Travel to High Altitude with Children: Treating Altitude Sickness

In the current issue of High Altitude Medicine & Biology (volume 9, number 4, 2008), there is an excellent article entitled "Travel to High Altitude with Young Children: An Approach for Clinicians," authored by Michael Yaron and Susan Niermeyer.

This article is a brief review of the principles of altitude illness in children. I found it helpful in my practice and in the advice that I give to persons who seek my opinions. The article emphasizes the following:

1. Children experience the full range of altitude-associated illnesses, including acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). 
2. AMS in children is characterized by fussiness, lack of playfulness, poor appetite, nausea, vomiting, and poor sleep. This is the most common altitude illness in children.
3. HAPE, which is often preceded by AMS, is caused by low blood oxygen content, and is manifested as shortness of breath, rapid breathing, blue discoloration of skin in the fingers, toes, around the lips and in the earlobes, reduced activity tolerance, cough, coughing blood, and fever.
4. HACE, which is often preceded by AMS, carries features of headache, unbalanced gait, behavioral changes, and altered mental status, randing from confusion to hallucinations or coma, as well as a variety of neurological deficits.
5. The approach to a child traveling to high altitude should focus on planning the ascent, management of altitude-associated illness(es), and diagnostic follow-up:
   1. Planning the ascent. Ascend slowly. Avoid difficult descents in which initial rapid ascent will be necessary. Do not bring children younger than 4 to 6 weeks to high altitude, because their circulatory system maturation may not be sufficiently complete to prevent an increased incidence of altitude-associated illness. Infants who required supplemental oxygen during the neonatal period are at particular risk. Avoid traveling to altitude with children who have suffered recent inflammatory processes, such as viral infection, or situations associated with pulmonary hypertension. Children with trisomy 21 are more prone to HAPE than are those with normal chromosomes.
   2. Recommendations for management include slow, graded ascent, early recognition of symptoms combined with halting further ascent, and descent if rest and time do not diminish or eliminate symptoms. The Children’s Lake Louise Score can be used to recognize AMS in children modify activity, and/or provide treatment. Treatment of AMS should be initiated once symptoms develop. Descent is effective treatment, and further ascent is contraindicated. The dose of acetazolamide recommended to treat AMS in children is 2.5 milligrams per kg (2.2 pounds) of body weight given every 12 hours, with a maximum dose of 250 mg. If prophylaxis for AMS, which is not routinely indicated, is undertaken, the dose is 1.25 mg/kg of body weight every 12 hours, begun 24 hours prior to ascent and continued for 48 hours after the maximal altitude is attained.
   3. Diagnosis of structural cardiopulmonary abnormalities should be considered after an episode of altitude-associated illness in a child.

There is a great deal more useful information in this article, and I highly recommend it for health care providers and for persons who will be responsible for bringing children to high altitude environments.