What is malaria?
Malaria is a serious and potentially deadly disease found in many tropical countries. It is transmitted through the bite of an infected mosquito. Malaria carrying mosquitoes most often bite in the evening and overnight. The malaria parasite replicates once in the body so you can get very unwell from just one bite.
Is it safe to take children to malaria regions?
Children are particularly at risk of contracting severe, and potentially fatal, cases of malaria. We would advise parents travelling to malaria zones to avoid taking infants and children without a thorough consultation and advice from a Nomad travel nurse, and with proper precautions to to prevent the disease for the duration of their trip.
If you are planning a holiday to a malaria region with young children under 5 years it would be best to change the destination to one free of malaria because it is such a significant risk. If, however, you are travelling for a family event, to visit friends or for another reason that means you cannot avoid the malarious area; it is vital that you as the parent/carer take steps to reduce the risk of your child getting malaria.
Avoiding mosquito bites
It is vital to avoid being bitten mosquitoes that can transmit many diseases, including malaria. Cover up with long, loose clothing, regularly spray insect repellent with DEET onto exposed skin, and sleep under treated mosquito nets at night if you are not staying in a room with air conditioning. You can buy specific nets to cover prams and cots. 50% Deet mosquito repellent is the best one to use if you are trying to avoid diseases like malaria. The UK malaria prevention guidelines state that DEET can be safely used on babies older than 2 months of age.
Malaria tablets options for children
There are several malaria tablets available in the UK, but not all of them are suitable:
- Doxycycline – not suitable for children under 12 years of age as it can discolour developing teeth
- Chloroquine – can be taken by children in doses suitable for their weight. However, there is now a lot of resistance to this drug worldwide so there are not many places where this is a suitable malaria medication option.
- Mefloquine (Lariam) – this medication can be given to children, but the tablet must be broken and the dose given according to the child’s weight.
- Atovaquone & Proguanil (Malarone) – this is suitable for children and is available in paediatric tablets, the number of tablets needed depends on the child’s weight.
The choice of malaria tablets depends on a number of factors including; what works at the destination, any pre-existing medical issues, budget available, and personal preference. Mefloquine and Atovaquone & Proguanil are now discussed in more detail below to help you understand the advantages and disadvantages of each one. However, it is important to discuss your travel plans with an experienced clinician to help you decide. All Nomad clinics are specially trained to advise families on protecting against malaria – book a consultation for your family 6-8 weeks before travel.
Mefloquine (Lariam) for children
Mefloquine is only available in 250mg tablets, so children needing smaller doses will need the tablet to be broken into quarters. The tablets are scored so can be split easily, or a pill cutter can be used. Children then take a quarter, half or three quarters of a tablet per week depending on their weight. Mefloquine is quite a bitter tasting tablet, but it is recommended to crush it up and mix it with something sweet like a teaspoon of jam, banana, or chocolate spread.
Mefloquine can, on rare occasions, cause psychological side-effects such as depression, bad dreams and hallucinations. Children tend to tolerate better than adults but we would always recommend a thorough risk assessment to assess the suitability of any medication, plus a 3-week trial to check someone is not affected by such side effects prior to travel.
- Only taken once per week, so much easier for parents to administer
- Cheaper antimalarial medication
- May need to be started 3 weeks before travel
- Needs to be continued for 4 weeks after travel
Atovaquone & Proguanil (Malarone) for children
Atovaquone & Proguanil, also sold under the brand name Malarone, can be taken by children but they need a smaller dose than adults and the dose is calculated according to their weight. The generic versions of Atovaquone & Proguanil and the branded version Malarone are available in paediatric specific tablets. One paediatric tablet is the equivalent of a quarter of an adult dose, meaning that children may require 1-3 tablets per day.
Atovaquone & Proguanil is suitable in all malaria regions in the world. Atovaquone & Proguanil should be started 1 day before travel, every day while there, and continued for 7 days after leaving the malaria region. Malarone Paediatric tablets are stocked in all Nomad clinics.
- Available in paediatric specific tablets
- Only needs to be continued for 7 days after being in malaria region
- Has to be taken every day
- Older children may need to take 3 tablets per day
Malaria symptoms to watch out for
No medications are 100% effective, so it is always important to watch out for signs of malaria. It usually presents as a high fever. If you or your children are unwell, either during your trip of after you get back, it is always important to let a doctor know where you have been travelling to. Malaria is likely to kill the quickest of the various tropical diseases so must always be ruled out first and a blood test is needed to do this.
Suspected malaria is a medical emergency and should always be taken very seriously. If your children go to nursery or school then parents should ensure that all teachers/carers are aware that your child has been to a malaria region, and know that if the child becomes unwell, they must contact you immediately and the child needs to go to hospital for assessment. Remember to let the doctor know to test for malaria urgently.
Ensure you keep all medications (and repellents etc) out of sight and reach of children. There is a serious issue with fake medications being sold in other countries and on the internet that can be harmful when taken. Stock up with a reputable pharmacy or travel clinic before you go. Nomad clinics stock Mefloquine and Malarone Paediatric tablets for children. Book a consultation to discuss your family’s travel plans and get up to date advice on which medications are recommended.