Dear Christa, thank you very much for this interview! Could you briefly tell us what your professional background and your current focus are?

I am a pediatrician and infectiologist and have been working at the Children's Hospital Zurich for 20 years, the last 15 of them in infectiology. There, together with my colleagues, I am responsible for all areas of pediatric infectiology. We care for outpatient and inpatient children with a wide variety of infectious diseases. For five years, there has been a successful collaboration between the Travel Clinic at the EBPI and the Children's Hospital. One afternoon a week, I work at the ZRM and am allowed to contribute my pediatric expertise to travel medicine consultations. At the same time, this job gives me a wonderful view into travel medicine and allows me to learn a lot.

The topic of "traveling with children" is very comprehensive. I think it's worth organizing it a bit thematically.
Before the trip: From a medical perspective, what preparations do parents need to make to best prepare their children for a trip? Are there health risks that apply only to children, if so which ones?

That is certainly a crucial question. It seems very important to me to start planning early, to take enough time and to inform oneself sufficiently. Spontaneous actions can bring unforeseen difficulties. It is also important to choose the destination according to the needs of the children, and not necessarily those of the adults. These needs can be quite far apart.
Regarding health risks, there are some aspects that should be considered. It can be said as a general rule that many tropical diseases are more dangerous for young children than for older children or adults. We therefore generally recommend not traveling to the tropics with infants (children under 12 months). Caution is still advised with older infants as well. Parents should be aware that a sick child on a trip is not an exception, but the rule, since small children also often get sick at home. In a bad phase, a child may have an infection every few weeks. If you're used to simply dropping your child off at the pediatrician's office quickly, this can become a challenge on a trip - even if it's for non-travel-related, or perhaps even trivial illnesses. Depending on the travel destination, a competent contact person may not be found quickly. You may have to go to a hospital where other treatment methods are practiced, where there are no pediatricians available, or where there may be different hygiene practices than you are used to. So you have to take into account that children can get sick while traveling just like they get sick at home. However, harmless illnesses can be more difficult to treat when traveling, such as when a child has diarrhea, loses a lot of fluids, and is hot. That's when it can be difficult to maintain fluid balance. In summary, plan your trip early enough, consider the needs of your children when choosing a destination, and avoid high-risk areas (such as the tropics) when traveling with very young children. There are many nice alternatives.

That kind of ties into my next question, too, when you bring up the accessibility of health care facilities: are there things to consider when planning lodging or programming?

Children need and tolerate much less program than adults. An overloaded travel program can overwhelm and tire children - which can lead to bad moods. That's why the principle for children is: less is more. For small children, it makes no difference at all whether they play on Lake Maggiore or on the beach in Thailand. They just want to "sändele". So you have to ask yourself whether you're really doing yourself a favor by flying to Thailand as a family to the beach and putting up with the heat, the unfamiliar food and the jet lag, or whether Lake Maggiore is not enough.
But if you are planning a long-distance trip with small children, it is important to allow enough time for acclimatization. Acclimatization means different aspects: not only jet lag, but also time to get used to the new environment, the temperature, the food. You should allow enough unscheduled time for this. Older children are also quite happy to spend a day playing on the beach instead of visiting the sights.
The choice of suitable accommodation depends on the habits of the family. It is possible to go camping with small children as well as to stay in a 5-star hotel. However, if a child is not accustomed to sitting quietly in a stylish restaurant for an evening, the campground may be the more relaxing alternative. Regardless of the type of accommodation, I recommend not changing it every day, but also staying in one place for a while once in a while. Routine and familiar routines are important for children, even on vacation. Too many changes can be exhausting, which in turn can have a negative effect on the mood in the family.

Do you have any tips and tricks on how parents can best address the topic of health with their children while traveling?

Some things that are important for children's health while traveling can already be practiced at home in everyday life, such as normal hygiene behavior. I am not a fan of excessive hygiene measures. A child should be able to play in the dirt from time to time; that is healthy and beneficial for development. Nevertheless, it makes sense to teach small children some hygiene measures. A child should learn to wash his or her hands with soap and water, for example, before eating, after going to the toilet, and after traveling on public transportation. If children learn this early, they will take it for granted when traveling. Of course, this is not yet possible for very young children, but a lot of support is needed here anyway. In addition, I recommend all parents to teach children not to pet unknown animals. Because of the risk of rabies, this is even more important when traveling. But actually it is also quite useful, even in this country, to ask dog owners first if you can pet their dog. For journeys into areas where rabies is prevalent is better to found petting animals at all. This saves a lot of trouble and effort.

Are there any documents that travelers with children must remember?

These are not very different from those of adults. I recommend taking a copy of the vaccination card with you so that you can show it if necessary. In addition, certainly the health insurance card with emergency numbers, which you can also dial from abroad and perhaps the phone number of the pediatrician - that is, of someone who knows the child and their medical history. 

During the journey: Are there things you recommend all parents have with them on the trip? And what belongs in the first-aid kit?

What to have in the hand luggage is not so much and can also vary depending on the child. It is certainly advisable to have something against pain or fever - and perhaps nasal drops for a blocked nose.
But for long plane trips, it's important to think about more than just medications. It is advisable, especially for small children, to have something with you that they know well and that gives them a sense of security and safety, such as a cuddly toy, a pillow or a "Nuscheli". In addition, a few snacks in small portions belong in the hand luggage. Eating and drinking distracts and makes the time go by faster. Of course, age-appropriate toys should not be missing from the hand luggage. It's best to bring something that doesn't require electricity or Wi-Fi and, at best, doesn't make any noise - for the sake of the people sitting next to you.

