GERM
00:00:10.080 – 00:00:11.120
My name is Germ.

WORM
00:00:11.200 – 00:00:12.040
I’m Worm.

GERM
00:00:12.040 – 00:00:28.080
Welcome to episode 117 of the Germ and Worm Travel health podcast, Travel with Kids, a conversation with pediatrician Dr. Rachel Barr. It’s a big planet. See it in good health. I’m Dr. Paul Pottinger, also called Germ.

I’m a professor of infectious diseases at the University of Washington in Seattle.

WORM
00:00:28.400 – 00:00:34.000
I’m Dr. Chris Sanford, also known as Worm, family medicine doctor, also at the University of Washington.

GERM
00:00:34.320 – 00:01:37.880
What an exciting episode for us today to reconnect with an old student who is now a great colleague, Dr. Rachael Barr, a specialist in immunology and pediatrics based in Bristol in the United Kingdom. In a moment, Chris will introduce her a bit more and have a conversation about her perspective on safe and healthy travel with kids around the world.

We know that many of our listeners have kids enjoy traveling with children. There’s clear concerns about how to keep kids safe, healthy and have a fun time when they’re traveling to far flung places across the planet.

Dr. Barr is an expert in this area. Friendly reminder that these questions come to us from you, our listeners. Please contact us with your own questions.

Germandworm@gmail.com and please check us out online germandworm.com and follow us on the socials. As always, our medical disclaimer. This podcast is designed to inform, entertain and inspire, but it does not establish a doctor patient relationship.

And so of course, it should not replace your conversation with a qualified healthcare professional. Please see one before your next adventure. With that, let me hand things over to Chris.

WORM
00:01:38.520 – 00:02:23.800
I’m here today with Dr. Rachel Barr. Thank you, Dr. Barr, very much for joining us today. Dr. Barr is a pediatric physician in Bristol in the United Kingdom.

She has an interest in pediatric immunology and infectious diseases and she’s currently actually working on her PhD in immune responses in group A, strep. She has two little boys, so she is a very busy person.

She also has a robust Instagram presence and I enjoy her show, which is known as the Kids Doctor. And actually Rachel and I go back a decade. Rachel took the course in East Africa taught by, among others, Dr. Paul Pottinger and myself.

So, Dr. Barr, thank you so much for joining us today.

Dr. BARR
00:02:24.440 – 00:02:27.960
Thank you so much for having me, Chris. It’s so nice to see you again after such a long time.

WORM
00:02:28.420 – 00:02:32.580
Yeah, it’s fun to see how your career has, has evolved over the last decade.

Dr. BARR
00:02:32.740 – 00:02:41.940
Yeah. I was very, very young when we first met and I think I had only been qualified as a doctor for maybe two years or so. So I was very new to the world of medicine.

WORM
00:02:42.500 – 00:02:51.940
Right. Right. Now, tell me a little bit, how did you come to start an Instagram account and how has that grown over recent years?

Dr. BARR
00:02:53.140 – 00:04:11.060
Yeah, so I. I started my pediatric training in the UK back in 2018, and then in 2022, I had my first son.

And after he was born, he had some kind of, I guess, relatively minor health issues in the grand scheme of things, but he went to neonatal intensive care for a little while with sepsis, essentially.

And so I experienced my job from the other side, from being a patient, and I think it just made me realize how challenging that is to be on the other side of it and how disempowering it can sometimes feel if you don’t have the information to back up your experiences and you don’t have the knowledge to maybe advocate for the best things. And I felt very privileged to have that knowledge, but realized that most people don’t.

And so I decided to start the Instagram page to try and just offer some general basic health information for parents around their children. And it’s grown kind of gradually, I guess, over the last four years, and I think now around 35,000 followers across across platforms, which is.

Which is great. It’s really nice.

WORM
00:04:11.860 – 00:04:22.460
Nice.

I think people appreciate pragmatic advice from someone who doesn’t just do the book reading, but has actually lived the busy life of being a parent of young children.

Dr. BARR
00:04:23.660 – 00:04:29.340
Yeah, absolutely. I think that that plays a key role. I’m here in the trenches with you. I haven’t slept either.

WORM
00:04:30.860 – 00:04:48.370
Well, first, let’s get into travel.

Now, first, before we start talking about preparing children for travel and potential health risks, in your opinion, both as a doc and as a parent, what are some of the advantages of international travel for children?

