Travelling with kids: how to handle common illnesses abroad

Children get ill on holiday for the same reasons they get ill at home, plus a few new ones: different food and water, heat, insects and long journeys. Almost all of it is the ordinary stuff. What changes abroad is that you are deciding without your usual doctor, your usual pharmacy, or your usual sense of what the system around you does.

Before you go: a health checklist for travelling with children

See your child's own doctor first

Four to six weeks before an international trip is the usual window, because most vaccines should be given at least a month before you travel. Make sure routine vaccines are up to date and ask what is recommended for where you are going. Take written copies of your child's vaccine record, regular medicines and allergies.

Pack a kids' travel health kit

Save the numbers, and check the insurance

Save the local emergency number in your phone on arrival; it is 112 throughout the European Union. Note where the nearest pharmacy is. Check that your travel insurance covers every child on the trip, and whether it reimburses a video consultation if you pay for one yourself; how self-pay telemedicine works explains the options.

Fever in a child abroad: what to do and when to worry

A high temperature is 38C or more. In a child who is otherwise drinking, playing on and off and responding normally, it is usually the body fighting an ordinary infection, and the aim is comfort rather than a number on the thermometer.

What to do

• Offer plenty of fluids, and food if they want it.
• Give paracetamol or ibuprofen if they are distressed or uncomfortable, following the pack for their age or weight. Do not give paracetamol under 2 months, ibuprofen under 3 months or 5kg, or ibuprofen if they have chickenpox or are dehydrated. Never give aspirin to a child under 16.
• Do not undress them or sponge them down to cool them.
• Check on them regularly, including overnight.

When to get urgent medical advice

• A baby under 3 months with a temperature of 38C or higher
• A baby aged 3 to 6 months with a temperature of 39C or higher
• A temperature that has lasted 5 days or more
• Signs of dehydration, or a rash together with the fever
• Your child seems unwell, is not eating, or you are worried

A fever after time in the tropics is different

If you have been somewhere malaria is found, a fever needs a doctor the same day, during the trip or after it. Malaria symptoms usually start 7 to 18 days after the infected bite, sometimes much later, and in children often look like tiredness and sleepiness as much as a high temperature. A clinical review of sick children after travel puts it plainly: almost all life-threatening illnesses after a trip present with fever. Dengue is the other common cause in the tropics; our guide to fever after mosquito bites covers its warning signs.

Vomiting and diarrhoea: keeping a child hydrated

The short answer is fluids first, food when they are ready. Vomiting usually stops within 1 or 2 days and diarrhoea within 5 to 7. The real risk is dehydration, which happens faster in small children.

• Give small, frequent sips of water, or an oral rehydration solution.
• Keep breast or bottle feeding. If your baby is being sick, try smaller feeds.
• For babies on formula or solids, give small sips of water between feeds.
• Let them eat when they feel able. There is usually no need for medicine.
• Do not give anti-diarrhoeal medicine to a child under 12.

Signs of dehydration

In babies and young children: fewer wet nappies, few or no tears when crying, sunken eyes, a sunken soft spot on top of the head, or being drowsy or irritable. Blue, grey, pale or blotchy skin, cold skin or difficulty breathing alongside dehydration is an emergency.

When to get urgent medical advice

• You are worried about a baby under 12 months
• A child under 5 has signs of dehydration, or an older child still does after rehydration sachets
• Bloody diarrhoea or bleeding from the bottom
• Vomiting for more than 2 days

If the whole family is ill after the same meal, our guide to food poisoning on holiday covers what to do first, including for children.

Cuts, grazes, bites and stings

• Cuts and grazes: rinse with tap or bottled water or a sterile wipe, pat dry and cover. Get it checked if it becomes swollen, red and more painful, or pus is coming out. Call emergency services if it will not stop bleeding, is very large or deep, or has something stuck in it.
• Insect bites: a cloth soaked in cold water or a wrapped ice pack for at least 20 minutes, and try to stop them scratching. A child under 1 with a bite should see a doctor; a bite that becomes hot, red and swollen needs advice from a pharmacist or doctor.
• A sting near the mouth or throat, or one in a child who has reacted badly before, needs urgent advice. Swelling of the lips, mouth or throat, or difficulty breathing, is an emergency: how to tell if an allergic reaction is an emergency explains the signs.

Not sure whether your child needs a doctor?

That uncertainty is the hardest part, and it is normal: you are judging without your usual doctor, in a place you do not know. This is a rough guide, not a substitute for your own sense that something is wrong. If you are worried, that is reason enough to get advice.

For the middle rows, a video consultation can be a sensible first step. A doctor can take a careful history, see your child, their skin, their breathing effort and how they are behaving, and tell you whether this can be managed where you are or needs to be seen in person. What a video call cannot do is an examination: ears, chest, tummy and throat need someone in the room, and if that is what your child needs, the doctor will tell you so.

What to have ready for the call

• Their temperature, and when you took it
• When the symptoms started and how they have changed
• What they have drunk, and how many wet nappies or toilet trips since the morning
• Any medicine you have given, the dose and the time
• Their age, rough weight, and any allergies or regular medicines

Pomodoc connects travellers with English-speaking doctors by video, licensed to treat you in the country you are physically in, and you can book a consultation for your child as their parent or guardian. More on how that works is in our page on online doctor consultations for children, and preparing for a video consultation covers the practical side of the call.

In short

• Pack: thermometer, child paracetamol or ibuprofen with its syringe, rehydration sachets, plasters, regular medicines.
• Fever: fluids and comfort; under 3 months at 38C, 3 to 6 months at 39C, or 5 days of fever needs urgent advice.
• After the tropics: any fever needs a doctor the same day.
• Stomach bugs: small sips, keep feeds going, and watch for dehydration.
• Emergencies: a rash that does not fade, stiff neck, seizure, breathing difficulty, unusual drowsiness, colour change.
• In between: if you are unsure, speak to a doctor; a video consultation can tell you whether your child needs to be seen.