Travel Packing Tips

Traveling is not a good excuse stopping breastfeeding. With good planning and packing, you can still keep the breastfeeding routine.

Prior to departure, talk to your health-care providers as they can help breastfeeding mothers find out about available breastfeeding support at the destination.

Depending on your destination, you should try to avoid immunizations and medications. However, if you visit some countries in the world that requires immunizations, you should talk to your health provider to make sure they’re compatible with breastfeeding.

A mother traveling with her nursing infant less than six months of age need not make provisions to supplement breastfeeding, even when traveling internationally. Breastfed infants do not require water supplementation, even in extreme heat environments. And, when accompanying their mothers, nursing infants and children may feed on demand. The most effective way to maintain a mother’s milk supply while traveling is to engage in frequent and unrestricted nursing opportunities. This is also the best way to meet the physical and emotional needs of the infant or child.

The traveling mother may find it helpful to take along a sling or other soft infant carrier, which may be used to

• Ease the burden of carrying a child for extended periods of time
• Increase opportunities for unrestricted nursing, effective in maintaining an abundant milk supply
• Maintain skin-to-skin contact with the child, which helps in maintaining a milk supply
• Protect the child from some environmental hazards

Source: Centers for Disease Control and Prevention

Travel need not be a reason to stop breastfeeding.

• A mother traveling with her breastfeeding infant or child may find that nursing makes travel easier than it would have been with a bottle-fed infant or child. And, by planning well before the travel date, a mother can overcome many potential obstacles.
• A mother planning a long separation from her nursing infant or child might wish to work with an International Lactation Consultant (IBCLC) or her pediatrician to obtain assistance and suggestions specific to her situation.
• Mothers may wish to identify breastfeeding support local to her destination. In this way, support may be only a phone call away at any time throughout the trip. Visit  La Leche League International* to find support groups and breastfeeding experts in other countries.

Source: Centers for Disease Control and Prevention,

A breastfeeding mother traveling without her nursing infant or child who does not build a supply of milk to be fed in her absence can still maintain her milk supply while she is traveling. These efforts will help maintain her breastfeeding relationship for when she and her infant or child can be together again.

Milk expression approximately every 3-4 hours for infants less than 6 months old, less frequently for older infants and children, helps a mother maintain her milk supply and provides milk that she may choose to bring home for her infant or child. A mother who will be separated from her infant or child for a long period of time while traveling might have a difficult time maintaining lactation. In general, separation of a week or less does not pose a major problem for a mother wishing to maintain breastfeeding while separated from her infant or child. This time is more flexible as the child becomes older and complementary foods play a larger role in the child’s diet.

Depending on her destination, a mother may need to plan for milk expression without a reliable electrical power source. Expressing milk without an electrical power source is less reliable for maintaining milk supply over a long period of time than expressing milk with a hospital-grade electric breast pump. Intermittent milk expression can be successful with battery and manual breast pumps, as well as manual (hand) expression. Manual (hand) expression is the most hygienic way to collect milk. Mothers planning on travel to locations without reliable electrical power should learn and practice manual expression techniques well before travel is to begin.

The destination for travel can impact decisions for milk storage. Expressed milk should be stored in clean, tightly sealed containers. Any container that may be cleaned well with hot, soapy water and that seals tightly and reliably may be used. Once milk is cooled, a cold chain needs to be maintained until the milk is consumed. Refrigerated milk can subsequently be frozen; however, once frozen milk is fully thawed, it should be used within 1 hour.

Handling expressed breast milk does not require special medical precautions. Breast milk may be stored in any refrigerator or other location where other foods would be safe and may be stored with other foods. Breast milk requires no special labeling, it is not considered a biohazard, and the universal precautions for prevention of transmission of human immunodeficiency virus, hepatitis B virus, and other bloodborne pathogens (known widely as “Universal Precautions”) do not apply to it.

Source: Centers for Disease Control and Prevention

Breastfeeding mothers may wish to find local breastfeeding support before beginning travel and keep pertinent contact information handy throughout the trip.

A mother traveling with a nursing infant younger than 6 months old need not plan to supplement breastfeeding because of travel . Breastfed infants do not require water supplementation, even in extreme heat environments. While traveling, the best way to both maintain a mother’s milk supply and ensure ideal nutrition and hydration for the child is frequent, unrestricted nursing opportunities. Breastfeeding also protects the infant from water that is possibly contaminated.

A breastfeeding mother traveling without her nursing infant or child may wish to produce and store a supply of milk to be fed to the infant or child during her absence by another caregiver. Building a supply to be fed in her absence takes time and patience and is most successful when begun gradually, many weeks in advance of her departure. It is also important to consider that infants who have never consumed milk from a bottle or cup need opportunities to practice this skill with another caregiver prior to the mother’s departure.

