Flying with kids is never as straightforward than flying solo, but if your child becomes ill, it adds another layer of complication and worry. You might find yourself having to decide if you need to delay, interrupt or cancel your travel arrangements because of your child’s illness. It’s a hard call to make.
When is your child too sick to fly? The complication is that child illnesses- because their immune system, whole body and organs are still developing- may become worse rapidly. It is essential to evaluate the situation carefully before deciding on the best action to take. The sickness can quickly turn into a medical emergency during the flight. There are some basic measures to evaluate and know when to check with medical specialist and your travel insurance company.
… because, with kids especially, there is no place for complacency about full, comprehensive travel insurance!
Let’s look at how to gauge if your child is too sick to travel on an airplane:
- How Sick Is Your Child?
- My Child has a Fever
- Vomiting Child
- Diarrhea in Children
- Child with a Cold or Ear Infection
- Flying with a Concussion
- Pre-Existing Conditions
- Infectious Diseases: Guidelines for International Travel
- Can an Airline Refuse Sick Travelers?
- Prevention and Preparedness
- When Travel is Necessary
How Sick Is Your Child?
There is a fine balance when judging whether your child is too sick to fly. Some illnesses are not pleasant, but the symptoms are manageable. Sometimes the illness is almost over, and the worst has passed. Over the counter medications are a vacation-saver in such situations where the sickness is not severe or is close to passing.
You have to take into consideration the progression of the illness, and how likely are the symptoms to worsen. Some illnesses are more severe and can even be life-threatening to other people as well. When this is the case, more precautions must be taken.
If you have the slightest doubt, consult with a doctor and your travel insurance provider. (Your travel insurance provider may need you to consult with a specific doctor they are contracted with in order for them to be able to cover the costs related to delays in travel.)
My Child has a Fever
A fever is a sign that the body is fighting off an infection or an illness.
As your child’s temperature rises, they become increasingly uncomfortable, drowsy, irritable. The concern is that distress and the underlying condition that the fever is addressing can create medical issues while in flight.
Since fever is a sure sign indicator that something is wrong, it is essential to understand what may be causing the fever. An unchecked, unregulated fever might result in seizures or other complications.
Although a fever (pyrexia) could be considered any body temperature above the normal temperature of 98.6 degrees Fahrenheit / 37 Celcius,MedicineNet
Medically, a person is not considered to have a significant fever until the temperature is above 100.4 F / 38.0 C.
It’s prudent for all parents to have a thermometer in their travel medical kit. You can measure the temperature of your child in their armpit, mouth or rectally. The most accurate measurement, and also the most uncomfortable, is the rectal temperature (but also check what measurement your particular thermometer is calibrated to. As all of these give slightly different measurements.)
Some guidelines for handling fever with children include:
- If your child is three months or younger, see a healthcare provider right away.
- Any child, regardless of age, should seek urgent medical attention if the fever is above 104 F/ 40 C.
- A child younger than two years with a fever of 100.4 F / 38 C with a fever that lasts longer than a day should see a doctor.
- If the fever is 100.4 F/ 38 C and it has lasted more than three days for a child two or older, you should seek out a healthcare provider.
Treatment of fever
Depending on the age of the baby or child and local licencing and recommendations of pharmacists’ and medical professionals’ the medicines will generally be paracetamol (acetaminophen) or ibuprofen (isobutylphenylpropionic acid)-based medication, adjusted to the weight and age of the child.
We always carry both paracetamol and ibuprofen- that is suitable for the kids and some for us parents- in our medical kit.
Decision whether to fly with a fever
As fever is not the illness itself, but the indicator of the immune response of the body.
Your judgement call, whether to fly, should be based on the level of fever, how it responds to medication and whether you fully understand the underlying cause of the fever. If in any doubt, consult medical professionals.
If you decide to fly with a low-grade fever
There are some important steps to take as long you, understand the underlying cause and, do decide to fly (whether on your own or with a medical recommendation):
- It’s vitally important that you monitor your child’s temperature!
- Dress the child lightly, so you are helping the body’s natural thermal regulation. Use blankets and easy to zip open layers to help keep them comfortable.
- Keep your child hydrated and their electrolyte balance up. (The body’s natural defence is sweating, which loses it a lot of minerals too.) With a drowsy, irratable child, this will probably be your biggest challenge.
Just remember, dehydration on its own will make your child more irratable.
There are several reasons a child vomits. It could be because of food poisoning or be a symptom of illnesses affecting the gastric tract or extreme anxiety. In some cases, you may need to see a doctor.
In general, you won’t be allowed to fly with a child who is vomiting, just like you wouldn’t be allowed to leave them at any childcare facility.
