IS THERE A DOCTOR IN THE COUNTRY?What to know before you fly off to exotic locales

Susan and Austin had been planning the trip for 18 months - a reunion that would bring Austin, his two sisters, and their families together for the first time in three years. The destination was a sprawling rented beach house in Mexico, where the clan was to spend the Christmas holidays. Everything went according to plan until, three days after arrival, the couple's four-year-old daughter, Victoria, became ill with diarrhea and vomiting. After 48 hours, the parents became truly concerned; but since they were not staying in a hotel, they had no resources for a physician referral for Victoria, and they were loath to take her to a hospital.

"When families with young children are planning to travel out of the country, it is wise to obtain physician referrals before they leave," advises Bradley A. Connor, M.D., an internist with a specialty in gastrointestinal diseases. "Vacations are easily ruined when a family member becomes ill, but there are precautions that can be taken prior to the trip, and there are measures that should be taken once the family reaches its destination."

Dr. Connor is the founder and medical director of Travel Health Services, a Manhattan clinic devoted to travel medicine. "Travel medicine is an emerging medical specialty," Dr. Connor explains. "Our aim is not to make people fearful about traveling - I love to travel myself and I often do it with my young children - but to enable people to travel in a healthy and safe way."

The journey itself is often the first concern. Parents will be happy to learn that airplanes are not necessarily incubators for airborne infections, as many of us have been led to believe. It is true that air is recirculated on an airplane, but one's risk of contracting infection is no greater on a plane than on any other public conveyance, according to Dr. Connor.

"There have been follow-up studies made of those unfortunate instances when it was learned that someone with active tuberculosis has traveled by air," says Dr. Connor. "What they indicate is that some people sitting very close to the sick person did become ill, but those in other parts of the plane did not."

Dr. Connor stresses that when vacationing with kids, the operative word is anticipation. In the Caribbean, Mexico and other developing countries, travelers' diarrhea is common and a well-known hazard. He reiterates- Foods should be well-cooked and served piping hot. Beverages should be carbonated if possible, and only bottled water should be offered to children. "Milk, salads, fresh fruits and juices, while normally healthy for children, may be risky in an environment like Mexico."

Since most travelers' diarrhea is caused by bacteria, some adults may be in the habit of taking along a treatment dose of an antibiotic such as Cipro. "These strong antibiotics may not be appropriate for children," Dr. Connor advises. "Talk to your pediatrician before you leave. He or she may prescribe a milder antibiotic to pack in your travel kit, or suggest youtake along Pepto-Bismol or Imodium in case of an attack." He stresses that it is crucial for children to drink a lot of fluids if diarrhea does strike.


Traveling with children through Europe does not pose unusual health risks for infectious disease, although Dr. Connor reiterates that leaving with a list of referred physicians in the cities on your itinerary is always a good idea. However, jet lag and an over-ambitious touring schedule can compromise children's health and well-being. "Take it easy the first few days and factor in rest time," he suggests. "Children need time to recuperate from long flights and a change of time zones."

Additional forethought and planning is needed when families are headed to the world's more exotic destinations in Africa or Asia. Dr. Connor emphasizes that polio, typhoid fever, malaria, hepatitis, and tetanus remain very real problems in much of the developing world. Young children are protected from some of these potential killers with their childhood inoculation series, but teenagers may have to be updated. There are specialized vaccines now available for hepatitis and typhoid fever that can be given to children over the age of two.

Malaria is a disease transmitted by a parasite carried by mosquitoes, and Dr. Connor warns that even the most upscale safari expedition cannot ensure that travelers will not get bitten by mosquitoes. There are medications that can be prescribed for children in small doses which offer protection against malaria. Insect repellents are also important.

"The problem with Deet in repellants and children, however," Dr. Connor notes, "is that it has been shown to cause neurological problems when absorbed through the skin. But there are products out there that contain Deet in low concentrations or in polymer form, which prevents it from being absorbed through the skin."

Of course, the worst-case scenario involves a trip on which a medical emergency necessitates a blood transfusion. "This is a real concern," Dr. Connor says, "because in many parts of the world, the blood supply is not screened. In Africa, for example, HIV is a major risk factor, and there should be a 'what-to-do' mechanism in place." He notes that many tour groups that sponsor trips to Africa and Asia offer evacuation policies. In other words, if you are on safari and a family member suffers an injury severe enough to require a blood transfusion, he or she will be evacuated to Johannesburg, London or Frankfurt. "A two-week policy for a family usually costs under $100 and is an excellent idea," Dr. Connor says. "I would be very reluctant to permit a blood transfusion in most of the developing world."

Fortunately, most vacation mishaps are mundane - ear infections, allergy, sunburn, or strep throat. To alleviate these, Connor advises families to vacation with well-stocked travel kits containing fever thermometers, pain relievers, sunblock, antihistamines, antiseptic cream, and anti-diarrheal medications. Family vacations can be pleasurable, memorable experiences, but when traveling with children, it is important to remember that an ounce of prevention is most definitely worth a pound of cure.