The couple had bought an extra seat on the plane. They were getting ready to strap their infant into it when airline employees told them they couldn't have the seat. They either had to fly with their child on one of their laps, or they had to leave the plane.
This event in early May prompted wide criticism of the airline, Delta. Avi Gurwitz was among the critics, and not solely because the family was treated so shabbily. Gurwitz, a pediatrician with Holy Redeemer's Pediatric UrgiCare Center, was mostly concerned about the infant's safety. His view is that sitting in an adult's lap during a flight is not the best place for a baby.
Many families will be vacationing away from home this summer, and their children likely will face safety issues different from the norm at their homes. Gurwitz spoke to us recently about how best to cope.
What concerned you most about the recent Delta incident?
There are a couple of issues here. The Federal Aviation Administration allows that anyone under age 2 doesn't need their own plane ticket and can fly on their parent's lap. But that's not optimal. The No. 1 cause of nonfatal injuries in an airplane is turbulence. If you're a baby sitting on a lap, you're not going to stay still. The American Academy of Pediatrics recommends that every child have its own seat and be restrained properly — the same as in a car. A child weighing less than 20 pounds — up to about a year old — should be in a rear-facing car seat, strapped in. From 20 to 40 pounds, toddler age, they should be in a forward-facing car seat.
The car seat should be FAA rated because not every car seat that can be strapped into a car can be strapped into an airplane. The advantage of bringing your own safety seat is you can take that right off the plane into the taxi, or however you're getting around, so your child can be just as secure.
Another issue is oxygen masks. Children need more oxygen than adults because they breathe more quickly. But there's only one oxygen mask per seat. If your child is on your lap, you're going to put it on your child, I would guess. But then there's no mask for you.
Another issue with air travel: People always ask about ears. Adults can chew gum to pop their ears. What do infants do? Most tolerate the change of pressure quite well. Somehow they equalize. But you can also have your baby suck on a pacifier or nurse or drink from a bottle, which pulls the jaw muscles and opens the inside of the ear. Your child will also be soothed by that.
What are potential issues with international travel?
Broadly – this is mainly for international travel – there are three main issues: Vaccines and malaria, water and foodborne illnesses, and injuries. Injuries are by far the most common reason for needing medical care when you're away.
Make sure your child is up to date on regular vaccines, and see whether anything additional is needed. This needs to be done about a month ahead of time. Many places in Asia, South America, and Africa require malaria prophylactics. There is dosing for every age. Some have to start prior to traveling. So get in to see your pediatrician well before you travel.
As for water and food-borne illnesses, for the most part, this involves prevention. The rule is, make sure it's packaged water, not tap water. If you're going to eat something, boil it. Cook it. Peel it. If your child does become ill from contaminated food or water, there are antibiotics, but the more important thing is hydration. Kids will dehydrate much more quickly than adults. You can get oral rehydration packets overseas that are certified by the World Health Organization. They have not only water, but also sugar and electrolytes. Babies don't have a lot of sugar storage.
When it comes to injuries, it's important to think about getting international insurance because most care abroad is cash. If you require specialty care or medical evacuation back to the states by helicopter or plane, that can run into tens of thousands of dollars. Most international insurance plans will cover that and any overseas cash care.
Another thing we rarely think about in the U.S. is rabies. But across the world, mainly in developing countries, hundreds of thousands of people die from rabies every year. When it's caught early and the child is vaccinated and given immunoglobulin, it can be cured. In general, avoid animals. If your child is bitten by one, try to get the rabies vaccine or come home and get it.
Are injuries an issue with domestic travel, as well?
Injuries are just a problem everywhere. Kids are active, they're small, they run into things. Especially on vacation, they are on unfamiliar terrain. They are in hotels or on hikes that are not necessarily child-friendly. So the risk of injury goes up a lot more. If something happens, seek local care. For things that are more serious, you might want to come back home. That depends on how remote the country is and how good the health care is.
When it comes to the risk of waterborne injuries, make sure children are supervised and are wearing flotation devices.
Grandma's house is a particular problem. It's definitely not baby-proof. It's also highly likely that Grandma is on some kind of medication. And she probably dropped one of her pills a while ago and never found it. Medicines need to be locked up. Kids need to be watched extra closely. Grandmas have hearing aids, and those have little button batteries. If they get stuck in the esophagus, they are lethal within hours.
What about travel by car?
The same rules apply everywhere with car seats. The only difference is that driving abroad, especially in developing countries, is more dangerous. It's a reason to be more diligent, drive slower, and drive more carefully. A lot of hotels will offer transportation, which is probably better than local taxis.
If you're on a long drive, stop frequently. Children get edgy. Every two hours is a good number for stopping. Also, dealing with a child who is screaming and kicking in the back seat is on a par with driving and texting. It's that disruptive. It would be beneficial to pull over and give the child a break, maybe let them run around a bit and get rid of some energy.
All this sounds daunting. What are some good reasons to travel?
Remember that it doesn't have to be a large, expensive, exotic vacation for a child to have a wonderful getaway. Kids have fun with minor things. They don't need expensive entertainment. They are creatures of wonder. Small things amaze them much easier.
It's good for them to interact with nature. So camping trips are good. Just watch out for campfires.
In the end, travel is educational. As your children get a little older, it's good to give them another perspective of the world. And maybe instill in them a lifelong love of travel and interest in other cultures.