04 - DR Ari - Traveling Safely With Infant and Children

27-Oct-18
INFORMASI UMUM
• Presentasi ini disampaikan pada kegiatan 1ST ASMP-ID
• Hari / Tanggal : Sabtu - Minggu / 27-28 Oktober 2018
• Tempat : Hotel Novotel Tangerang
• Narasumber : UKK Infeksi dan Penyakit Tropis
• Semua isi dan materi presentasi adalah hak cipta dari

narasumber, digunakan untuk kalangan terbatas dalam
kepentingan edukasi kesehatan di bidang terkait.
Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

In collaboration with 1
Indonesian Pediatric Society (IPS) – Banten Branch
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protected under the copyright laws of IDI & IDAI. Used by permission. All right reserved.
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PRESENTATION.

1
27-Oct-18
Traveling safely with infant

and children
ARI PRAYITNO
Infectious and Tropical Disease Working Group of Indonesian Pediatric Society .

In collaboration with .
Indonesian
Infectious and Tropical Disease Working Group of Pediatric
Indonesian Pediatric Society
Society (IPS) – Banten Branch .
In collaboration with
CURRICULUM VITAE
• Tempat Tanggal Tanggal Lahir : Jakarta, 30
Oktober 1967
• Alamat Rumah : Jalan Manggar Vii Blok G8
FOTO
No. 19 Pondok, Kelapa Kavling Dki Jakarta
Timur 13450
• No. HP : 081349699959
• E-mail : ariprayitno@yahoo.com
dr. Ari Prayitno, SpA(K)

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27-Oct-18
STTB/TANDA
NO. NAMA PENDIDIKAN JURUSAN TEMPAT
LULUS/IJAZAH TAHUN
1 UNIVERSITAS INDONESIA KEDOKTERAN 120/Dok.II/’92 JAKARTA
2 UNIVERSITAS INDONESIA SPESIALIS ANAK 099/PPDS/2003 JAKARTA
SPESIALIS ANAK
3 UNIVERSITAS INDONESIA 0019/Sp2-FK/1/2015 JAKARTA
KONSULTAN
Kedudukan/jabatan
No Nama organisasi Periode
organisasi
1 Sekretaris bidang II Ilmiah PP IDAI 2011 – 2014
2 Anggota Buletin IDAI PP IDAI 2011 – 2014
Anggota Satgas
3 PP IDAI 2015 – 2017
Perlindungan Anak
Anggota UKK Infeksi dan 2011 – sekarang
4 UKK IPT
Pediatri Tropis
5 Wakil Ketua IDAI Jaya IDAI Jakarta 2017 – 2020

Outline
• Traveling preparation
• Smart Travel
• Pre-travel consultation
• Travel vaccination
• Flying with children
• Post-travel assessment
• Take home massages

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Referances

Facts of children traveler (I)

• The number of children who travel or live
outside their home countries has
increased.
• Children are less likely to receive pretravel
advice
• GeoSentinel Surveillance Network:
• 51% of all children
• 32% of the children visiting pretravel medical
advice friends and relatives (VFRs)
• 59% of adults

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27-Oct-18
Facts of children traveler (II)

• The most commonly reported health
problems among child travelers are as
follows:
• Diarrheal illnesses
• Dermatologic conditions, including animal and
arthropod bites, cutaneous larva migrans, and
sunburn
• Systemic febrile illnesses, especially malaria
• Respiratory disorders

Traveling with children and

infants
• Traveling with children is a challenge :
• Different needs with adult  growing maturity for
infants, children, or adolescents
• Children does not have immunity to the
microorganism
• Food and lifestyle for example will greatly affect the
child's health
• Vaccination must be completed before leaving

• Consultation is necessary especially when the child
has chronic illness or recurrent disease

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27-Oct-18
Preparation
• Choice the destination
• Travel document
• Travel insurance
• Medical examination and consultation
• Vaccination
• Medicine and First Aid
• Food and drink
• Packing luggage

Choice destination
The same island or country or another
continent?
How many seasons? How many hours of the
day / night? What season is it?
Endemicity of disease  what is endemic in
destination?
Collect information as much as possible

