Tuesday, November 22, 2011

Flying the Fussy Skies

 Carseat, check. Breastpump, check. Diaper bag, check. 
Big brother, check.  Baby...baby??

Three and a half million U.S. travelers are expected to fly over the Thanksgiving holiday this year; and about 1% of passengers are children under the age of 2.  That's a whole lotta caterwauling at 25,000 feet.  Few things can be as stressful as flying with young children.  Here are the answers to some common questions about traveling with kids:

Should I pay for an extra ticket, so my child can sit in her carseat?  The FAA has long considered a proposal to require carseats for children under two.  Thankfully, they haven't mandated this rule, and here's why:  a carseat is highly unlikely to save the life of your kid.  That's because plane crashes are extremely rare, and of those, 30% aren't survivable.  Even extreme turbulence resulting in serious injury is uncommon.  One analysis found that requiring a carseat for every child under two would save 0.4 lives a year in the U.S.  I'm not sure, but I think you need at least 50% of your body to survive!  They estimated that the additional cost of saving one life would be $6.4 million per each dollar cost per round trip.  With the average price of a domestic ticket being $360, that's $2.3 billion dollars to save one life.  Now, my kid may be worth that much, but yours isn't -- and I'm sure you'd say the same to me.  Not only that, but some families will be deterred by the cost of the extra ticket and end up driving several hundred miles, which is significantly more dangerous than flying.  The study concluded that because of this expected shift in air to land travel, requiring carseats on planes will end up killing more children than it saves.  That said, bring the carseat along, just in case you win the lottery and find yourself next to an empty seat.

How can I prevent ear pain?  Ear pain is greatest on ascent and descent, as cabin pressure drops and then increases.  The pressure lags behind in the middle ear, leading to an changes in the volume of air in the ear, causing discomfort.  If the Eustachian tubes leading to your middle ear are open, pressure equalizes quickly, relieving pain.  Children have smaller Eustachian tubes that often clamp down with viral infections and allergies, so they're more susceptible to pain.

Swallowing helps open the Eustachian tubes, so you can try nursing or bottle feeding your baby, or having your older kids chew gum.  The decongestant pseudoephedrine has been shown in randomized, controlled trials to reduce ear pain in adult air travelers.  Unfortunately, a small study performed in children under the age of 6 found no reduction in ear pain with ascent or descent.  

If your kid has a history of ear pain with flying, you could consider giving an over-the-counter analgesic 30 minutes prior to descent, when the pain is worst.  There aren't any studies looking specifically at prevention or treatment of barotrauma ("baro" = pressure), but if I had to choose a medicine, I'd go with ibuprofen, which was shown in a randomized trial to be more effective than Tylenol in treating the pain of ear infection.

I saw a blurb in a parenting magazine about "EarPlanes," ear plugs designed for kids to wear on flights.  The problem is, there's no evidence that they work.  In one study, each volunteer was given pressure-equalizing earplugs in one ear, and a placebo earplug in the other.  The pressure-equalizing earplugs were useless: 75% experienced ear pain on descent.  So save the earplugs for yourself, so you won't have to hear the little tyke yowling.

Should I slip my kid a mickey?  Some of you will no doubt have trouble with the idea of sedating a child for your own comfort.  I don't have a moral objection, but I do have an evidence-based one:  It doesn't work, at least with any over-the-counter medications.  Diphenhydramine, which is Benadryl, is the most studied OTC sedative.  Although there are no studies of pediatric in-flight sedation, we can extrapolate from the TIRED* study.   The exhausted parents of 44 infants with frequent night-time awakenings drugged their progeny with either diphenhydramine or placebo.  Almost no child (and by extension, no parent) was reported to have improved sleep by the end of the trial.  In addition, Benadryl can cause paradoxical excitation in children -- the last thing you need when they're already giving the passenger in front of them a back massage with their feet.

Bottom line:  There's not much you can do to make the flight more comfortable for you, your baby or your fellow passengers, other than the time-tested methods of feeding, holding, and walking him up and down the aisles.

Here's hoping we aren't on the same flight.

*Trial of Infant Response to Diphenhydramine.  They kind of had to work for that one.

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