Regular air travel with children is a reality for most expat parents and, unfortunately, fellow passengers aren't always  as sympathetic as you might hope to crying children - even less so to children who are playing up or being downright disobedient. Helpless parents are often driven to despair trying to soothe, entertain or discipline their children in the restricted and uncomfortable environment of an aeroplane. Dr Richard Jones, a dad of two and family medicine doctor based in Dubai, shares his guide to help alleviate some of the stress...

Ear Pain

Kids will often get ear pain during take-off and landing.  Their Eustachian tubes are smaller, so equalisation is less effective than in adults.

It is important if you think your child has or has already been diagnosed with a middle ear infection (otis media) that you do not fly. 

If you are unsure or you want to check post-infection that they are ok to fly see your family doctor.  If they are blocked up, have a runny nose and/or a cough without an ear infection they are generally ok to fly, but, again, check with your doctor.

What can you do to minimise your child’s ear pain when flying?

  • Encourage them to drink water (breast or bottle feed) during the climb after take-off.  Swallowing encourages the eustachian tube to open and equalise the middle ear with the cabin pressure.
     
  • Let them suck on sweets, dummies/pacifiers.  This encourages equalisation like swallowing.
     
  • If congested try ocean spray or drops (this is simple salt water/saline, not a medication).  This can be used in new-borns upwards.
     
  • Otrivin (0.05%) nasal drops.  Do not use in children under 1.  Apply 2 drops up to twice a day.  Pre-take off and just before descent is ok – 4 hours between the doses is fine. This acts as a nasal decongestant which may also help blocked ears.
     
  • Give paracetomol/ibuprofen for pain.
     

Read more: The UAE's 5 most common childhood illnesses and how to guard against them

The Sedate Debate

As a parent I used to dread flights with my two children.  They are nine and seven years old now and have become ‘good’ travellers over the eight years we have lived overseas.  However, having overheard two people engaged in the ‘sedate debate’ while sitting in a coffe shop one day, I thought I’d share some thoughts from both a parent and doctor viewpoint.

In my opinion sedation, with antihistamines, should not be given.  Why?

  1. The first thought a doctor has when prescribing any medication, even something as safe as paracetamol, is risk vs benefit.  No medication ‘comes for free’.  In other words, side effects can occur.  So, the benefit must be significant and/or higher than the potential risk, to justify recommending or prescribing any drug.  
     
  2. Complications / Unwanted side effects:
    1. Paradoxical agitation/hyperactivity - Giving an antihistamine, such as Chlorphenamine/Piriton can cause the opposite to sedation. Although this is rare I’m sure you would agree that it would be a nightmare.
    2. Allergic reaction - Any medication can cause an allergic response, even those drugs used to treat allergies!  Again, remember this is very uncommon.  Also bear in mind you will likely be at 30,000 feet plus where medical help and appropriate equipment is not accessible. 
    3. Over-sedation can affect breathing - This is more significant when flying as commercial aircraft generally maintain a cabin pressure equivalent to that at 8000ft above sea level, i.e. a lower amount of oxygen. If sedation does cause a reduction in breathing rate or depth this could cause a serious medical problem related to hypoxia (not enough oxygen). If your child has a cough, cold or congestion then sedation is a definite No-No as this again could potentially lead to hypoxia.
    4. Anti-histamines can have a laxative effect with resultant profuse diarrhoea/loose stools - This would be most unpleasant during a plane journey.  If diarrhoea were to happen, from any cause, make sure you increase fluid intake. Increased fluid loss combined with diarrhoea and an already dehydrating cabin environment can become a serious issue.

      Read more: From Carrying Milk Through Security to Choosing the Best Flight Time: All  a new mum needs to know about flying with baby for the first time
       

Other top tips for plane travel with little ones

  • Take your own bottled water
  • Take lots of antiseptic wipes and hand gel.  When seated, clean everything that you are likely to touch…..twice (i.e. TV screen, handsets, tray stable, arm rest, overhead cabin crew call buttons.  Everything you can!  This is probably where people pick up most coughs and colds.  Aeroplane systems are reportedly very good at filtering out airborne bugs so infections from those who are seated further than one row in front or behind you is unlikely. If you have someone who has a cold or cough near you clean ‘your area’ regularly. 
  • Wear shoes to the toilet or if you are walking around the cabin.  The carpets are full of germs. 

Read more: 17 Genius travel products to help you survive your trip home with the kids

Advice from my own experience - how we did it

  • Took favourite toys / comforters, travel pillows, treats, games, puzzles, books etc.  Played games that involved surprise prizes/treats.  Reward systems for good behaviour (this always started well but rapidly became ineffective with our two rascals).
     
  • Encouraged the kids to get up every now and again and walk around the cabin.
     
  • Administered paracetamol / ibuprofen for ear pain, sore throats, headaches.  Single dose sachets (age specific) are now available – rip the top off and drink. So much easier than bottles which invariably make a mess, leak or you forget the measuring spoon (all three have happened to me).
     
  • Wore slip-on shoes. Laces are a pain through airport security.
     
  • Wore a hoodie / loose top as it can sometimes get pretty cold onboard.
     
  • Took healthy snacks.  Airplane food is generally high in salt and fat and contains what seems to be child hyperactivity inducing additives.
     
  • Tried to change sleeping times to align with those of your destination.  You need to start this a few days before flying.  I’m not sure it works.  The kids are usually so excited that even if they are exhausted they seem to be able to stay awake. 
     
  • Relaxed! Sometimes they just sleep (bliss) regardless of what you have tried or done.  I think the more relaxed we are as parents the more likely this is to happen.  Preparation and having everything to hand (my wife is a true professional in this regard) equals a more relaxed parent in my experience.


    Dr Richard Jones is a British family medicine doctor (GP) who treats both children and adults. He also specialises in sport and exercise medicine. Keithnicholl.com / 04 394 1000, drrichardjones@keithnicholl.com

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