Source: Centers for Disease Control and Prevention

Everyday life doesn’t stop once you are pregnant. Most healthy pregnant women are able to continue with their usual routine and activity level. That means going to work, running errands, and for some, traveling away from home. To take care of yourself and help keep your baby safe, consider these points before taking a long trip or traveling far from home:

• Talk to your doctor before making any travel decisions that will take you far from home. Ask if any health conditions you might have makes travel during pregnancy unsafe. Also consider the destination. Is the food and water safe? Will you need immunizations before you go? Is there good medical care available in the event of an emergency? Will your health insurance cover medical care at your destination? Also, avoid traveling to very high altitudes (12,000 feet).
• Bring a copy of your medical record and find out about medical care at your destination so you will be prepared in the event of an emergency.
• Avoid sitting for long periods during car or air travel. Prolonged sitting can affect blood flow in your legs. Take frequent, 10 minute breaks while traveling by car to walk and stretch. Stand up, and move your legs often during air travel. Wearing support pantyhose also can help blood flow.
• If you suspect a problem with your pregnancy during your trip, don’t wait until you come home to see your doctor. Seek medical care right away.

Source: U.S. Department of Health and Human Services.

Travelers should be advised that permethrin-containing repellents (e.g., Permanone) are recommended for use on clothing, shoes, bed nets, and camping gear, and are registered by the U.S. Environmental Protection Agency (EPA) for this use. Permethrin is highly effective both as an insecticide and as a repellent for ticks, mosquitoes, and other arthropods. Clothing treated according to label instructions should provide protection for up to 2 weeks and through several machine washings before re-treatment is required. Clothing pre-treated with permethrin is commercially available and should be used and washed according to the manufacturer’s instructions. There appears to be little potential for toxicity from permethrin-treated clothing. Permethrin-treated clothing should be supplemented with topically applied repellents to protect exposed skin.

The EPA has registered several active ingredients for use in personal repellents applied to skin. EPA registration of repellent active ingredients indicates the materials have been reviewed and approved for efficacy and human safety if applied according to the instructions on the label. These active ingredients are DEET (N,N-diethylmetatoluamide), Picaridin (KBR 3023), IR 3535, p-menthane 3,8-diole (PMD or oil of lemon eucalyptus) and oil of citronella. Two additional compounds are also registered as repellents by EPA (MGK-326, MGK-264); however, they are generally formulated with other active ingredients to enhance repellent activity and are not found alone in repellent products.

All the EPA-registered active ingredients have some repellent activity (1-5). Published data indicate that repellent efficacy and duration of protection vary considerably among products and among mosquito species and are markedly affected by ambient temperature, amount of perspiration, exposure to water, abrasive removal, and other factors. In general, higher concentrations of active ingredient in a repellent formulation provide longer durations of protection, regardless of the active ingredient. Lower concentrations are not as long lasting, offering short-term protection only and necessitating more frequent reapplication.

DEET is the most common repellent active ingredient, and its efficacy and toxicity have been the subject of numerous scientific studies. Most authorities recommend repellents containing DEET (N,N-diethylmetatoluamide) as the most reliable and long-lasting active ingredient. DEET repels mosquitoes, ticks, and other arthropods when applied to the skin or clothing. In general, the more DEET a repellent contains, the longer it can protect against mosquito bites. Low concentrations provide shorter-duration protection than higher concentrations; however, there appears to be no added benefit of concentrations of more than 50% DEET. A microencapsulated, sustained-release formulation can have a longer period of activity than liquid formulations at the same concentrations (6).

DEET has been so widely used that a great deal of testing has been done. Over the long history of DEET use, very few confirmed incidents of toxic reactions to DEET have occurred when the product is used properly. No definitive studies have been published about what concentration of DEET is safe for children. However, reports of serious illness in children after the use of DEET are extremely rare; DEET was used inappropriately in most of these cases. DEET formulations as high as 50% are recommended for both adults and children >2 months of age (7-9). The recommendations for DEET use in pregnant women do not differ from those for nonpregnant adults.

Repellents that do not contain DEET have not been tested as thoroughly as DEET-based products, although available data indicate that many offer a duration of protection from biting mosquitoes similar to that provided by similar concentrations of DEET. Used according to label instructions and reapplied as necessary, EPA-registered non-DEET repellents can provide acceptable protection from biting insects and are not expected to pose health risks to people, including children and other sensitive populations. Similar to DEET, summaries from EPA indicate that Picaridin is slightly toxic by eye, dermal and oral routes. PMD (p-menthane-3,8-diol) shows no adverse effects except for eye irritation. IR3535 has been used as an insect repellent in Europe for 20 years with no substantial adverse effects. Toxicity tests show that the IR3535 is not harmful when ingested, inhaled, or used on skin, although it may cause eye irritation if it enters a person’s eyes. Oil of citronella shows little or no toxicity, but may cause skin irritation.

Repellents applied according to label instructions may be used with sunscreen with no reduction in repellent activity (10). Products that combine sunscreen and repellent are not recommended, as sunscreen may need to be re-applied with greater frequency and in greater amounts than are needed to provide protection from biting insects.