Dr. BARR
00:04:48.930 – 00:05:27.220
Yeah, so I see.

I see comments made about this all the time and how, you know, it’s not worth traveling with children when they’re really young and you should wait until they’re older and they can really, fully take in those experiences. And I just. I kind of really fundamentally disagree because I think those.

Those experiences and seeing other cultures, other nationalities, different foods, different languages, even if children can’t explicitly recall those memories, they. They still become a part of who that child is as they grow.

And I think those experiences are just so important if, you know, if you’re in a position to offer them, then I think it’s just wonderful.

WORM
00:05:27.620 – 00:05:32.180
So you think it actually may influence their personality and worldview?

Dr. BARR
00:05:33.140 – 00:05:59.160
Yeah, I think so. I think, you know, I was lucky enough to travel a lot with my parents when I. From quite young.

And I think it helps with your worldview, it helps with your knowledge of other cultures and that not everything is the same as how you see it on your doorstep, but I think also maybe helps with your confidence. You know, I feel very confident to travel with my children, and I’m sure that’s at least in part related to my parents traveling with me.

WORM
00:06:00.120 – 00:06:03.160
And when you were a child, where did your parents take you to?

Dr. BARR
00:06:04.690 – 00:06:37.940
We went to all sorts. My parents were vets. Veterinarians. So they. We went to lots of conferences and things. So let me think. We.

My dad took a lectureship in the States for a while, so we were living in America for a little bit. They were doing some work at a racehorse place in Chile, and we were in Chile for a little while.

Conferences in South Africa, in Sweden, Singapore, Hong Kong, Australia. Okay. So, yeah, lots of. Lots of different places.

WORM
00:06:38.260 – 00:06:45.380
And I met you in East Africa. So I wonder if your childhood experiences traveling opened you up to traveling as an adult.

Dr. BARR
00:06:46.100 – 00:07:04.300
I’m sure they did. I’m sure they did.

And I think, you know, it goes back and back because my mom was born in Zambia, because her parents traveled to Zambia in the 1950s, because her dad was. Was working there as a magistrate. And so, you know, it just comes down, down and down through the generations, I think.

WORM
00:07:04.620 – 00:07:07.020
Almost like a gene traveling through generations.

Dr. BARR
00:07:07.100 – 00:07:08.460
Totally. Yeah.

WORM
00:07:09.020 – 00:07:20.220
Now, where are some places children should not go to? If you were advising people taking their children potentially all over the world, what are the places that you would say? Maybe not?

Dr. BARR
00:07:21.420 – 00:08:47.270
Yeah. So I think my first protocol is always. So in the.

I don’t know, you probably have a similar thing in the States, but in the UK we have the Foreign Commonwealth and Development Office, which is essentially our government that advises on whether areas are safe to travel to or not, and they will explicitly advise against travel to certain countries. And I would always say if the explicit government advice is not to go somewhere, then don’t go there. Because it’s not just about, you know, the.

The risk to your personal safety and your child’s safety. It’s also about the government’s ability to get to you if you were to need it, you know, and to get you back home again.

And I think essentially what the government is saying with that is we’re not confident that we can keep you safe. So I would always advise listening to that. That level of advice.

Beyond that, I think it’s just taking more of a kind of a thoughtful approach to thinking through the risks. So, you know, anywhere where there’s, you know, active war, active fighting. Okay, I think twice about that.

And then you just need to be having a think, particularly around the age of your children, whether you’re going to have access to safe water, access to safe food, good sanitation, are you going to have access to health care if you need it. None of that means that you can’t do adventurous things with children, but you just need to have a little think.

And I think it does vary a bit depending on the age of your kids.

WORM
00:08:47.590 – 00:08:49.990
So it sounds like most of the world is fair game.

Dr. BARR
00:08:51.040 – 00:08:52.560
I think so. I think so.

WORM
00:08:52.880 – 00:09:07.600
Okay, good, good. And before you take. And let’s focus not on Western Europe and high income nations, but looking at low income nations as a general rule.

What are some things you think about for preparations for children going to these areas?

Dr. BARR
00:09:08.080 – 00:10:14.590
Yeah, so I think the NHS website might have recently changed, but there used to be a really great NHS website called Fit for Travel. There’s lots of other websites like Travel, Health Pro and things that will talk you through on a country by country basis.