Are there any health risks for children associated with the various means of transportation (planes, cars, trains, etc.)? I'm thinking specifically of airplane travel...

I don't think train travel is problematic. These also have the advantage of allowing children to run around, which is exciting for them and they usually like to do. If you travel in your own car, you are set up as you know it. When flying to a country and renting a car locally, you have to be mindful of the child seats. These are not always the right size, good quality or even available at all. If you are planning to travel for a longer period of time and make a lot of car trips, you can consider taking your own child seat with you. Otherwise, you should clarify in advance whether you can get one locally. Here you should not make any compromises. It makes no sense to use a tailor-made seat in Switzerland and then do without an adequate child seat at the vacation destination, where the traffic is perhaps more dangerous than at home.
Short air journeys are not very different from car journeys in terms of potential problems for children. But long air journeys can pose problems. As already mentioned, patience is required here. It can be annoying for children not to be able to move, especially if there is turbulence and you have to remain seated with your seat belt fastened. This is where parents need a bit of imagination to keep the kids well occupied so that the trip doesn't turn into torture for the whole family (and their surroundings!). Ear pressure is always an unpleasant topic. We adults are good at compensating for ear pressure, but young children can't do that very well yet. You can help them with this by giving them a nuggi or something to drink during takeoff and landing, depending on their age. For older children, chewing gum can help.

During the stay:
Keyword accidents with children - Are there risks here, which you hear about again and again and which one should pay attention to?

Of course, accidents happen on trips just as they do at home. Everything that is dangerous at home is also dangerous at the destination. In addition, there is the unfamiliar environment. Parents and children alike may not recognize a lurking danger at first glance. This applies not only to toddlers, but also to schoolchildren who can already move around relatively independently at home. For example, they may not realize that they have to look to the other side when driving on the left. This means that in terms of independence in traffic, you may have to take a step back and look at the new situation with them. A twelve-year-old may not be able to cross the street on his own without problems, which he may do every day at home without difficulty.
In addition to road traffic, the issue of water safety is also very important. You should always watch your children and really never leave them alone near a body of water. A child who can swim well in the pool may not necessarily be able to do so in the sea, depending on the waves and currents. A special degree of caution is needed here.
Depending on the accommodation, dangers may lurk in unsecured electrical outlets or cables hanging freely. Things standing around that look similar to an object from home can also pose a danger. For example, a bottle of cleaning supplies may be mistaken for a drink the child knows from home. Care must be taken to avoid exposing the child to a substance that could cause him or her to become poisoned.

Are there any special precautions for children in terms of food to protect them from food poisoning, for example, or is it "cook it, boil it, peel it or leave it" for the little ones as well?

Absolutely! This sentence can be transferred 1:1 to children. For infants who are still breastfed, the food thing is easiest. For children who drink from the bottle, it is clear that you prepare the bottle with boiled or purchased water. For all other children, the rules are exactly the same as for adults.

What is there to consider in terms of sleep and jet lag?

Children are not as good at classifying jet lag through their minds as we adults are. We know what it is and can actively adjust to it. A young child can't. You have to expect that children are therefore still a bit "off their feet" during the first few days after the trip. It makes sense, when traveling across multiple time zones, to include several days spent in the same place after arrival. This is also part of acclimatization, which we have already discussed. This allows the child to find a new rhythm before you travel further and do many activities.
Depending on the age, or sleeping habits of the child, you can shift the bedtime in stages. However, this is often difficult because the rhythm in the new place is determined by external circumstances. There is really not much you can do against jet lag. So I suggest to plan enough time, to know that it might be a somewhat tedious time and not to despair, but to be prepared for the fact that the children are a bit carried away during the first two to three days. Maybe it's only after that that the vacations really start. This is certainly an argument to think carefully about whether it is worth flying far away for only two weeks or whether it might make more sense to either travel a little longer or choose nearby destinations for short vacations.

After the return trip and back home, are there any health checks or precautions parents should take with their children after they return?

As long as the children are well and have no symptoms of illness, nothing special is needed. Just as with adults, if children have a fever after returning from a malaria area, malaria must be ruled out. It is important to mention the recent trip when visiting the doctor, so that the right tests can be carried out, if necessary.

What are the contact points parents can turn to if health complications arise after the trip? Or child-specific emergency numbers, if necessary?

Basically, the procedure is the same as if the child had not traveled. That is, the contact person is primarily the pediatrician. At night or on weekends, an emergency ward should be consulted if the child is unwell. In case of special questions, a referral to a tropical physician or to our infectious disease clinic at the Children's Hospital may be useful.

Last month we focused on the topic of "Responsible Global Citizenship". How can families ensure that when traveling to countries with different cultural norms and health practices, they understand and respect the health practices there while prioritizing the well-being of their family? Do such aspects also have a place in medical consultations or are there ways to raise children's awareness from an early age?

This is crucially related to the attitude and mindset of the parents. If the parents themselves treat the destination country and the local population with respect, and if they are sensitized to the fact that you don't just go somewhere and behave as if you were at home - then they are a good role model for their children. They model this attitude to their children, and in doing so, teach them how to behave respectfully in a new culture and toward local people. However, if parents lack a sense of this, it could be a difficult task to teach them these points in a travel medicine consultation. Respectful behavior is ultimately a way of life, even quite independent of travel. It's nice when parents can exemplify this to their children in everyday life and while traveling.

Interview: Sofia Ricar