Planning a holiday with children involves juggling a great deal, and health preparation can fall to the bottom of the list when there are flights to book and suitcases to pack. The gap between "we need to sort out travel health stuff" and actually doing it is where the problems tend to arise – arriving at a destination where malaria prophylaxis was needed and not taken, or discovering that a vaccination the child should have had requires three doses over six weeks.
Most travel health risks in children are preventable or manageable. Understanding what applies to the specific destination, and what to do promptly if a child becomes unwell while travelling or after returning, reduces both risk and anxiety.
Healthbooq (healthbooq.com/apps/healthbooq-kids) covers health preparation and illness in children.
Planning Ahead: When to Get Travel Health Advice
A travel health consultation should ideally be arranged 6-8 weeks before departure, for any international travel to destinations outside western Europe, North America, Australia, and New Zealand. The consultation should cover: destination-specific vaccination requirements and recommendations, malaria risk assessment, food and water safety advice, insect bite prevention, sun safety, and what to do in the event of illness.
NHS travel health is available through some GP surgeries (though access has reduced) and through travel health clinics, which may be private. The NHS Fit for Travel website (fitfortravel.nhs.uk) provides country-by-country guidance and is a useful first reference. Travel vaccinations that are required (e.g., yellow fever for certain destinations) must be documented in an International Certificate of Vaccination.
Travel Vaccinations
Many travel vaccinations are not on the routine NHS childhood schedule and need to be specifically arranged. Common travel vaccines for children include:
Hepatitis A: recommended for most destinations outside western Europe and North America. Two doses provide long-term protection; children aged two and over can receive a combined hepatitis A and typhoid vaccine.
Typhoid: recommended for travel to South Asia, sub-Saharan Africa, and parts of Latin America. The injectable typhoid vaccine provides protection for three years; an oral live attenuated vaccine is available for children aged six and over.
Yellow fever: required for entry to certain countries (including parts of sub-Saharan Africa and South America) and recommended for travel to endemic areas. It is a live vaccine and is not given to infants under nine months, pregnant women, or immunocompromised individuals. Yellow fever vaccination is given only at designated yellow fever vaccination centres.
Rabies pre-exposure prophylaxis: recommended for longer stays in high-risk destinations, particularly for children who are more likely to approach and be bitten by animals. Pre-exposure prophylaxis (three doses over 21-28 days) simplifies post-exposure management significantly – a bite still requires medical attention, but the timeframe for treatment is longer.
Meningococcal ACWY: recommended for travel to sub-Saharan Africa during the dry season ("meningitis belt"), and required for Hajj pilgrimage. Some countries require MenACWY vaccination for travel visas.
Japanese encephalitis: recommended for prolonged rural travel in Asia where rice paddies and pig farming are nearby. Given in two doses. Not routinely given for short city-based stays.
Routine vaccinations should be checked and brought up to date before travel: MMR (measles, mumps, and rubella) is particularly important, as measles remains endemic in many countries and can be severe in unvaccinated children. Chickenpox vaccination, not routine in the UK, is sometimes recommended before travel to countries where it is less prevalent.
Malaria Prevention
Malaria is caused by Plasmodium parasites transmitted by Anopheles mosquitoes. Children are at higher risk of severe malaria than adults. It can be fatal within 24-48 hours in severe cases, and a febrile child who has returned from a malaria-endemic area should be assessed urgently.
Malaria prevention has two equally important components: chemoprophylaxis (antimalarial tablets) and bite avoidance. No antimalarial is 100% effective, and bite avoidance must be maintained alongside medication.
Antimalarial tablets suitable for children include:
Atovaquone/proguanil (Malarone): very well tolerated; taken daily starting one to two days before travel, during, and seven days after. Available in a paediatric formulation for children over five kilograms. Most commonly recommended for children travelling to areas with chloroquine-resistant malaria.
Mefloquine (Lariam): taken weekly; suitable for longer trips. Can cause neuropsychiatric side effects (vivid dreams, anxiety, depression, occasionally psychosis) and is contraindicated in children with seizure disorders or psychiatric history. Increasing clinical preference is for Malarone over mefloquine for children.
Doxycycline: suitable for children aged 12 and over only. Taken daily. Causes photosensitivity (requires good sun protection).
Chloroquine and proguanil: still used in some low-risk destinations but resistance limits their utility in most of sub-Saharan Africa and much of South and South-East Asia.
Bite avoidance measures: DEET (diethyltoluamide) at 50% concentration is effective and safe for children over two months in appropriate formulations. Picaridin (also called icaridin) is an alternative with comparable efficacy and a better skin tolerance profile, increasingly used in paediatric practice. Long-sleeved clothing and insecticide-treated bed nets are essential, particularly between dusk and dawn when Anopheles mosquitoes are most active.
A febrile child who has been in a malaria-endemic area within the preceding year should be assessed as a medical emergency; a negative malaria test does not exclude malaria and should be repeated if clinical suspicion remains.
Travellers' Diarrhoea
Travellers' diarrhoea (TD) is the most common travel-related illness, affecting 20-40% of travellers to developing countries. In children, dehydration from TD can occur rapidly and is the primary risk. Oral rehydration solution (ORS – sachet-based, mixed with clean water) is the mainstay of management; children should not simply be given water alone, as it does not replace the salts lost.
Prevention: "Boil it, cook it, peel it or forget it" remains useful general guidance. Safe water (bottled, boiled, or treated) for drinking, teeth cleaning, and ice cubes; avoiding raw salads, unpeeled fruit, and food from street vendors in high-risk areas.
Antibiotic treatment: typically not indicated for uncomplicated TD in children but may be considered for severe or prolonged diarrhoea (particularly if bloody) following medical advice.
Sun Safety
The principles of sun safety are the same for travel as at home, with greater intensity required in high-UV destinations: SPF 30 or higher (SPF 50 recommended) broad-spectrum sunscreen; reapplication every two hours and after swimming; protective clothing and hats; and avoidance of direct sun during peak hours (typically 11am-3pm). Sunscreen is not recommended on infants under six months; shade and protective clothing should be used instead.
Heat exhaustion and heatstroke can develop rapidly in children, particularly in high-humidity environments. Ensuring adequate hydration and recognising the symptoms (heavy sweating, weakness, dizziness in heat exhaustion; high body temperature, hot dry skin, confusion in heatstroke) matters.
Key Takeaways
Travelling abroad with children requires specific health preparation that goes beyond what most families routinely arrange. Depending on the destination, this may include travel vaccinations, malaria prevention medication, and education about food and water safety, sun exposure, and insect bite prevention. Travel health appointments should ideally be arranged 6-8 weeks before departure. Malaria can be fatal in children and prevention is essential for at-risk destinations; no antimalarial is 100% effective so bite prevention is equally important. Travellers' diarrhoea is the most common illness in international travellers, and oral rehydration is the priority in children.