The sort of things that you to think about and that’s why you always go to, to start off with and you know, it’s thinking through things like vaccines which you do need to think about a little bit in advance if possible because some of them you might need several doses or they might need a bit of time to work. So vaccines and then things like protection against mosquito borne diseases.

So it’s, you may need to think about malaria prophylaxis, but also all the other mosquito borne diseases that people seem to forget about a little bit.

So thinking about, do you have appropriate insect repellent, do you need to think about nets, do you need to think about clothing, all of those sorts of things.

And then I guess further down the list is thinking about things like sun protection and access to water or any special particular things like if you had a very small baby, do I have a way to make up their formula if I need it or anything specific to your children.

WORM
00:10:15.390 – 00:10:55.300
Okay, good. You mentioned vaccines. As you may have heard, we have a vaccine expert as president.

Now we have another vaccine expert as Secretary of Health and Human Services named RFK Jr.

They’re recommending, in fact an executive order came out earlier this month from the President that the measles, mumps, rubella shot MMR not be administered as a single shot but be spread into three shots for reasons of safety and not overwhelming the immune system can use. As someone who knows about children vaccines scenes in immunology, can you remark on the on the wisdom of that executive order.

Dr. BARR
00:10:56.260 – 00:12:06.600
Yeah.

First of all, I’m just so sorry that you guys are having to deal with this on a day to day basis and you know, just what a nightmare the rest of the world are kind of looking on in. I don’t know, horror. I’m not really sure what to what word to use to describe it, but. But yes.

So the idea of splitting MMR is, is not founded or based in science or fact in any way. There were concerns raised a very, very long time ago about possible links between the MMR vaccine and autism.

They have since been heavily and repeatedly proven to be not true. There is no link between MMR and autism. There is absolutely no concern with giving it is as a combined vaccine, separating it.

All that really does is potentially increase the length of time that a child is vulnerable to one or more of those conditions. And there are significant risks with leaving your child vulnerable to any of those infections. So, you know, I would urge people not to listen.

WORM
00:12:07.720 – 00:12:15.820
What I’m hearing is not only is there no reason to go to a split mmr, but there are significant downsides to going to a split MMR vaccine.

Dr. BARR
00:12:16.620 – 00:12:45.580
Yeah, absolutely. And any concerns about overwhelming the immune system? Again, it’s not based in fact.

Your child’s immune system comes across probably thousands, at least hundreds of pathogens every single day.

Every time they put their hands in their mouth, every time they pick something up off the floor, their immune system is coming up against thousands and thousands of different pathogens, different bugs. So three in a vaccine is nothing to your child’s immune system.

WORM
00:12:45.900 – 00:13:23.510
And just to remind. Thank you for saying that. Just to remind listeners, Dr. Rachael Barr is not just some average educated person.

This is a physician with international medicine training who’s working on her PhD in immunology. So thank you. Thank you for that. Let’s talk a little bit now about bugs. You mentioned insect repellent.

Some of them smell petrochemically and some people think about carcinogens and whatnot, given dengue fever and malaria and other things transmitted by mosquitoes. For your pediatric patients, what are your favorite go to. Insect repellents.

Dr. BARR
00:13:24.790 – 00:13:42.870
Yeah. So the UK NHS advice at the minute is that things containing DEET are the best option.

I don’t know if that’s the same in the us, but it’s certainly the advice here and that they can be used on children from two months upwards. And I actually think in the States maybe there isn’t even an age limit on it. You may correct me on that.

WORM
00:13:43.110 – 00:13:50.630
You know, I think that, you know, I don’t recall what the CDC is currently. I know they also say picaridin is an option.

Dr. BARR
00:13:51.350 – 00:14:45.150
Yeah. So the NHS say DEET is the best option. But if you’re unkeen on DEET then they give a list of of four potential active ingredients.

One of them is picaridin, one of them is eucalyptus and I can’t remember the fourth one now, but there is a list of four and they basically say if it doesn’t contain one of these four active ingredients it’s probably not going to be effective. And that includes things like citronella. So the advice here is that they are probably not effective if that’s your only defense.

And so I personally use things that contain insect plants that contain deet. If we’re going somewhere with significant mosquito borne diseases, I understand they don’t smell very nice and there’s worries about them.

But there’s been extensive research on these things now and even around pregnancy and things like that and there haven’t been any concerns.

