathan Miller, medical director for value-based care at Nemours/Alfred I. duPont Hospital for Children in Wilmington. He recommends parents’ travel plans include bringing on board adequate supplies of any medications their children use, plus a small first-aid kit.

Airlines do carry first-aid kits, but few have pediatric medications, including liquid forms of pain relievers or allergy medications.

“I typically tell people to bring Tylenol with them in case of fever,” said Miller. He does not recommend a dose of Benadryl, an antihistamine some parents use to make their child drowsy for a long flight. It is better to keep the child as active as possible before takeoff to burn off the energy. In-flight walks when permitted can also help, he said.

If the child has a known, severe allergy problem, it would be worthwhile to wipe down the seat area and tray table with sanitizer, he said. If your child has a prescription for an EpiPen, bring two on the plane, said Miller. Don’t rely on airlines to have them on hand.

Since 2016, when there was a shortage of EpiPens, the medical device that delivers a dose of epinephrine to help with severe allergic reactions, the Federal Aviation Administration has let airlines leave the auto-injector out of their medical kits. The exemption is in effect until 2020, the New York Daily News reported.

Children with diabetes should carry on all their medications, Miller said.

“They need to make sure they have all the supplies and medications with them to handle all situations, whether it is low blood sugar or high blood sugar,” Miller said.

Another important tip is to make sure all children are well-hydrated before the trip. It will help with motion sickness and jet lag, he said.

If a child becomes ill while in-flight and is lethargic, has breathing difficulty, or is vomiting, parents should quickly alert the airline staff, as they are trained to help in such cases.

“I would engage them sooner than later,” Miller said.

Flying with a sick child depends on the situation and severity; parents need to weigh the risks and benefits. Not all trips are worth it, he said.

A child with the common cold is probably OK to travel, but the change in cabin pressure can sometime lead to ear pain. That can be managed by giving younger children something to suck on or swallow and having older children chew gum, he said.

“If kids are really complaining about the pain, that is when Tylenol can be useful,” Miller said.

It never hurts to check with a pediatrician well before travel to see if any additional vaccines, including boosters, are needed, Miller said. That goes for Europe and even parts of the United States, where measles outbreaks have been reported, he said.