Children at altitude
Introduction
Skiing in the Rockies, 10,000 ft and higher. Driving up Pike's Peak, 14,000 ft. Viewing the Grand Canyon, 8000 feet. Visiting Mexico City, 7550 ft. Such family holiday activities have become so commonplace that we tend to forget that these are high altitude destinations, and that there may be health issues that visiting families should consider1.
While most children will run circles around their huffing and puffing parents at these altitudes, some children will experience acute mountain sickness (AMS), and a few others should not be there because of preexisting medical conditions. But contrary to conventional wisdom, asthmatics living at or near sea level generally have fewer problems in mountain resorts than they do at home (in Europe, children with asthma are often sent to the mountains for recuperation). And children with cardiovascular problems who can run and play at home without shortness of breath generally do well at these altitudes.
Section snippets
Acute mountain sickness
The cause of AMS is often erroneously attributed to decreasing oxygen in the air as altitude increases. In fact, the percentage of oxygen in air is the same at sea level and atop Mt. Everest (29,000 ft), about 20%. But as altitude increases, atmospheric pressure decreases, resulting in less force to drive the oxygen from the air into the lungs and blood stream, resulting in lower arterial blood oxygen saturation (see Fig. 1). Symptoms of AMS include labored respirations (especially with
Preventing AMS
Most cases of AMS in children can be prevented or substantially minimized if parents are aware that the condition exists, are able to recognize symptoms early, and have planned ahead to take immediate remedial action if it does occur:
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Parents should choose high-altitude destinations where medical care is available and where all-weather, rapid descent is possible. Medical personnel in high-altitude resorts are generally well versed in treating AMS.
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Gradual ascent prevents virtually all cases.
Treating AMS in children
A descent of a thousand feet is often sufficient to relieve symptoms caused by AMS.9 If parents are not sure whether symptoms are AMS or an upper respiratory infection, they should seek medical evaluation or descend promptly, even in the middle of the night.
Oxygen and/or acetazolamide relieve AMS when prompt descent is not feasible. Oxygen should be administered until the arterial blood oxygen reaches acceptable levels.
Acetazolamide (Diamox) is very effective in adults in both preventing and
Sickle cell disease and trait
Parents of children with sickle cell disorders should be aware that the lower partial pressure of oxygen found at altitude can increase the degree of sickling in their children's blood, and may cause pain, vaso-occlusive crisis and other sickle cell disease-related problems.10
Children with sickle cell disease often experience symptoms at altitudes of 7500 ft, and occasionally at lower altitudes. Trips to higher elevations may be contraindicated, and, if such trips are necessary, parents should
References (13)
- et al.
Inflammatory processes may predispose children to high altitude pulmonary edema
J Pediatr
(1997) - et al.
Evaluation of diagnostic criteria and incidence of AMS in preverbal children
Wilderness Environ Med
(2002 Spring) - et al.
High altitude medicine
Emerg Med Clin North Am
(1997) Acute altitude sickness in children
J Travel Med
(1999 September)- et al.
Acute mountain sickness in a general tourist population at moderate altitudes
Ann Intern Med
(1993 April 15) Lung disease at high altitude
Adv Exp Med Biol
(1999)
Cited by (4)
Traveling with children: Beyond car seat safety
2015, Jornal de PediatriaCitation Excerpt :However, most healthy children can travel safely to altitudes below 3500 m, being at no greater risk than adults.34 Even asthmatics may find that their symptoms improved due to a relative lack of allergens at high altitudes and do not appear to be at a higher risk of altitude sickness than non-asthmatics.35,36 Children with a history of bronchopulmonary dysplasia with restrictive severe disease should undergo a hypoxia altitude simulation test in a plethysmography chamber, if available, prior to the trip.
High-altitude illness in the pediatric population: A review of the literature on prevention and treatment
2017, Current Opinion in PediatricsPaediatric and adolescent sport injury in the wilderness
2010, British Journal of Sports Medicine