You should wait 12-24 hours after your child has last vomited to fly. In the meantime, it is important to ensure your child is well-hydrated.
If you are planning to travel, despite vomiting, you will want a doctor to clear your child medically for travel. The doctor will also advise about medications, hydration and keeping their electrolyte balance intact during and after sustained vomiting.
Note, you can suppress vomiting with medicine, but the medication also causes the child to be drowsy and sleepy. Taking a child in that state onto an aircraft is not recommended, as you will not be able to judge if the child’s health starts to deteriorate.
Diarrhea in Children
A runny tummy in children might be a reaction to food or could be a viral or bacterial infection. It’s important to follow the progression and try to understand the cause. During travel, unfamiliar food and drinks can be as much the culprits as some infection. This is why it’s important to understand the underlying reason!
A paediatrician will be able to help determine if your child should not fly based on their symptoms and progression. They will also be able to advise whether over-the-counter medication will be sufficient to allow you to travel.
The latest research contradicts the old adage: “better out than in”, that advised against taking anti-diarrhea medication. The risk of dehydration is and the consequences are judged as more severe, than making the body cope with the infection for longer, by stemming the flow.
Factors to consider when flying with diarrhoea:
- How severe is the diarrhoea? Can your child hold it up when the seat belt signs are switched on? If not, then do not fly!
- Can you keep your child sufficiently hydrated? Dehydration, especially in the very dry air of aircraft is increased and can have serious consequences, leading to seizures.
- If your child has a couple of explosive episodes in the toilets, are you able to and willing to clean up and disinfect to stop the spread to fellow passengers?
Child with a Cold or Ear Infection
Flying with a cold or an ear infection is perhaps the most difficult call for parents to make, especially if your child doesn’t have a fever.
Even the slightest cold can make a flight extremely uncomfortable for a child (or an adult. Believe me, I’ve been there!) There are plenty of factors to consider and we have dedicated a whole separate post to this:
Flying with a Concussion
As any parent will know, kids fall and have minor accidents all the time. It’s part of growing up, exploring and testing the limits. However, once in a while such accidents end up in a serious fall and lead to a concussion.
There are a couple of things to judge the severity of the concussion and whether to seek medical advice immediately. (USA’s CDC has compiled a comprehensive guide to traumatic brain injury and concussion.)
Symptoms to look out for are that your child won’t act like themselves, might vomit, refuse to eat or drink, he or she will be sleepy. If your child experiences any of these symptoms, loses consciousness or complains of a persistent or worsening headache, seek medical advice.
Kids with a concussion can take up to four weeks to recover, but most concussions will get better on their own over several days. Following a mild head injury, your child will need to get plenty of rest and sleep, particularly in the first 24 to 48 hours. The suggested treatment for concussion mainly consists of rest and sleep, reduced stimulus (like staying in a dim or dark room with no TV or gadgets) and staying well-hydrated. None of this is very easy to do during air travel- bright, noisy airports, stressful timescales to get to the plane to name just a few.
There is very little consensus about the recommendations on flying after a concussion for adults, much less for children. Anecdotally, some people report that flying shortly after a concussion can cause or exacerbate issues like worsening headache and migraines or nausea.
What we do know is that the decreased cabin pressure means your child be getting less oxygen. So flying may make symptoms worse- especially headaches, fatigue, and nausea. If they have trouble equalizing the pressure in their ears or sinuses it could cause severe pain. (Here are some tips in helping your child “pop” their ears.)
It is sensible, if you can, to wait 24-48 hours after the knock before flying, in case any symptoms worsen. If you have any doubts about flying, contact a doctor (and your travel insurance provider.)
Tips to manage your child’s concussion symptoms while flying
- Make sure your child is well-rested before the flight;
- Arrive at the airport early, may even book special assistance through the airport;
- Request a light meal for the flight and bring some light snacks;
- Keep your child well-hydrated throughout the journey- bring your own water bottle and flavoured electrolyte powder sachets;
- Bring sunglasses (these are useful to block out the bright light of the airport and the cabin)
- Pack earplugs or noise-cancelling headphones (Puro are child-specific headphones we have personally tested- Check them out on Amazon; For earplugs, go for something like Earplanes, which address the cabin pressure changes)
- Encourage your child to sleep or listen to gentle music or stories, quietly
- Don’t allow your child to watch small screens, iPads, phones or reading on a screen.
- Plan in lots of time to rest after the flight
- Carry on giving the medication recommended by your paediatrician or other medical staff.
- Be aware that flying may worsen symptoms
- Notify the flight crew immediately, if you see any worrying change in your child’s condition.
If your child has had recent medical treatment or surgeries, seek the advice of the doctor to ensure travel is safe.
