For children with pulmonary or cardiac problems, Dr. Rotta said, the atmosphere in an airplane can be stressful, dry and with a lower than usual oxygen concentration.
There were also four lap infants — children under 2 traveling without seats of their own — without any known medical problems who died in flight, and Dr. Rotta warned that people on airplanes often ignore the sleep safety precautions that they practice at home. “On long-haul flights, with the window shades down and the lights off, a passenger will wake up and notice their infant is dead next to them, whether there was the equivalent of SIDS or a parent rolled over and asphyxiated the child,” he said. It has also been suggested that the lower oxygen concentration may predispose some infants to disordered breathing and put them at risk for SIDS, he said.
In a separate study, published in 2016, they identified 400 cases of children suffering injuries in flight, Dr. Rotta said. “These were kids that boarded a plane healthy.” Though such injuries were relatively rare, the children who got hurt were disproportionately lap infants. Some got hurt in turbulence, and others suffered burns from spilled hot liquids, with meal service a time of particular danger. “At home, you would never pass a hot cup of soup or a hot meal over your infant,” Dr. Rotta said.
Many were injured by objects falling from overhead bins or by service carts passing in the aisle. “We’ve had several kids who had fingers crushed, arms crushed,” Dr. Rotta said.
It makes sense that the risk of such injuries is higher if children are seated on the aisle, Dr. Alves said. “Children should fly in the middle seat or window seat.”
Dr. Sherif M. Badawy, an attending physician in the division of hematology oncology at Lurie Children’s Hospital in Chicago, responded to an appeal for help on a flight from Istanbul to Chicago and found himself caring for a 17-month-old who was having trouble breathing.
When he asked what medications and equipment were available, Dr. Badawy was offered an asthma medication in an inhaler — the child would have to cooperate to take it — and a single bottle of oxygen, good for a couple of hours at most. The emergency equipment available on the flight was also not suited to a child, with no face mask or endotracheal tube of the right size.