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Travelling Abroad

The greatest piece of advice when contemplating travel abroad is not location, location, location but planning planning, planning!

Before booking any holiday it is advisable to seek advice from your cardiologist or liaison nurse team whether flying is suitable for your child. Most children are able to undertake short haul flights, but long haul flights can pose different problems and each individual child will have different needs/requirements. It is easier and more fun to plan a holiday to destinations you know you can fly to, than planning first and then having to be disappointed. If your cardiologist advises travelling with oxygen or your child needs oxygen for the duration of the flight, this needs to be discussed with the airline you are going to travel with as each airline has different rules, regulations and costs.

Getting the details of the nearest cardiac centre/children's hospital to your destination can also be reassuring and if you have a patient held records folder take it with you so you have a your child's heart/medical condition, treatment and your cardiac centre's contact details to hand.

Insurance is the next hurdle to overcome. It is important that you are fully insured by a reputable insurance company. Many high street insurers are beginning to incorporate congenital heart defects into their insurance criteria so it is always worth ringing round and getting different quotes before resorting to the more expensive specialist insurance companies. Remember that if you don't declare your child's heart condition and their treatment in full, making any claim even for treatment not connected to their heart will be extremely difficult. If you are travelling to countries within Europe you can pick up an E111 form from the Post Office which entitles you to free treatment, however if you want/need to come back to your cardiac centre in the UK, you will need to be insured in order not to have to foot the very hefty transfer costs yourselves. If you are travelling to countries outside Europe, in particular to countries that operate a private medical system such as the USA, if you are not adequately insured, or have not fully disclosed you child's condition you will end up having to pay for their care. From experience of some patients and their families, it is always better to pay a bit more for the insurance than have to pay for an air ambulance!!

Once your destination and insurance have been sorted out then everything gets a little bit easier.
Make sure you have enough medication for the duration of the trip and then take extra to cover eventualities such as broken bottles! Splitting your tablets/syrups between hand baggage and your suitcases is a good idea in case of lost luggage/breakages, there is nothing worse than arriving safely in Spain to discover your child's diuretics are in Italy!!

If you are travelling during the summer or to a hot country make sure your child is well hydrated at all times. Children whose hearts work harder will always lose more fluid from sweating or just having a higher respiratory rate, so it is very important that they drink plenty, this is even more important if they are on diuretics. Try to make sure that children are not running around at the hottest part of the day, and encourage a "siesta". If you are going on sightseeing trips etc going early in the morning or later in the afternoon can be beneficial by both avoiding the heat and the crowds!

Keep the children well covered as scars burn very easily. You can invest in some surfer's sun block, or just use high factor children's cream and cover with a t-shirt. If your child's surgery has been fairly recent, try not to put anything on the scar directly as this can cause irritation, just keep well covered.

Be extra vigilant with the storage of your child's medication. When you are not in your own home and able to store medicines in a high or locked cupboard, it becomes easier for accidents to happen with children helping themselves to their medicine. You can use a room safe if you are staying in a hotel. In apartments/villas just try to find the most inaccessible point whilst also protecting the medicine from light/moisture.

If you are travelling with a child on warfarin you should take your coaguchek machine with you and remember that the machines are sensitive to both high and low temperatures, so try to avoid exposing them to temperature extremes. Always take plenty of test strips with you, and try to make sure your accommodation has a fridge for the strips. You can transport the strips in an empty thermos flask, as this protects them from sudden temperature changes. Take the contact details of the people who normally manage your child's anticoagulation so that you can get some advice about doses or testing if needed.

Though this may seem like a fairly arduous list of do's and don'ts, its important to remember planning really is the key to having a very safe and happy holiday. So in addition to all of the above remember your bucket and spade and have lots of fun!

Judith Hernandez del Pino
Paediatric Cardiac Liaison Sister
Bristol Royal Hospital for Children