WORM
00:14:46.030 – 00:14:49.310
And for children, what percentage DEET do you recommend?

Dr. BARR
00:14:51.160 – 00:14:59.160
So again the advice here is that ideally at least 50%. So that’s what we go for.

WORM
00:14:59.560 – 00:15:18.890
Good. And now turning to the sun fair people can fry to a crisp fairly quickly in equatorial climes. What do you recommend concerning sunscreen?

And then related question, what about the order of bug repellent and sunscreen? Should they be combination? Which should you apply first?

Dr. BARR
00:15:20.010 – 00:17:01.030
Yeah, so my youngest is very, very fair and very blonde despite my dark hair. So I have thought about this quite a lot.

But in terms of some protection you do need to be really careful and you need to think about both UVA and UVB protection. So I think people often talk about SPF which is important. But you again I don’t know if it’s the same in the us so I apologize if it’s different.

But we have a star rating as well as an SPF and one of them is VBA and one of them is for uvb. So it’s important that you look at both. And I would always recommend SPF 50 for children and ideally a 5 star rating as well.

Then you know you’re getting the highest protection against UVA and UVB and it’s important that those are applied really regularly, like every few hours. I don’t particularly buy any of these things that say they’re long lasting and you can apply them every eight hours.

Particularly the kids are going swimming and things like that. I just, once they’ve been in water it needs to go back on and it’s also worth thinking about just covering them up.

So hats, long sleeves, long long trousers. And then, yeah, you mentioned the interaction between insect repellent and sunscreen.

So there is, I think, quite good evidence now that they do interact and affect how the other one works, from my understanding is the advice in the literature varies quite a lot in terms of which you put on first. But I had a quick look last night to double check what the UK guidance is at the minute.

And the UK guidance is sunscreen and then deet and just to make sure you’re reapplying both regularly because they can affect each other.

WORM
00:17:01.670 – 00:17:11.110
And my mnemonic to remember that might be putting on the bug repellent second. That way it’s on the outside in the insects can smell it and thus be repelled by it.

Dr. BARR
00:17:11.670 – 00:17:14.390
Yeah, I like that. Yeah, that’s a good way of remembering it.

WORM
00:17:14.550 – 00:17:34.490
And let’s talk about cars a little bit. Motor vehicle accident risk. This is a significant risk for people of all ages, including children. Often parents don’t think about that.

They might think about vaccines and malaria, but not just about motorcycles and cars. So what are your thoughts concerning children and road traffic injury risk abroad?

Dr. BARR
00:17:35.760 – 00:18:47.280
Yeah, I think you’re so right.

I think, and it’s interesting because a lot of us as parents are so careful with our children in motor vehicles when we’re at home and, you know, what seat they have and all of these different precautions that we take. And then when we go abroad, we sort of forget about all of that, even though the roads are often much higher risk.

So it’s just worth firstly having a look at what the rule the law is in the place you’re traveling to. Because certainly, you know, in the UK you can’t have children below a certain age and height and weight and things. Not in a car seat.

In a car that you’re driving. It’s slightly different for buses and things like that.

But if you’re hiring a car, there will be requirements about what kind of car seat you have to have. It’s worth also thinking that it may not be the same car seat requirements.

So I know that in the U.S. for example, you guys have chest clips on your car seats and we don’t have those in the uk. So you just may need to consider what the laws are in different places.

But if you know that your seats can be used there, it’s worth investigating just taking your seats with you. That can often be the best, safest thing.

WORM
00:18:48.640 – 00:18:50.400
Yeah, okay.

Dr. BARR
00:18:51.040 – 00:19:24.380
There is always concern as well that it’s going to go in the hold of the aircraft and is that, is it going to be damaged in the hold?

And I know some people will buy a slightly cheaper one that’s still safe but that they use for travel so that the one that they use at home doesn’t get damaged and then they’re stuck.

But yeah, you know, it’s worth considering taking them with you or if you can find a reputable company that has them already installed in there, in taxis and things, then fine. But you don’t really know what’s happened to those car seats, so it’s a bit of a tricky one.

WORM
00:19:25.120 – 00:19:34.640
And now, concerning bicycles, supposing I’m going to bicycle with children abroad, can I assume that I will find helmets of an appropriate size in the country? I’m going to.

