Taking my baby to Cambodia

If you're seriously suggesting to take Lariam (and even administer it to your 20months-old daughter), I doubt that this post is serious!
For one thing, Lariam is long outdated as a malaria precaution - and not recommended for all of SEA - too high level of resistance amongst the local malaria strains.
Secondly, Lariam has always been a drug to take from 12 years up - not completely sure about the exact age limit, but in the 80s, when it was still prescribed for Africa, I took it at the age of 14, but my 6year-old brother had to take something different...
And thirdly, better be afraid of the side effects - all current malaria precautions have far less side effects - taking Lariam really is not funny - sadly, having malaria isn't either. Doxycyclin and Malarone are recommended drugs for SEA nowadays. But I have no idea, whether they're suitable for infants!
Before giving her anything, please consult your local centre for tropical medicine! There are also a lot of people who advise against all malaria pills, saying that good, diciplined measures against mozzies (covering up, mosquito-nets, -coils, spray...) is enough. Myself, I think that these kind of precautions will get you a long way, but I'm still taking the pills - but I might be biased, as I had malaria before...

I was shocked to read your post. You need to talk to your pediatrician immediately, and if it was your pediatrician who prescribed Larium for your 20 month old child, you need to talk to someone else familiar with tropical diseases and where you are going, now!.

Oh my God, you are really worrying me now guys. Actually, it was the doctor at the International Vaccination Centre (which is actually my local, only and official centre for tropical medicine here in Madrid) who gave me the prescription for Lariam. He also said that the infant dose is much less than the dose for an adult (1/4 tablet). I have the prescription right in front of me now!

I was worried too about the side effects, so yesterday afternoon I called the Roche Pharma customer service line and I asked them about these possible side effects: they just say that Lariam is suitable for kids over 5 kilos and that the side effects are very rare. Should I trust them?

The problem is that Malarone should not be taken by infants weighing less than 11 kg, and my daughter is actually 8.5 kilos now. I don’t know what to do. The paediatrician has no idea, because she does what the guys at the Vaccination Centre say. Shit, this is serious. What can I do apart from taking lots of DEET insects repellent?

I really appreciate your comments, thank you. I’m more confused now, though.

I am horribly sorry to scare you as I obviously have. Now that you explain who you have spoken with and where you got the Lariam and the dose prescribed for your daughter, I am less inclined to cause you distress, although the side effects of Lariam are not pleasant for those who experience them. I would suggest you get a third opinion, perhaps from the CDC on line, weigh your options and decide. It may be that if you are only going to Siem Riep, mosquito repellent in a concentration suitable for small children is all you will need.

If you are only going to Siem Reap then a lot of people who live in Siem Reap will probably tell you not to take Malaria tablets as there is no Malaria carrying mosquitos in Siem Reap town.

For your baby I would suggest just ensuring your baby is well protected from mosquitos by covering her up especially at night and Spraying your room with mosquito killer spray an hour before you retire to your room if possible.

I would also suggest not staying on the ground floor in a hotel and take a room on a higher level as there will not be as many mosquitos and other insects that bite.

I would also get some more expert medical advice from someone who is up to date with the Malaria situation in Cambodia.

Siem Reap information

If your so worried about taking a small child to a risk area, why are you doing it?

A small child is still developing its immune system, and also its ability to fight off infections, food born or otherwise. If your comfy putting a chile from the western modern world, into the developing world, where not only risk factors exist, but also medical atmosphere is barely as sophisticated outside of Bangkok, why are you asking a travel forum?

Its seems selfish to me that you are willing to take such risk for your own vacation, when you have valid concerns for the safety and health of your child.

It amazes me when I read these post. and wonder why people like yourself, lack any common sense.

<blockquote>Quote
<hr>It amazes me when I read these post. and wonder why people like yourself, lack any common sense. <hr></blockquote>

Common sense? It amazes me that someone like you, who obviously hasn't any kids, or much hope of ever having any, can get so high and mighty. People bring kids with them on trips all around the world, and guess what? They survive it all.

As for the original post, I dont see why you would need any anti-malarials anyway, Id be careful about dengue fever though, which there is an epidemic of in Cambodia right now, so cover up your kid and use deet.

Lots of people take their children to Siem Reap with little or no problems, so don't be too scared.