Travelers should be advised to check the container to ensure that the product bears an EPA-approved label and registration number. The entire label should be read and the directions followed carefully. For example, if a tick repellent is needed, the product label should list this use. If ticks are not listed, the product may not be formulated for that use. Repellents should be stored away from children’s reach.

Travelers should be advised to use the following precautions when using repellents:

• Use enough repellent to cover exposed skin or clothing. Do not apply repellent to skin that is under clothing. Heavy application is not necessary to achieve protection.
• Do not apply repellent to cuts, wounds, or irritated skin.
• After returning indoors, wash treated skin with soap and water.
• Do not spray aerosol or pump products in enclosed areas; do not inhale the aerosol.
• Do not apply aerosol or pump products directly to the face. Spray hands and then rub them carefully over the face, avoiding eyes and mouth.
• When using repellent on a child, an adult should apply it to his or her own hands and then rub them on the child. Avoid the child’s eyes and mouth and apply sparingly around the ears.
• Do not apply repellent to children’s hands. (Children tend to put their hands in their mouths.)
• Do not allow children younger than 10 years old to apply insect repellent to themselves; an adult should do it for them. Keep repellents out of reach of children.

Protect infants younger than 2 months of age from biting mosquitoes by using an infant carrier draped with mosquito netting with an elastic edge for a tight fit.

Bed nets and repellents should be purchased before traveling and can be found in hardware, camping, sporting goods, and military surplus stores.

When purchasing repellents overseas, look for the EPA-registered active ingredients on the product labels. Permethrin or a similar insecticide, deltamethrin, may be purchased to treat bed nets and clothes.

Source: Centers for Disease Control and Prevention

Tick-, mite-, and mosquito-borne parasitic and viral infections characteristically are diseases of “place” that are linked to known geographic or ecologic regions, and the amount of disease transmission in these areas often varies seasonally. Risk of infection increases when visiting areas of the world where these diseases occur and when epidemics are in progress. International travelers should consult CDC’s Travelers’ Health web page for alerts and information on regional disease transmission patterns that may change periodically. Travelers to areas with identified risks should take the precautions described below to reduce the likelihood of acquiring a vector-borne disease. When possible, known foci of epidemic disease transmission should be avoided.

Travelers should be advised that exposure to arthropod bites can be minimized by modifying patterns of activity or behavior. Some vector mosquitoes are most active in twilight periods (i.e., dawn and dusk) or in the evening after dark. Avoidance of outdoor activity during these periods can reduce risk of exposure. Wearing long-sleeved shirts, long pants, and hats minimizes areas of exposed skin. Shirts should be tucked in. Repellents applied to clothing, shoes, tents, mosquito nets, and other gear will enhance protection.

When exposure to ticks, chigger mites, or biting insects is a possibility, travelers should be advised to tuck their pants into their socks and to wear boots, not sandals. Permethrin-based repellents applied as directed to clothing or camping equipment will enhance protection. Travelers should be advised to inspect themselves and their clothing for ticks, both during outdoor activity and at the end of the day. Ticks are detected more easily on light-colored or white clothing. Prompt removal of attached ticks can prevent some infections.

When accommodations are not adequately screened or air conditioned, bed nets are essential to provide protection and to reduce discomfort due to biting insects. Bed nets are most effective when treated with a repellent such as permethrin. Pre-treated, long-lasting bed nets can be purchased prior to traveling, or nets can be sprayed after purchase. The permethrin repellent will be effective for several months if the bed net is not washed. Bed nets should be tucked under mat-tresses. Aerosol insecticides can help to clear rooms of mosquitoes.

Source: Centers for Disease Control and Prevention

Although vaccines or chemoprophylactic drugs are available against important vector-borne diseases such as yellow fever and malaria, travelers still should be advised to use repellents and other general protective measures against biting arthropods.

The effectiveness of malaria chemoprophylaxis is variable, depending on patterns of drug resistance and compliance with medication, and no similar preventive measures exist for other mosquito-borne diseases such as dengue or chikungunya. For many vector-borne diseases, no specific preventives are available.

The number of insect repellents available has been increasing, with several ac-tive ingredients now registered by the US Environmental Protection Agency (EPA). However, for travel to areas where the intensity of disease-transmitting vectors is high, it may be wise to use a product containing DEET or picaridin rather than an herbal product. DEET is the most studied repellent and travelers (military and civilian) have had the most experience with it.

Source: Centers for Disease Control and Prevention

* Pack your prescription medications in your carry-on luggage.
* Pack copies of all prescriptions, including the generic names for medications.
* Pack a note on letterhead stationery from the prescribing physician for controlled substances and injectable medications.
* Leave a copy of your prescriptions at home with a friend or relative.
* Check with the American Embassy or Consulate to make sure that your medicines will be allowed into the country you are visiting. Some countries do not let visitors bring certain medicines into the country.

Source: Centers for Disease Control and Prevention