Need preparation  itinerary should be studied
Should be discussed to children

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Travel document
• Identity document :
Passport
• Medical Record Book :
Road to health chart
(KMS), Vaccination
history card
• Travel insurance book

Child health insurance

• Health/medical insurance
• National/international
• Out patient and or hospital coverage
• Vaccination

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Medical examination and

consultation
• Regular medical check-up
• Special and complete medical check-up
for children with health problems
• Communication with family doctor
• Contact a doctor about special diseases in
tourist destinations
• Consult to doctor 4-6 weeks before interna-
tional travel or 4-8 months for longer trip

Pre-travel consultation
• Past medical history
• Detail of traveling 
itinerary
• Medical Record Book :
Road to health chart
(KMS), Vaccination history
card
• Recommended
vaccination

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Pre-travel vaccination
• Recommended vaccination:
1. Routine vaccination
2. Special vaccination according to disease
endemicity appropriate tourist destinations
3. WHO recommendation vaccination
• Don’t forget previous Adverse Events
Following Immunization (AEFI)

Vaccine for traveller

Category Vaccine
Routine vaccination Hepatitis B Pneumococcus
Polio Influenza
BCG Varicela
Difteri, Pertusis, Tetanus Rotavirusb
Measles Human Papilloma Virus
MMRa Hepatitis Ac
H. influenza type B Typhoidc
Optional vaccination Kolera Rabies
Hepatitis A Tick-borne encephalitis
Japanese encephalitis Typhoid
Meningococcus Yellow Fever
Mandatory vaccination Yellow Fever Meningococcus (and polio) for Hajj pilgrims
a = optional for travel abroad
b = available in Indonesia since 2011 , c = not routine in non-endemic countries
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Medicines and First Aid Kit

• Bring Paracetamol or Ibuprofen
• Complete with plaster, sterile gauze,
antiseptic, disinfectant (small packing)
• Commonly consumed personal medicines
• Medicine will be difficult to obtain in
destination area : antibiotic, diarrhea
(older children/ adolescent), asthma
drugs, seizure drugs (with seizure history)
etc

Essential Medical Equipment

• A shatter-proof medical equipment
• Sterile compresses
• Adhesive tape
• Disinfectant
• Dreassing for blisters
• Gauze bandages
• Sunscreen (high factor, suitable for children)
• Scissors, nail clipters and tweezers for splinters, nail-brush (not pack
in carry-on luggage)
• Antiseptic lotion for cleaning wounds
• Antibacterial hand gel
• Antiseptic mouthwash
• Water purification tablets
• Dispossible syringe

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27-Oct-18
Food and drinks

• Bring food and drinks are usually
consumed
• Take as briefly as possible
• Infant : milk formula in sufficient packaging,
thermos, spoon and bottle of milk
• Eat and drink enough before long trips
• Maintain continuity of eating and drinking

Food and drinks are

avoided
• Food that makes thirst: dried chips, starchy,
spicy foods
• Food / beverages that produce gas: fatty
foods, soft-drinks
• Food / beverages with taste sharp: bitter
food, beverages, spicy or sour
• Foods that increase intestinal peristalsis:
nuts

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27-Oct-18
Guidelines for healthy food

for travellers
• WHO recommendation, 2010
• Access :
http://www.who.int/foodsafety/publicatio
ns/travellers/en/

Other needs are prepared

• Baby or children's clothing adapted to the
climate of destination:
• Tropical places  thin and light clothing, with
cotton material that easily absorbs sweat
• In cold areas, thick clothing layered up to the
arms and neck
• Light but strong and closed footware
• Diapers
• Baby carriers, strollers and car seats

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27-Oct-18
Child’s luggage
• Bring only the necessary items
• Packaged in a concise and neat manner
• Bag/suitcase separate from parent’s
• Do not leave the child’s backpack too
heavy or use a small suitcase with wheels

Flying with children

• FAQ from parent :
• Can I take my baby 1 month old from Jakarta
to Balikpapan?
• Why does my son take a plane every "take-off"
and "landing" always cry?
• Why are babies told to suck at "take-off" and
"landing"?
• In order not to fuss when flying, can my child
be given "antimo"?