Malaria is not so much of an issue there as much as DENGUE FEVER is. Unfortunately, there's nothing you can take, only preventive measures, such as wearing lighter coloured clothes, using DEET, covering up, etc. Dengue mosquitoes are DAY mosquitoes and are likely to strike at dawn and dusk, so try to be inside for these periods especially. However, you can get them at anytime during the day, so don't let your guard down.

I personally don't take Malaria tablets when in SR, nor would I give them to my 6 MO baby.

As for general toddler things

1) Eat at popular places where the food is cooked to order, not off carts
2) Drink plenty of bottled water - usually the water they serve you in retsaurants is ok too
3) Diapers, formula and baby food can be bought in Cambodia but may not be the brands you know and like. It's mainly French baby foods, Asian Diapers and Australian/French formulas. They are reasonably priced
4) Cambodian LOVE children. The fairer/blonder the chld, the more they are facinated by them. prepare your child by letting them know they will be stared at a lot and touched. The upside is that in restaurants, if your child cries or misbehaves, no-one will bat an eyelid, excpet other westerners. The Khmers will all fawn over your daughter and try to make her happy.
5) take a basic first aid kit with you with antibiotics suitable for tummy troubles, band-aids etc...
6) Sunscreen and hats for kids are essential
7) a pram may not be much use excpet for letting your daughter sleep in restaurants but a baby backpack may be a good idea
8) kids get bored at temples really easily, so try and spread out your time and activities

<blockquote>Quote
<hr>It amazes me when I read these post. and wonder why people like yourself, lack any common sense. <hr></blockquote>

Thank you Dr. Tim.

However, there are plenty of kids, yes, Western kids, living in these places. My son was born in BKK and spent the first 4 months of his life in Vientiane, with trips to KM 52, Vang Vieng, Xieng Khuang, Luang Prabang, and KM 52 thrown in for good measure. You take precautions, just as you would with your kid anywhere, to deal with local conditions.

Montera, if you decide to go through with the trip, despite Tim's diagnosis of lack of common sense, take those precautions that together will provide the most protection. Use mosquito spray with deet (30% deemed safe for kids, but spray into your hands and rub it on your child to avoid contact with her mouth and eyes), a treated mosquito net, and malaria prophylaxis. You have already consulted a Dr. and were given their advice on medication. Now it's up to you to decide what to do.

From the CDC Website

Chemoprophylaxis for Infants, Children, and Adolescents

Infants of any age or weight or children and adolescents of any age can contract malaria. Therefore, all children traveling to malaria-risk areas should take an antimalarial drug. In the United States, antimalarial drugs are available only in tablet form and may taste quite bitter. Pediatric dosages should be carefully calculated according to body weight but should never exceed adult dosage. Pharmacists can pulverize tablets and prepare gelatin capsules for each measured dose. If the child is unable to swallow the capsules or tablets, parents should prepare the child’s dose of medication by breaking open the gelatin capsule and mixing the drug with a small amount of something sweet, such as applesauce, chocolate syrup, or jelly, to ensure the entire dose is delivered to the child. Giving the dose on a full stomach may minimize stomach upset and vomiting.

Overdose of antimalarial drugs can be fatal. Medication should be stored in childproof containers out of the reach of infants and children.

Infants, Children, and Adolescents Traveling to Areas with Chloroquine-Resistant P. falciparum: Chloroquine is the drug of choice for children traveling to areas without chloroquine-resistant P. falciparum.

Infants, Children, and Adolescents Traveling to Areas with Chloroquine-Resistant P. falciparum: Mefloquine is an option for use in infants and children of all ages and weights who are traveling to areas with chloroquine-resistant P. falciparum. Doxycycline may be used for children who are at least 8 years of age. For atovaquone/proguanil, treatment efficacy, safety, and pharmacokinetic data in children who weigh 5-11 kg have recently been extrapolated, allowing for prophylaxis doses in these children. Providers should note that this prophylactic dosing for children weighing less than 11 kg constitutes off-label use in the United States. Atovaquone/proguanil may now be used for prophylaxis for infants and children weighing at least 5 kg (11lbs). Atovaquone/proguanil is available in pediatric tablet form; dosage is based on weight. Pediatric dosing regimens are contained in Table 4-11; additional information on atovaquone/proguanil dosing is found in Table 4-10.

Good luck.