Dr. BARR
00:19:35.680 – 00:19:56.440
Definitely not. I wouldn’t say so. Again, if you know that you’re going to be doing a significant amount of biking, then think about taking your own.

Especially if you’re going to be on the roads and that small children coming on the back of your bike or riding their own bikes just. It’s not worth, it’s not worth taking the risk.

WORM
00:19:56.760 – 00:20:15.560
So take, take with. Yeah, okay. Moving on to water safety. Can you give a general rule on tap water and the planet? Where can you drink tap water?

Where can you not drink tap water? And related question, where you can’t drink it. What should you do to provide safe water to children?

Dr. BARR
00:20:15.880 – 00:20:37.150
Yeah, general rule for the planet. I don’t know if I can provide a general rule for the planet.

I know that broadly a lot of Europe is fairly safe to drink tap water, but I usually just check, as I say on the Light Travel Pro website where I’m going, if the tap water is going to be safe or not. You may have a better rule of thumb income.

WORM
00:20:37.870 – 00:20:56.910
I don’t have a great, I don’t have great data, but it’s a gross marker income of the nation and if it’s high income like Western Europe or Australia or Japan, I feel pretty good about the tap water, but I’m shooting from the hip on that one and I would love to see data and coliforms and correlation to see if I’ve been wrong all these years.

Dr. BARR
00:20:57.630 – 00:21:55.750
Right, Yeah, I would love to see the same.

But yeah, and then in terms of safety, if you can’t drink the tap water, then I think it’s important to think about bottled water being probably the safest option and making sure that that’s sealed. You know, if the seal is broken, then you can’t be sure that someone hasn’t just filled it up from the tap and resold it to you.

The only thing to remember if you’re traveling with a small baby who’s having formula is that bottled water is not necessarily the best thing to make up baby formula with. It often contains a little bit too much salt, a little bit too much sulfate. It may be a balance of risks.

Making it up with tap water that you can’t boil is also not going to be good. So, yeah, balance of risks.

And there are some bottled waters that are better, as a rule of thumb, less than 200 milligrams per liter of salt, less than 250 milligrams per litre of sulfate, and it should be okay. So you can have a look on the back of bottled water and some is better than others, but that’s what I would look for.

WORM
00:21:56.070 – 00:22:01.270
And can you mention again that website that you just referenced, the Health Information Government site?

Dr. BARR
00:22:01.990 – 00:22:03.910
Yeah, I use Travel Health Pro quite a lot.

WORM
00:22:03.910 – 00:22:07.080
And that’s a UK government site?

Dr. BARR
00:22:07.880 – 00:22:16.800
The NHS one used, the UK government one used to be called Fit for Travel and I just have a feeling that it may have changed recently, but it used to be called NHS Fit for Travel.

WORM
00:22:16.800 – 00:22:17.280
Okay.

Dr. BARR
00:22:17.280 – 00:22:26.600
And then there’s one called Travel Health Pro as well, which is part of naslac. I think so, yeah. Also an official, official information source.

WORM
00:22:26.920 – 00:22:37.170
Okay, good. Now what about if you’re taking children to a very hot place, suppose you’re going to Cairo in the summertime.

What are some reasonable precautions to take?

Dr. BARR
00:22:38.130 – 00:24:01.140
Yeah, so young children in particular are really high risk of heat related illnesses. So heat exhaustion and things like that. So you do just need to be a little bit careful.

My basic advice would be to think about being inside or certainly out of direct sunlight, particularly during the peak hours of the day. So between like 11 and 3, that’s when you know heat is going to be at its peak.

And so spending a bit of time indoors where there’s some aircon in the shade, resting is really important. And then it’s just a fact of like recognizing potential signs and symptoms, you know.

So if you’re starting to notice that children are getting really red, really sweaty, those might be just early signs that they’re getting a little bit too hot and not managing things.

And then later signs that you’d be really worried about and would need to seek medical care would be if they get signs, get very drowsy, any of those kind of things.

So, yeah, keeping them out of the heat in the hottest part of the day, thinking about points in the day where you might factor in some cooling off time. So things like swimming pools can be really great just to have a little dip and cool things down anywhere you can find aircon.

So regular, regular little breaks, powering through.

WORM
00:24:01.140 – 00:24:12.340
The day might not be your best strategy.

But actually tailoring your activities around the weather a little more toward dawn and dusk and just in the middle of the day, be graceful, take a siesta.

