Travel Health for Children: Vaccinations, Sun, Insects and Tummy Bugs

Travel with children adds three things to a normal holiday list: vaccines you may need to start six weeks ahead, malaria tablets if you are heading anywhere endemic, and a small kit for the most predictable problems (sunburn, tummy bug, mosquito bites). Most of the rest is the same advice you would give yourself, with smaller doses and earlier thresholds for getting medical help.

The biggest avoidable mistakes happen because travel health gets postponed: the rabies course that needed three weeks, the typhoid jab that was missed, the malaria tablets that were started the day of travel instead of two days before. Sort it early; everything is easier from there.

Healthbooq (healthbooq.com/apps/healthbooq-kids) covers travel health and illness in children. For a wider overview, see our complete guide to child health.

Booking the Travel Health Visit

For trips outside western Europe, North America, Australia and New Zealand, book a travel health appointment 6 to 8 weeks before you fly. Some GP surgeries still do this on the NHS; many now refer to a private travel clinic for non-NHS travel jabs. Either way, going in late means rushed schedules, sometimes incomplete protection.

Two free, reliable resources to use first:

• fitfortravel.nhs.uk — NHS country-by-country guidance, updated frequently.
• travelhealthpro.org.uk — clinician-facing equivalent, useful if you want more detail.

Bring a list of every routine vaccine your child has had (the red book or NHS app) so the clinician can check what is up to date. Yellow fever vaccinations have to be given at a designated yellow fever centre, and the certificate becomes part of your travel paperwork — leave time for the appointment to be findable.

The Vaccines That Are Often Worth It

The routine UK schedule covers a lot, but several common travel vaccines are not on it. Common ones for children:

• Hepatitis A — most of Asia, Africa, Latin America and parts of eastern Europe. Two doses, the second 6–12 months after the first. A combined hepatitis A + typhoid vaccine is available from age 2 and saves a jab.
• Typhoid — South Asia, sub-Saharan Africa, parts of Latin America. Injectable form lasts 3 years; an oral live form is available for children 6 and over.
• Yellow fever — required for entry into a number of African and South American countries. Live vaccine, so not given under 9 months, in pregnancy, or to the immunocompromised. Single dose now considered lifelong by WHO.
• Rabies pre-exposure — for longer stays in endemic areas, especially with children, who are more likely to approach animals and less likely to report a small bite. Three doses over 21–28 days. Does not remove the need for treatment after a bite, but simplifies it dramatically.
• Meningococcal ACWY — sub-Saharan Africa during the dry season ("meningitis belt"), and required for Hajj and Umrah pilgrims to Saudi Arabia.
• Japanese encephalitis — for prolonged rural travel in parts of Asia, especially around rice paddies and pig farming. Two doses over 28 days.
• Cholera — selected destinations and circumstances; not routine for most family travel.

Equally important: routine UK vaccines should be up to date before travel. MMR in particular — measles is endemic in many countries with low coverage, and unvaccinated UK children continue to catch and import it. If your baby is travelling to a high-risk area before their routine first MMR (12–13 months), an early dose from 6 months is sometimes recommended; the routine doses still need to be given afterward.

Malaria: Tablets and Bite Avoidance Together

Malaria kills children faster and more often than adults. Severe falciparum malaria in a child can progress from "feverish" to critically unwell in 24 to 48 hours. Prevention is non-negotiable for endemic destinations, and it has two equal halves — neither alone is enough.

Antimalarial tablets suitable for children:

• Atovaquone/proguanil (Malarone) — well tolerated, daily, paediatric formulation from 5 kg. Start 1–2 days before, continue throughout, finish 7 days after leaving. Currently the most commonly recommended option in children.
• Mefloquine — weekly, useful for long trips. Can cause vivid dreams, mood changes, anxiety, and rarely psychosis. Avoid in children with epilepsy or psychiatric history. Less commonly used in paediatric travel now.
• Doxycycline — daily, age 12 and over only. Causes photosensitivity, so good sun protection is non-optional.
• Chloroquine and proguanil — older regime, mostly obsolete because of widespread resistance, still used in a small number of low-risk areas.

Bite avoidance — equally important:

• DEET 50% repellent on exposed skin from 2 months of age (younger infants need physical barriers — long sleeves, mosquito nets — instead).
• Picaridin (icaridin) is a good DEET alternative with similar efficacy and gentler on skin; increasingly preferred for children.
• Long sleeves and trousers, especially dusk to dawn when Anopheles mosquitoes feed.
• Insecticide-treated bed nets — bring your own if uncertain about local availability.
• Air-conditioned accommodation reduces (but does not eliminate) indoor exposure.

The most important rule for after the trip: any fever in a child up to a year after returning from a malarial area is an emergency, and you must mention the travel history at the front door of A&E. Anti-malarials reduce risk but do not eliminate it. A negative malaria test does not exclude malaria — if there is clinical suspicion, it should be repeated.

