Can a Sick Child Fly on an Airplane?

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Dr. Steve Silvestro is a board certified pediatrician who is also a father of two. As a father he knows first hand of the many complexities traveling with children can bring and as a pediatrician also knows when you should or should not fly on an airplane with them. This article discusses a few of the more common ailments that your child may get right before a vacation and what you can do about each one. 

Prefer to listen to this content? You can hear it on Dr. Steve’s Child Repair Guide Podcast:

When you’re getting ready to travel with your kids, there are plenty of things you’ll likely plan for ahead of time:

How will you entertain them on the flight? How will you entertain them once you’ve arrived? How will you create a memorable experience that everyone in the family will enjoy?

And if you’re feeling really on top of things, you might even prep for the possibility that your child might get sick during your adventure. You’ll pack medicine and gear accordingly.

But the one thing none of us plan for–a child getting sick right before the trip.

If your little one has fallen ill and you have a family adventure on the horizon, this article will cover just about everything you need to know.

I’ll start with some general considerations to think about when it comes to flying with a sick child and then share tips on dealing with common childhood illnesses. I will devote particular attention to ear infections, as that’s the illness we tend to fuss about most when flying.

Some big-picture thoughts about flying with a sick child

When it comes to flying with a sick child, there are three things you’ll want to think about:

1. Will flying make your child feel worse?

The airplane cabin is a fairly unique environment. The air tends to be quite dry and—most importantly—the air pressure changes as the plane ascends and descends. These physical changes can have an impact on how your child feels when sick.

2. Will you or your child be miserable?

While some illnesses won’t necessarily be made worse by flying, they can still make the flight a pretty horrible experience. For example, a child with a stomach bug isn’t more or less likely to throw up during a flight, but dealing with a vomiting kiddo in a crowded, cramped cabin is no one’s cup of tea…

3. Will your child get others sick?

Even though we often worry about getting sick on a flight—there are even products marketed specifically responding to this fear—studies show that we’re no more likely to get sick on a plane than we are on other public transportation such as a bus or train. However, certain illnesses—say, influenza or chickenpox—are extremely contagious and a child sick with these is likely to get others sick.

Flying with toddlers suffering from an ear infection

The most common health-related travel question I get as a pediatrician is “Can my child fly with an ear infection?” The answer is a little complicated as we’ll see below.

First, it’s helpful to understand what’s going on with air pressure and inside your child’s ears when you fly.

What happens to the ears when you fly?

Inside your head, the nose, throat, sinuses, and ears are all connected. The Eustachian tube is the connection that helps regulate pressure inside this system trying to equalize it with the air pressure outside your body (chewing, swallowing, and sucking can help the Eustachian tube do its job). Sitting between the inside of your body and the outside world is the eardrum, a thin sheet that can be pushed inward or outward with changes in pressure.

Think of air pressure as the weight of air in the atmosphere pressing down on your body. When you are on the ground, the Eustachian tube has helped to make the pressure inside your nose/ear/throat system equal to the air pressure outside your body.

When a plane is ascending, there is less and less atmosphere pressing down from above you—so the air pressure outside your body is less than the pressure inside your body. This makes the eardrum bulge outward as the plane ascends until the Eustachian tube helps make the pressure inside of you match that outside of you.

When a plane is descending, there is more and more atmosphere above you. Because your nose/ear/throat system got used to the higher altitude, descending means that more and more pressure is outside of you than inside of you—resulting in your eardrum being pushed inward as you descend.

1. Will flying make your child feel worse?

With an ear infection, there is pus and pressure behind the eardrum because of the infection.

Therefore, when the plane is ascending, the already-bulging eardrum might be forced to bulge outward even more—resulting in more pain and, potentially, rupturing the eardrum. Don’t worry even though a ruptured eardrum hurts during that particular moment, it usually heals very well. Still, your child should see a pediatrician if this happens.

When the plane is descending, the added air pressure will be pushing against an eardrum that has nowhere to move—potentially resulting in more pain.

In fact, there are very few studies that have looked at this. Most recommendations are based on these theories and expert opinion. There is one very small study—involving only 14 children—that showed that kids with ear infections didn’t have increased pain while flying.

The authors hypothesized that because as the Eustachian tube was filled with pus instead of air, the eardrum couldn’t fluctuate with ascent and descent—meaning that the kids’ ears felt the same as if they were on the ground during the whole flight.

Still, most of us pediatricians stick with the idea that an actively infected ear will likely feel worse on a plane.

2. Will you or your child be miserable?

Aside from the study involving only 14 children, the common premise is that the change in pressure will likely cause an increase in pain. So unless you pre-medicate your child with acetaminophen or ibuprofen, chances are pretty good that your child won’t be happy.

3.  Will your child get others sick?

Unlikely. Ear infections aren’t directly contagious.

What to do?

The usual recommendation is that if child is diagnosed with ear infection within 48 hours of flight, try to reschedule your flight. If that’s just not possible, give your child pain medication—acetaminophen or ibuprofen (the latter if your child is over 6 months old) 30-60 minutes before takeoff.

Call your pediatrician to see if a decongestant nose spray would be appropriate for your child. In theory, using a decongestant nose spray 30-60 minutes before takeoff might help to drain the fluid behind the eardrum thereby allowing the pressure change to occur more smoothly and comfortably.

If an ear infection is diagnosed and treatment has begun more than 48 hours before your flight, then it’s likely totally okay for your child to fly. Much of the fluid and pressure caused by the infection behind the eardrum typically improves most in the first 24-72 hours of treatment.