Also, some conditions impact the ability to travel. For instance, pulmonary disease might be rare for children, but the pressure in the cabin may impact this condition. Furthermore, strokes and deep-vein thrombosis may be unusual for children, but they require clearance from a doctor.
Lastly, any child recovering from an infectious disease will need to see a doctor to verify that they are well enough to travel.
Infectious Diseases: Guidelines for International Travel
There are a number of diseases that pose a risk to other passengers on the plane and you must wait a certain amount of time before travelling to prevent the spread of an infectious disease. Some of these illnesses may cause extremely serious complications for others with underlying conditions, who immuno-compromised or in pregnancy (to the mother or the unborn child.)
The Fit for Travel website of the National Health Services Scotland discusses specific infectious illnesses and how long they are contagious.
|Disease||Period It Is Contagious|
|Chickenpox||Chickenpox is contagious the day or two before onset and will continue to be contagious until all the pox lesions have scabbed over. This usually takes an extra five days.|
|Influenza||The flu will be contagious for three to five days from the first symptoms, but very young children may need up to seven days to get over the illness.|
|Measles||Measles is contagious from a day before symptoms begin until four days after the rash is present.|
|Mumps||The contagion range for mumps is seven days before symptoms and for five days after the glands begin to swell.|
|Whooping Cough||The early stages of whooping cough are highly contagious, from the beginning cough stage and then up to three weeks after.|
|Rubella||This disease is very easily spread and is contagious for a week before the rash begins to four days afterward.|
|Tuberculosis||Tuberculosis will remain contagious for the two weeks following treatment.|
Can an Airline Refuse Sick Travelers?
There are, currently, no laws in place regarding the refusal of sick travellers, but airline crews do have the right to refuse passengers.
This refusal is allowed because they want to avoid unplanned landings and putting other passengers at risk of contagious diseases.
Usually, the crew will let the captain know if there is a traveller who might be too sick to fly. The decision then falls onto the captain to decide. The World Health Organization discusses refusal to fly scenarios in “International Travel and Health” and indicates some airlines may require clearance from a medical professional.
With the current Covid-19 epidemic, these rules may well become more outlined and strict over the coming year.
An airline can refuse to carry a passenger who meets any of the following criteria:
- Their sickness could be hazardous to other passengers.
- Their sickness could be hazardous to the plane’s safety.
- The passenger may need special medical attention or equipment during the flight.
- The flight may make the sickness worse.
It is also recommended to check with specific airlines regarding their applicable rules when travelling.
Prevention and Preparedness
Governments tend to have very good resources online about the measures recommended before travelling to different destinations. These resources help you plan and suggest the recommended and necessary vaccinations and medication you may need based on your destination. Your local travel clinic will also be able to advise on your individual circumstances.
Before you travel internationally, it is helpful to check with the Travelers’ Health Section on the Center for Disease Control website.
For US citizens, it’s worth considering enrolling in the Smart Traveler Enrollment Program (STEP). This program works to keep you informed about the safety and security in the country you are visiting. Plus, the embassy can know where you are to help you and your family in the event of an emergency.
When Travel is Necessary
There are times when travelling is unavoidable, or a child becomes ill in the middle of your journey. Not the stress you need added to any trip!
It is very important to consult medical staff, if you have any uncertainty.
Your travel insurance company will also be one of your first phone calls, as they can advise on the best course of action and on what they can and cannot cover. This will help you make better-informed decisions too, hopefully, taking any financial aspect out of the decision process.
Check with Your Child’s Pediatrician
Check with your pediatrician to have your child’s doctor make recommendations and write prescriptions, just in case. Having medical clearance from a doctor will help if you are questioned about your child’s health by aircrew before boarding a plane.
What’s in your medical kit?
When travelling with kids, it is vital to have some medications on hand, even when they seem well. Fever reducers and medicines for stomach issues are often necessary and may waste your time in hunting down a pharmacy, and some countries may not have the brands you prefer.
While you may find you can travel with your sick child, you may have to adjust the activities you planned for your trip to allow your child to rest long enough for the illness to pass. Have back up plans in place to allow for longer sleep and rest.
Have you ever had to face the decision of whether or not to fly with a sick child? How did you decide? (Join the conversation and comment below)
This post and it contents has been reviewed by Dr Shireen Khanum
, paediatrician of Belhoul Hospital http://www.belhoulspeciality.com/doctorprofile/53/18
References and resources:
– Head injury from falls in children younger than 6 years of age
P Burrows,1 L Trefan,1 R Houston,2 J Hughes,1 G Pearson,3 R J Edwards,4 P Hyde,5 I Maconochie,6 R C Parslow,7 and A M Kemp1- 2005, BMJ, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4680174/