Barb Himes, IBCLC

We are approaching the time of year when parents of infants may be considering holiday travel, even during the COVID-19 pandemic. We know some families may be assessing and discussing whether they will travel to be with family, and what extra risks they should be aware of, and precautions they should take.

Traveling with infants has always required a degree of planning, but now, that degree is even higher, and clinicians and other health care providers may be in a position to help families decide on a course of action. Weighing how essential the trip may be and if it can be postponed until safer times (or if the infant has underlying health conditions that make any travel inadvisable) is a necessary first step. It is ultimately the family’s decision, but looking at the additional planning and precautions required may be helpful to them.

Initial issues to examine include the levels of COVID-19 spread where the family lives and the levels at their destination. If quarantine restrictions are in place where they are going or imposed when they return, it may make the effort too burdensome. The family should also review the health risk for itself and those who are being visited, including individual age brackets and any underlying conditions that could increase the potential for morbidity or death from the virus.

More Planning and Preparation

Government health agencies and maternal and infant healthrelated outlets have been providing information based on what is currently known in this changing environment. The American Academy of Pediatrics offers guidelines for car and air travel (1) in general, which are still relevant during the pandemic.

These guidelines range from allowing extra time for airport security clearance to using an FAA-approved car safety seat if possible instead of lap-seating, as well as steps to counter ear pain. Families should now add to this the need to clean car seats and their surroundings, mask, and social distance as much as possible. Airlines have instituted various pre-flight precautions, including ongoing touchpoints cleaning, temperature checks, and increased in-flight HEPA filtration, and families should check with individual carriers to learn what regimen they have put in place.

If families do not plan to use a car safety seat, some airlines also offer bassinets that fasten to the wall in front of bulkhead seats. They cannot be used during landing and take-off or during turbulence, but if they are available may nonetheless provide a change-up from lap-seating. Parents may also choose to “wear their babies” during the flight but should be careful to position the infant’s head, so breathing is not obstructed.

Travel by car traditionally begins with planning ahead on what to bring, such as a car seat and a play yard, and planning the route and anticipated stops. It now must include cleaning the vehicle interior, disinfecting where possible and washing where not (e.g., avoiding corrosive disinfectants on car or booster seats and seat belts), and carrying disinfectants that can be used on surroundings in rest stops, motels, hotels, and Airbnbs.

In addition, if families cannot bring a crib of their own they should try to ensure that the hotel or motel they are driving or flying to will have one and be prepared if it does not or fails to provide one upon their arrival. Even when traveling, it is important to provide a safe sleep environment for infants as a precaution against Sudden Unexplained Infant Death (SUID), which includes Sudden Infant Death Syndrome (SIDS) and Accidental Suffocation and Strangulation in Bed (ASSB) and is the leading cause of U.S. infant death from one month through the first year of life.

The surface must be firm and flat, with no extraneous bedding materials. Possible substitutes include a dresser drawer, a laundry basket, or even a cardboard box. Still, they do not include bedsharing with parents or overnight sleep in a car seat, both of which increase the risk of impaired breathing (if baby’s head tilts forward in the seat) or suffocation. The baby’s clothing should be layered to avoid using blankets.

Breastfeeding and Travel

Breastfeeding carries with it a number of maternal and infant benefits ranging from natural inoculation to bonding and has been associated with a reduction in SIDS deaths. (2) During air travel, nursing can also help alleviate cabin pressure-induced ear pain in babies. If families plan to travel with expressed milk, in the U.S., it is exempt from the Transportation Security Administration limits on liquids. As of October 2020, under the Friendly Airports for Mothers (FAM) Act, the Federal Aviation Administration requires large- and medium-sized airports to provide separate (restrooms do not count), sterile private facilities where mothers can express milk. Families should also consider the equipment and cooler needs for traveling with expressed milk and what they plan to do with it when they reach their destination.

Another consideration is the infant’s sleep habits and maintaining a sleep plan during travel. Among the rituals incorporated into a sleep plan, which may include baths and cuddling and lullabies, is timing and creating a habit for the infant, and this will naturally be disrupted during travel. Families should discuss with their health care providers what their current sleep plans are, how to make adjustments for travel, and how to resume the routine when they return.

We know these are trying times, and there may be occasions when the need to be with family overrides the risks involved in getting there and back. If parents are encouraged to seek advice from their health care providers, map out detailed planning in advance and allow for the extra time, equipment and effort that will be required and consider testing to monitor their status, there may be hope for a successful outcome.

References:

1. https://www.healthychildren.org/English/safety-prevention/ on-the-go/Pages/Travel-Safety-Tips.aspx
2. Two Months of Breastfeeding Cuts SIDS Risk in Half: University of Virginia Health System Physician Resource. https://www.uvaphysicianresource.com/sids/