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27-Oct-18
Reference/Tip’s for Flying

with children
• http://Kidspot Newsletter. Brooks A. Seven must-knows to make
flying with kids, 2010.
• Mendes I. Today parents. Ten tips for taking your kids on an airplane, 2012
• http://kidsflysafe.com. Flying with children
• http://skyscanner. Flying with children: 20 top tips for keeping kids
happy on board
• http://American Airways. Traveling with children and infants, 2010
• http://sq.com. The complete guide to flying with kids, 2007.
• http://www.tsa.gov/travelers/airtravel/children/index.shtm
• http://www.tsa.gov/travelers/airtravel/prohibited/permitted-prohibited-
items.shtm
• http://www.tsa.gov/traveler-information/traveling-children
• http://www.tsa.gov/travelers/airtravel/children/index.shtm

Can not fly

• Newborn baby, <48 h
• Pregnant women > 36 weeks (32 weeks in multigravida)
• Patients with angina pectoris
• Patients with infectious diseases
• Post-dive decompression disease
• Patients with ICTs increased any reason
• Patients with sinusitis, rhinitis or OMA
• Post myocardial infarction attack or stroke
• Post surgery or major trauma / severe
• Patients with severe chronic lung disease
• Patients with sickle-cell anemia
• Patients with psychotic disorders
http://www.who.int/ith/mode_of_travel/contraindications/en/
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27-Oct-18
Flight provisions
for infants and children
• Children aged 2-11 years must be
accompanied by an adult
• Some airlines allow children aged > 5
years-old to fly unaccompanied adults, but
need to be registered when booking
tickets so they will get supervision of the
crew (flight crews)
http://Kidspot. Brooks A. Seven must-knows to make flying with kids, 2010.
Mendes I. Today parents. Ten tips for taking your kids on an airplane. Blog, 2012


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Rear-Facing CRS Forward-Facing CRS
The Cares Safety Harness

Effect of cabin quality on child

health
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27-Oct-18
Humidity
• Humidity in the cabin is relatively low, less
than 20%.
• Low humidity causes an unpleasant feeling
in the eyes, mouth, and nose.
• To reduce the discomfort
• Drinking enough fluids before and during
flight,
• Wear skin moisturizing lotion,
• Using saline nasal spray to moisten the
airways in the nose,
• Wearing glasses is better than contact
lenses
http://kidsflysafe.com. Flying with children
http://skyscanner. Flying with children: 20 top tips for keeping kids happy on board

Dehydration
• Dehydration can occur if Fluid
intake during flight less fulfilled
• Solution :
• Children are given regular drink
during the flight
• It is advisable to drink water or
juice
• Prepare a drink for the baby and
child before leaving

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27-Oct-18
Hypoxia
• Oxygen in the cabin is reduced, there will
be a slight decrease in oxygen saturation
in the blood resulting in mild hypoxia.
• It does not matter to a healthy child.
• Children with cardiovascular disorders, lung
disease, or anemia may not tolerate well.
http://American Airways. Traveling with children and infants, 2010

http://sq.com. The complete guide to flying with kids, 2007.

Temperature in the cabin

• The temperature in the plane is uncertain
• It can be cool and suddenly hot
• So that children feel comfortable and not
fussy, should be prepared 3 kinds of
clothes:
• Short sleeve T-shirt ,
• Long sleeve T-shirt,
• Thin sweaters (sweaters)

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27-Oct-18
Air pressure
• The air in the body will fill all the body
cavities as a result of decreased air
pressure in the cabin.
• The presence of air in the stomach will feel
bad, preferably:
• Do not drink drinks containing bicarbonate
• It is advisable to drink water or juice.