While no pediatrician can truly predict the likelihood an eardrum rupturing when flying, ask your doc about this when she diagnoses the infection. If the ear really looks terrible, she might recommend that you reschedule the flight.

COMMON COLDS

If you’re traveling between October and March and your child is under 10 years old, chances are good he’ll have a stuffy nose, maybe even a cough. That’s life with kids!

But more often than not, this shouldn’t keep you from enjoying your travels.

1. Will flying make your child feel worse?

It’s likely that your child won’t feel any worse than she would when flying any other time. Nasal congestion can potentially cause an increase in pressure behind the eardrum, making ascent and descent a bit uncomfortable, but it shouldn’t be nearly as bad as with an ear infection.

2. Will you or your child be miserable?

Not likely.

3. Will your child get others sick?

Not likely. The story is different if your child has something highly contagious like the flu or whooping cough. A common cold, however, is no more contagious on a plane than on other forms of transportation.

What to do?

Use nasal saline spray leading up to the flight to try and rinse out the nose and reduce the chances of pressure problems with the ears. As mentioned above with ear infections, you should consider calling your pediatrician to get her thoughts on a decongestant nasal spray before your flight.

See this article for more information about coughs, and this one for more about fevers.

VOMITING & DIARRHEA

Oh man, not fun!

1.  Will flying make your child feel worse?

It shouldn’t.

2.  Will you or your child be miserable?

There’s a good chance you’ll regret having flown.

If your child is vomiting, I would absolutely recommend rescheduling if possible. The plane’s cramped quarters and usually rapid onset of the urge to throw up mean you’re unlikely to be able to steer your kid to the bathroom when he has to vomit. And if you don’t make it, then you and your child won’t be the only ones who are miserable on the flight.

If your child isn’t vomiting but has diarrhea, then the decision really relies on how “containable” it is. If a baby or toddler’s diapers are manageable, or if an older child is able to possibly wait in line for the bathroom, then you can probably make it work. But if neither diapers nor your child’s ability to hold it are reliable, then you could be in for a messy flight.

3.  Will your child get others sick?

Probably not. Stomach viruses are transmitted through contact with gastrointestinal contents and oral secretions—i.e., touching saliva, or not washing your hands well enough after cleaning up your child’s vomit or stools. The worst-case scenario is that your child doesn’t make it to the bathroom and a flight attendant has to clean up. Assuming the attendant wears gloves, the odds of transmission aren’t very high. Others on the plane should be okay.

What to do?

If your child is actively vomiting, there is an anti-nausea medication called ondansetron that might help. It’s not a guarantee, and it’s prescription-only in the U.S. Call your pediatrician to see if this medication might be useful for your child.

If diarrhea is the problem, there is unfortunately not much you can do. We don’t usually recommend over-the-counter anti-diarrheal medications for kids. It’s better to get it all out than to hold it in, as the latter can potentially make some infections worse.

Listen to this short podcast for more information on vomiting and diarrhea.

STREP THROAT

Out of all the infections I see in my office, the strep throat diagnosis is probably the one parents are the happiest to receive.

Why? Plenty of parents are happy to:

1) Know what’s wrong;

2) Obtain medicine that can fix it.

Luckily, when it comes to air travel, strep throat shouldn’t pose much of a problem.

1.  Will flying make your child feel worse?

It shouldn’t.

2. Will you or your child be miserable?

Not likely.

3. Will your child get others sick?

Not likely. Plus, if your child has been on antibiotics for over 24 hours, he no longer considered contagious. If it’s been less than 24 hours since starting the medicine, just do your best to not to let your child wander down the aisle.

What to do?

Start the antibiotic when prescribed and enjoy your flight.

For more on strep throat, check here.

PINKEYE (also known as CONJUNCTIVITIS)

As pinkeye is a pretty common childhood infection, it’s quite possible that you’ll fly with a little one with this condition at some point if you’re a frequent traveler.

Luckily, though, there’s no real reason that pinkeye should alter your flight plans.

1. Will flying make your child feel worse?

No.

2. Will you or your child be miserable?

Nope.

3. Will your child get others sick?

It’s possible, but unlikely. Pinkeye is spread most via direct contact with the pus or mucus discharge from the eye(s).  If you can either keep your child’s hands fairly clean, keep her from touching her face much, or keep her seated during the flight, the chances of spreading it to a fellow passenger are pretty slim.

What to do?

If your doc has deemed that the pinkeye is bacterial,  use the prescribed drops or ointment. If it’s viral or allergic, applying a compress to the eye (warm for viral; cool for allergic) can help if your child lets you do so—but it’s not necessary to do this during the flight.

Conclusion: Should your child contracts pinkeye, there’s no need to alter your travel plans.

For tips on how to tell the difference between bacterial, viral, and allergic pinkeye, take a listen to this short podcast episode. http://www.drstevesilvestro.com/pinkeye-in-children.

SUMMARY

Being a parent inevitably means dealing with little ones who get sick. And because we expect the average child to get sick between 8 and 12 times a year in elementary school, it can feel like you’re dealing with sick little ones all the time.

The frequency of illness in kids also means that there’s always a chance that one of your kids will be sick when you travel.

Luckily, most childhood illnesses shouldn’t keep you and your family from enjoying your adventures together. Use this article as a guide to help decide whether you should change your plans and how to handle flying with a sick kiddo. And, as always, give your pediatrician a call if you have any doubts or concerns about what to do.

Happy trails!

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