Travellers' Diarrhoea

Hits 20 to 40 percent of travellers to developing countries; a higher proportion of children, who tend to put more in their mouths. The risk in children is dehydration, which arrives faster than in adults.

The one thing to pack: sachets of oral rehydration salts (ORS — Dioralyte, Electrolade, generic). Plain water alone replaces fluid but not salt and sugar; in a small child losing fluid quickly that becomes its own problem (low sodium, more vomiting). Mix sachets with safe (bottled, boiled, or treated) water. Encourage frequent small sips rather than large drinks that come straight back up.

Practical food and water rules:

• "Boil it, cook it, peel it, or forget it."
• Bottled or treated water for drinking, brushing teeth, and ice cubes.
• Hot food served piping hot; raw salads, unwashed fruit, and street food in high-risk areas are common culprits.
• Pasteurised dairy where possible; skip unpasteurised milk and cheese.
• Frequent hand-washing or hand sanitiser before eating, especially for children.

When to see a doctor abroad:

• Blood in the stool.
• High fever with diarrhoea.
• Persistent vomiting unable to keep fluids down.
• Reduced wet nappies, sunken eyes, very listless child — signs of dehydration.
• Diarrhoea lasting more than 48 hours in a small child.

Routine antibiotics for travellers' diarrhoea are not recommended in children — most cases settle with rehydration alone, and antibiotics are reserved for specific situations (severe, bloody, or prolonged) on medical advice.

Sun, Heat, and the Bits Most Holidays Forget

Children burn faster than adults and tan less. The risks worth taking seriously are sunburn, heat exhaustion, and heatstroke — particularly in the first few days when the body has not adjusted.

• SPF 30 minimum, SPF 50 better. Broad-spectrum (UVA and UVB), water-resistant.
• Reapply every 2 hours and after swimming or heavy sweating, regardless of "all-day" claims on the bottle.
• Hat, UV-rated swimwear/rash vest, sunglasses with UV protection.
• Avoid direct sun between roughly 11 and 3 in tropical and Mediterranean destinations.
• Sunscreen is not recommended on babies under 6 months — keep them in shade, dressed in lightweight long sleeves and a hat. They cannot regulate their temperature well in heat.
• Hydration: water at every break in the activity, more frequently than you think. Lost appetite, headache, and unusual irritability in the heat are early signs that need shade and fluid.

Heat exhaustion — heavy sweating, pale, clammy, weak, headache, nausea: cool down in shade, sips of water with electrolytes, cool flannels, rest. Should improve over 30 minutes.

Heatstroke — hot dry skin (sweating may have stopped), confusion, very high temperature, vomiting, sometimes collapse — is a medical emergency. Cool aggressively (wet sheets, fan, ice packs to neck/groin/armpits), call for help.

Insects and Bites Beyond Malaria

Even outside malarial areas, mosquitoes can transmit dengue, Zika, chikungunya, and other infections. Bite prevention applies wherever mosquitoes bite. Add to it:

• Tick checks at the end of each day in wooded or grassy areas — Lyme disease occurs across Europe and parts of Asia, not only North America. Remove ticks promptly with fine tweezers, grip near the skin, pull steadily, do not twist.
• Avoid stray animals — even friendly ones. Any bite, scratch, or lick from a mammal in a rabies-endemic area requires medical attention urgently. Wash the wound with soap and water for 15 minutes and seek post-exposure prophylaxis.
• Cover food and drinks at outdoor meals to avoid wasps and bees; carry an antihistamine if your child has any history of larger local reactions.

Coming Home

Children sometimes get unwell in the days or weeks after travel, not during. Bring back to mind, and to the GP if relevant:

• Any fever after travel to a malarial area, up to a year later — A&E with the travel history.
• Persistent diarrhoea over a couple of weeks — possible giardia or other parasites; needs stool tests.
• Unexplained skin lesions or rashes — including a non-healing sore or expanding red ring (consider Lyme).
• Jaundice, dark urine, pale stools — possibly viral hepatitis.
• Persistent cough or weight loss after travel to TB-prevalent areas.

Most family travel goes off without anything more dramatic than a sunburn and a few mosquito bites. The point of all this is to keep the dramatic things in the small minority — and to make sure that when something does happen, you and the doctor at the other end have the information you need to deal with it quickly.

Book the travel health consultation 6 to 8 weeks before departure — some vaccines need a course over several weeks, and rabies pre-exposure needs three doses over 21 to 28 days. Check fitfortravel.nhs.uk for destination-specific advice. Malaria prevention has two equal halves: tablets and bite avoidance. No antimalarial is 100 percent effective, and a febrile child up to a year after travel to a malarial area is an emergency until proven otherwise. Travellers' diarrhoea is mostly about hydration — oral rehydration salts in the suitcase, not just bottled water. Sun and heat: SPF 50, hat, shade between 11 and 3, no sunscreen on under-6-months.