Airplane Ear
• Airplane ear is a pain in the middle ear due
to changes in air pressure when flying
• In general, if the child is suffering from flu,
nasal congestion, runny nose due to
allergies, respiratory infection, or sinusitis.
• Airplane ear can cause temporary pain
and deafness

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27-Oct-18
Decreasing of air pressure in

the cab
When take off air will
come out of the middle Uncomfortable in the
ear and sinus, and when ear due to differences
the air landing will re- in air pressure
enter
Swallow, chew, yawn

Baby: given a pacifier to
stimulate swallowing
Big boy: swallowing
(Valsalva manuever)
Jet lag
• Changes in "body clock" or circadian rhythm
affect sleep rhythm
• Related to the distance of the meridian (east-
west) traveled, not the length of the traveling
• It takes one day, so that the child's body
adapt to the new environment
• Symptoms of jet-lag
• Tired and difficulty sleeping (insomnia)
• Other symptoms: difficulty concentrating, nausea,
vomiting, or constipation
Mendes I. Today parents. Ten tips for taking your kids on an airplane. Blog, 2012 http://kidsflysafe.com. Flying
with children

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27-Oct-18
Aerophobia
• Some children are afraid to fly,
• Have not fun experience
• Seeing the ship crashed
• Children who are not calm (often panicked)
• Suggestions for children afraid to fly
• Tell us that flying is safe, safer than a car or train
ride
• While on the plane talk, see a movie, read a
book, or eat a snack
• Tell the flight attendants to avoid the
frightening voices of the child

When to leave
• The child should be well rested
• Eat but not too heavy before leaving
(especially children with motion sickness)
• Child activity during on board
• Need to be prepared toys, stationery, etc.
• While waiting at the airport
• Prepare drinking water and snacks
• Special foods for babies or children
• Can be booked before flight
• Provide simple medicines that are often
required
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27-Oct-18
Motion sickness
• Some children suffer from motion sickness,
need to get attention from parents.
• The feeling of nausea caused by aircraft shock
can be reduced by sitting near the window so
that the child can look out freely
• Avoid filling food before leaving
• Drugs hangover
• Only allowed for age> 2 years
• Given an hour before leaving

Motion sickness medicines

Medicine Dose
Diphenhydramine 5 mg/kgBW/day, oral
Dimenhydrinate 2-6th: 12,5-25 mg, oral, max 75mg/day

6-12th:25-50 mg,oral, max 150mg/day
>12th: 50mg, oral
Promethazine 2-6th: 12,5-25 mg, oral, max 75mg/day

6-12th:25-50 mg,oral, max 150mg/day
>12th: 50mg, oral
Note : given to children aged > 2 years-old

Mackell SM. Travel advice for pediatric travelers: infants, children, and adolescents.
Dalam: The travel and tropical medicine manual. Jong EC & Mc Mulen R, penyunting.
Edisi ketiga. Philladelphia, Saunders: Elsevier Science 2003.h.167- 85.
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27-Oct-18
Post Travelling
• Travel-related health
problems are reported as
much as 22% -64% of all
travelers
• Most health problems are
mild
• When the cause of infection
 when symptoms occur in
accordance with the
incubation period
Take home messages

• Traveling should be well prepared,
especially for children
• Preparations include before departure,
during the trip and after the trip
• Understand and anticipate what can/may
and who do not during the traveling
• Consult to the doctor and complete the
necessary vaccinations

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27-Oct-18
TRAVEL CLINIC CMKH KIARA
THANK YOU

24

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27-Oct-18

• Semua isi dan materi presentasi adalah hak cipta dari

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Traveling safely with infant

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society .

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Facts of children traveler (I)

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Facts of children traveler (II)

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Traveling with children and

• Vaccination must be completed before leaving

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Collect information as much as possible

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Child health insurance

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Medical examination and

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Vaccine for traveller

Medicines and First Aid Kit

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Essential Medical Equipment

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Food and drinks

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Food and drinks are

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Guidelines for healthy food

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Other needs are prepared

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Flying with children

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Reference/Tip’s for Flying

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Can not fly

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Rear-Facing CRS Forward-Facing CRS

The Cares Safety Harness

Effect of cabin quality on child

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

http://American Airways. Traveling with children and infants, 2010

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Temperature in the cabin

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

http://American Airways. Traveling with children and infants, 2010

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society

Decreasing of air pressure in

Swallow, chew, yawn

Infectious and Tropical Disease Working Group of Indonesian Pediatric Society