Air Travel for Infants and Young Children, Part II

Upper respiratory infections and ear infections

A questionnaire survey conducted by us several years ago found that the vast majority of American pediatric otolaryngologists believe that air travel is safe for infants and young children experiencing upper respiratory infections, nasal allergies, and ear infections. Most of these specialists have never seen serious ear problems that could be attributed to air travel. In the rare incidences that ear problems were seen soon after flights, it could not be determined if the flight played a significant role in causing the problem.

Do preverbal children experience pain in their ears during flights? This is an age group that very frequently has upper respiratory infections, for example, conditions that cause earaches in older children and adults. Yet our surveys of parents show that the vast majority of infants and young children seem to cry no more during flights than they would at a similar time of day or night back home. This is surprising considering all the other reasons that this age group has to cry in flight: disrupted eating and sleeping schedules, uncomfortable positions in strange surroundings, and, for infants being held on a parent’s lap, being awakened when parents change their positions, for example.

Several small studies indicate that children traveling by air with ear infections experience pain less often than children without such infections. Ear infections tend to produce fluid in the middle ear. The fluid obliterates the middle ear air space. Therefore pressure differentials can not occur, and there is no pain. Aerating tubes also prevent pressure differentials from occurring, making flights safe and comfortable for children with such tubes.

Parents are sometimes told to keep infants awake during ascent and descent. Sleep decreases the frequency of swallowing, and swallowing is a mechanism that helps keep the Eustachian tubes open. But if an infant is sleeping there is little or no pain and there is no reason to wake them.

The use of decongestants and nasal sprays for URIs and nasal allergies may help minimize pain in adults, but several small studies indicate that these products are not very helpful in children.

Feeding Infants during the Flight

Conventional wisdom recommends giving bottles or nursing infants during ascent and descent, frequently during the flight, and when infants become fussy or cry. As a result, many parents feed their infants more often in flight than they do at home. This may be counterproductive, and may be one of the reasons that some infants do cry during flight. The rational for frequent feedings is that infants cry because they are experiencing ear pain and/or because they are dehydrated. Ear pain is not that common, as already mentioned, and in-flight dehydration is an oft-repeated myth.

Drinking copious amounts of fluids during air travel, as is recommended by most travel/health advice columns and books, does nothing for health or comfort; it only creates long lines at the toilets, and results in more wet diapers. More important, it may make infants irritable. Air travelers erroneously interpret as dehydration the fact that their mouths and throats become parched during flight. The dry membranes are the result of the aircraft’s air conditioning removing most of the humidity from the cabin air. This is not dehydration. Studies show that adults who eat and drink during flight almost invariably gain weight, some of it in the form of fluid accumulation in their legs, the result of continuous sitting.

Frequent feedings may have a direct negative effect on passengers, especially on young infants. At the cruising altitude of jet aircraft, the air in the intestine is already expanded by 20%, the result of lower atmospheric pressure. This gives many adults a bloated feeling. Eating, and especially sucking, adds food and more air. Infants may actually be crying because of a bloated feeling in their abdomen, as is often the case in colic. Forcing them to suck and feed when they cry may worsen this situation. In fact, a few minutes of crying may be beneficial. If infants are crying because of pain in their ears, crying, like swallowing, helps open the Eustachian tubes. Parents should feed infants no more often during flight than they do at home, and allow them to feed/suck briefly during ascent and descent.

Antihistamines/Tranquilizers

Parents often ask for medications to sedate their infants and young children during air travel. Often parents administer medications (usually antihistamines) on their own, on suggestion from friends and family.

In fact, with rare exceptions, infants tolerate air travel remarkably well; the vibration of the aircraft seems to have a soothing effect, as does automobile travel. The trip for infants consists not only of the hours in the air, but starts when they are first aroused for the trip and continues until they are put to bed at the final destination.

Some toddlers are unruly and difficult to manage during flight but, commonly, this appears to be due to poor parenting skills and indifference on the part of some parents to the sensitivities and comfort of other passengers. However, there is little rationale for sedating toddlers, even for long night flights. There are no data as to which medication to choose, how much to give and when to give it, and whether or not it is effective. Parents who have given their children antihistamines for long flights often say that it was not helpful or made the child more difficult to manage. It is known that antihistamines can make children more active, especially children who are generally active. Also, in adults, medications (tranquilizers, for example) taken in conjunction with long flights through many times zones may results in enhanced or altered effects.