Dr. BARR
00:24:14.340 – 00:24:14.900
Yeah.

WORM
00:24:15.300 – 00:24:24.030
Related topic, with big cities getting more air pollution as decades go on, are susceptible potentially to air pollution?

Dr. BARR
00:24:25.230 – 00:25:14.980
Yeah, they absolutely are. And I think the kids you need to be particularly, I mean any, any child is potentially susceptible to air pollution.

The kids you need to be particularly conscious of are children who, you know, have what we would call like reactive airway disease.

So kids who have asthma or if they’re a little bit too young to have a diagnosis of asthma, but they, they get wheezy whenever they get a cough or a cold, then those are the sorts of children who really might find a highly polluted environment quite difficult.

So I would, a child with any underlying medical condition, I would always be sure that you’re making, making sure you’ve got enough of their regular medication with you.

So make sure you’ve got their inhalers and their spacers, anything that you might need, but just keeping an extra close eye on those children in those sorts of environments and, and how they’re managing with their breathing.

WORM
00:25:15.300 – 00:25:45.320
Okay, good, good. Now let’s talk about something that comes up with almost any trip with children. Jets and mental health and prolonged trips.

And this is the mental health of the child, the parents and everyone else on the jet. I don’t know if you’ve traveled by jet with your, with your little boys, but do you have tips?

Often an 18 month old does not like to be strapped down for a jet ride. What are your, your tips for jet travel with children?

Dr. BARR
00:25:46.600 – 00:27:26.810
Yeah, so we’ve traveled a fair bit with both boys. I’m trying to think the last, the longest haul we did recently was to Sri Lanka.

So that was a tennis hour flight from the uk and my, it was just with my eldest, but he was, he was just under two at that point. So yeah, it was, it was an experience. But broadly I would say it’s really, it’s often not as bad as people think it’s going to be.

Children are broadly pretty resilient little creatures. But having said that, my tips would be that you need to, basically you need to think about the basics of what a child is going to need. Right.

So they need, they need to Sleep.

If you’re doing a 12 hour flight in the middle of the day and they usually nag and it’s very bright and noisy and people coming up and down, then you may find that they really struggle to sleep and then they’re going to really start to struggle with everything else. So just factor that into your thinking.

So if we’re doing long haul flights, we often go for an overnight flight just because all the lights get turned off, the blinds get put down and they’re more guaranteed to get a couple of hours at least, which often helps. Just get them through without struggling too hard. And then food and water so you know, they need to be well fed.

And kids will often not be massive fans of what is on offer on an airplane.

So if you know that they’re not going to eat what’s on the plane, then just make sure you’ve got plenty with you and it will help immeasurably if they’re not hungry.

WORM
00:27:27.050 – 00:27:27.450
Right.

Dr. BARR
00:27:27.610 – 00:28:09.820
And the same with, same with having drinks, you know, water, milk, whatever. Lots of airlines have allowances for taking on milk for small children particularly.

So have a look at what those are, make sure you’re well stocked with the kind of basics of what they need. And then my last tip would be if they’re a bit upset and they’re crying at various points, don’t worry too much about it.

Don’t get yourself too stressed because they have absolutely as much right to be on that plane as anybody else on that plane. And it’s up, it’s up to an adult to regulate their own emotions about the situation. You’re dealing with your child.

You know, if someone wants to be upset about it, that’s not, that’s not on you.

WORM
00:28:10.060 – 00:28:25.900
Good point. And I like your point too. I hadn’t really thought about that. For as an adult I think it’s better to fly during the day.

But as a parent, nothing is more important than your child sleeping at the right hour. And an overnight flight actually might be more conducive to a child sleeping.

Dr. BARR
00:28:27.050 – 00:28:42.970
Yeah. I just think for shorter flights we often try and do them in the day.

But the long flights, we’ve done long haul flights in the day and overnight and I would say overnight was immeasurably better Good than trying to keep a 2 year old still for a 12 hour flight. Yeah.

WORM
00:28:43.210 – 00:28:52.900
And that leads into. Any tips on jet lag for a child. Suppose you go to an area it’s 11 hours off where you were at home. What are tips for children?

Dr. BARR
00:28:54.100 – 00:29:53.800
Yeah. So it’s it’s hard. It is hard.

There will inevitably be not as much sleep as you might hope, but I think it’s important to try and relatively quickly tap into their natural melatonin. So if it’s daytime when you arrive, try and get outside, try and teach their body.

