Montezuma’s Revenge, Bali Belly and the Rangoon Runs. All creative names for traveller’s diarrhea. The risk of acquiring traveller’s diarrhea is particularly high for those travelling to Asia, the Middle East, Africa, Mexico, Central and South America.
The most common illness experienced by travellers, traveller’s diarrhea is defined as three unformed stools in a twenty-four hour period. Belly ache, nausea, vomiting and fever may all accompany the diarrhoea. A smorgasbord of nasty germs may act as the culprit inducing the illness. Most of these germs are spread a nasty way, by faecal-oral transmission. While this is unpleasant, and often leads adult travellers to spend a few uncomfortable days over the toilet, the situation may be more sinister for children.
Babies and small children are particularly prone to dehydration as a result of traveller’s diarrhea. Each year an estimated 1.6 million children under five die as a result of diarrhoeal illness. Responsible travelling with your little one involves being informed about the risk of traveller’s diarrhoea, and minimizing this risk. Unfortunately, even with good hygiene practices many travellers still succumb to these infections. Knowing how to care for your baby or small child if they are one of the unfortunate ones, and knowing when to get medical help are therefore essential.
Minimizing the risk
- Food is safest if it is freshly cooked.
- Avoid raw fruit and vegetables unless you peel them yourself.
- Bottled or boiled water only should be used. This includes when teeth are brushed.
- Effectively sterilize bottles and dummies.
- Avoid reconstituted drinks such as cordial unless you constitute it yourself using boiled or bottled water.
- Avoid ice at restaurants.
- Wash both your and your child’s hands well before meals (potentially using a hand sanitizing product).
- Ensure immaculate hygiene after toileting your child if they are unwell to avoid transmission to yourself or other children.
- Exclusive breastfeeding (babies taking breast milk only) provides unique protection against traveller’s diarrhoea. If your baby is between 4-6 months of age and you will be travelling to an area of high risk for travellers diarrhoea so consider delaying the introduction of solids until you are home. If follow this advice please remember that the introduction of solids should occur by 6 months of age.
What to do if your baby or small child develops traveller’s diarrhoea.
- Breastfed babies should continue to breastfeed, just increase the duration and/or frequency of feeds. This means that breastfeeding mothers need to pay special attention to maintaining their own hydration and nutrition.
- Formula-fed babies should continue with their formula feeds. Formula should be made at the regular concentration.
- Increasing the amount of oral fluids should suffice however you may consider purchasing oral rehydration solutions (ORS). It can be purchased in pharmacies or stores worldwide.
- Avoid sugary drinks such as soft drink or full strength juice as they pull water back into the bowel.
- Talk to your doctor before you go about whether you should take antibiotics with you just in case your child gets invasive diarrhoea (usually indicated by bloody stools). You will need to get good advice from them about if and when this may be useful.
- Imodium, a medication commonly used to stop traveller’s diarrhoea in adults is not recommended for babies and small children.
- Breastfeeding mums with traveller’s diarrhoea should increase their own intake of fluid. A breastfeeding mother who has traveller’s diarrhoea may take Imodium as it is not expressed in breast milk.
- Traveller’s diarrhoea can lead to a terrible buttock rash for little ones in nappies. Liberal use of barrier cream and frequent changes may lessen this. Application of 1% hydrocortisone cream may also assist.
Seek immediate medical attention when travelling if:
- Your child develops any of the following signs of dehydration:
Reduced urine output.
Reduction in tears.
Sunken fontanelles (The fontanelles are the soft bits over baby’s head).
Irritability or lethargy.
- Your child develops a fever over 38.5º.
- Your child is vomiting so much they are not able to keep fluids down.
- There is blood in the stools.
- Loose stools continue for more than three days.