It look, it’s daytime, it’s bright, there’s sunshine and that sort of tries to start switching. Then when they’re releasing their natural melatonin, which is the hormone that tells you, tells your brain that you’re sleepy.

So in bright sunshine that our melatonin drops and as it starts to get dark, our melatonin starts going up.

So if it’s daylight outside, try and get outside and have that kind of awake time and then you just maybe need to accept a little bit of difficulty with routine in the first day or two. So maybe just don’t over plan in the first couple of days.

WORM
00:29:54.760 – 00:29:57.080
Don’t hit the ground at full speed the first day.

Dr. BARR
00:29:57.080 – 00:30:01.160
Yeah, yeah. Things just might be a bit skewer for a bit.

WORM
00:30:01.400 – 00:30:07.160
So it sounds like to some extent you need to be graceful with the circumstances and not control every minute.

Dr. BARR
00:30:07.880 – 00:30:09.640
I think so. I think so.

WORM
00:30:09.880 – 00:30:26.950
Okay.

Lastly, suppose you’re abroad away from all your usual medical care and your little one has a medical issue, maybe so severe that you want to involve a medical professional. What are some resources, what can a person do to find medical help outside of their native country?

Dr. BARR
00:30:27.190 – 00:31:35.000
Yeah. So depending on like where you are, I guess some, some countries may have very extensive information online.

So I know that if you’re not native to the UK and you come to the uk, if you looked it up, there would be really great information about, you know, NHS 111, which is the advice line that we have in the uk that anyone can call at any time and get advice and they will direct you to the most appropriate medical care. Like they can either get you to see an out of hours GP or direct you to go to hospital where the nearest hospital is and all of those things.

So, you know, if you’re in a developed country, it’s worth having a look online and seeing what information there is available.

If you’re not, then the other sorts of places that I would probably start, you may be able to contact your travel insurance company, they may have information on the best places to go.

If you’re staying in accommodation like hotels, then staff may well be able to help, you know, people with local knowledge on how to get hold of a doctor or where the best place to go is. I think those should be My two main starting points, I don’t know if you have any better tips than that.

WORM
00:31:35.240 – 00:31:47.720
No, those are good. And actually you mentioned insurance and I’m glad you brought that up.

It sounds like one advantage of insurance, other than paying for things and evacuating you, would be to connect you with medical professionals, should you need one.

Dr. BARR
00:31:48.520 – 00:32:22.670
Yeah, absolutely. And often, I mean, it depends what what kind of travel insurance you get.

But sometimes they will have a system whereby you can talk to someone to give you medical advice from your own country, you know, so you know that you’re getting advice. Yes, only over the phone.

So it’s not necessarily they can’t do anything in person, but it may be that that’s all you need is some advice over the phone and you know that you’re going to get someone who you can communicate with and all of those factors. And then they can often advise if you are needing, you know, face to face medical care, where best to go.

WORM
00:32:23.070 – 00:32:39.400
Got it. Thank you. Well, Rachel, thank you so much for talking with me today.

I’ve been talking with Dr. Rachel Barr, who is a pediatrician, mother of two young boys, and the host of the very successful Instagram show the Kids Channel. Rachel, appreciate you sharing your expertise.

Dr. BARR
00:32:39.480 – 00:32:40.680
Thank you so much, Chris.

GERM
00:32:48.520 – 00:33:14.210
Well, thank you so much for joining us here on episode 117 of Germ and Worm. As always, we hope to see you in in future episodes and we hope to hear from you.

If you have questions about how to stay safe and healthy when you travel, please send them along.

You can find us online germandworm.com or just send us an email germanworm@gmail.com We hope that you’ll follow us on the socials and spread the word with friends and family. Those are free ways to support this podcast. Until next time, I’m Germ.

WORM
00:33:14.210 – 00:33:17.370
I’m Worm. It’s a big planet. See it in good health and we.

GERM
00:33:17.370 – 00:33:38.240
Look forward to seeing you next time.

This podcast is designed to inform and inspire and entertain, but it does not establish a doctor patient relationship.And so it should never replace your conversation with a qualified healthcare professional. Please see one before your next adventure.The opinions in this podcast belong to Dr. Sanford and Dr. Pottinger alone and do not necessarily represent the opinions of the University of Washington or UW Medicine.