newborn air travel rules

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Is air travel safe for an infant?

Air travel is typically safe for most healthy, full-term infants after the first few weeks. Air travel may not be a good idea for babies born before their due date, called premature or pre-term.

Babies born early may still need time for their lungs to mature. So check with a healthcare professional before flying in a pressurized cabin or visiting high-altitude places.

And any infant with heart or lung problems should be cleared for air travel by a healthcare professional.

As you plan your trip, here are some things to keep in mind, such as the baby's age, your health and some basics of flying.

The baby's age, overall health

Experts caution against flying in the first seven days after a baby is born. Some healthcare professionals suggest not traveling for the first few months.

In general, babies and adults face the same risk of exposure to illness from travel. But a baby's immune system is still learning how to protect against germs. And in most cases, a baby's illness needs to be more closely watched by a healthcare professional.

Caregiver health and planning

It is important for caregivers to think about their own health too. Flying with a child can cause added sleep loss and stress. And adults are at risk for new germs and illness, as well.

Finding out what illnesses are spreading in your area and where you're going can help you prepare and take thoughtful action. And basic things like handwashing are even more important to prevent the spread of germs while traveling.

The baby's ears

Offering a baby something to suck on may help relieve the baby's ear discomfort. You can offer the baby a breast, bottle or pacifier to suck on during takeoff and the start of the landing process. It might help to try to time feedings so that your baby is hungry during these times.

Ask a healthcare professional when it's safe to fly with babies who have had ear surgery or an ear infection.

Also, airplane cabin noise levels are loud, mainly during takeoff. Cotton balls, noise-canceling headphones or small earplugs may limit your baby's exposure to this noise. This may help make it easier for your baby to sleep.

The baby's safety seat

Most infant car seats are certified for air travel. Airlines often allow infants to ride on a caregiver's lap during flight. But the Federal Aviation Administration recommends that infants ride in properly secured safety seats.

If you choose not to purchase a ticket for your infant, ask about open seats when you board the plane. It's possible an open seat could be assigned to your infant.

Don't be tempted to give your baby medicine, such as diphenhydramine (Benadryl, others), to help the baby sleep during the flight. The practice isn't recommended, and sometimes the medicine can have the opposite effect.

Jay L. Hoecker, M.D.

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• Jana LA, et al. Flying the family-friendly skies. In: Heading Home With Your Newborn: From Birth to Reality. 4th ed. American Academy of Pediatrics; 2020. https://www.aap.org/en/shopaap. Accessed Oct. 30, 2023.
• Newborn-flying and mountain travel. Pediatric Patient Education. https://publications.aap.org/patiented. Accessed Oct. 30, 2023.
• Centers for Disease Control and Prevention. Traveling safely with infants & children. In: CDC Yellow Book 2024. https://wwwnc.cdc.gov/travel/yellowbook/2024/family/infants-and-children. Accessed Oct. 30, 2023.
• AskMayoExpert. Infant Fever. Accessed Nov. 18, 2023.
• Schmitt BD. Pediatric Telephone Protocols: Office Version. 17th ed. American Academy of Pediatrics; 2021.
• Child safety on airplanes. Federal Aviation Administration. https://www.faa.gov/travelers/fly_children/. Accessed Nov. 18, 2023.

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Flying With a Baby? Here’s What to Know Before You Go

Medical review policy, latest update:, how old should a baby be to fly, read this next, what do children need to fly, tips for flying with an infant.

What to Expect the First Year , 3rd edition, Heidi Murkoff.  WhatToExpect.com, Do Babies Need Passports? , May 2019.  WhatToExpect.com, Should You Bring Your Child’s Car Seat on an Airplane? , August 2021. WhatToExpect.com, Your Ultimate Guide to Traveling While Breastfeeding , August 2020. American Academy of Pediatrics, Family Friendly Flying , November 2015.  American Academy of Pediatrics, Flying With Baby: Parent FAQs , November 2019.   American Airlines, Traveling With Children .  Delta Air Lines, Infant Air Travel , 2021.  Federal Aviation Administration, Flying With Children , March 2021.  Transportation Security Administration, Coronavirus (COVID-19) FAQ .  Transportation Security Administration, Identification .  Transportation Security Administration, Will Minors Need to Have a State ID to Fly Domestically? United Airlines, Traveling With Children , 2021.  U.S. Customs and Border Protection, Children – Child Traveling With One Parent or Someone Who Is Not a Parent or Legal Guardian or a Group , December 2019.

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When is it safe to fly with a newborn baby?

It's not always a clear-cut answer. Here's what you should know about flying with a baby before booking a plane ticket.

When is it safe to fly with a newborn?

What to consider before flying with a newborn, how to keep your newborn safe when you fly.

When my husband and I decided to settle in an Asian city more than 8,000 miles away from our American family and friends on the East Coast, we did so knowing that we wanted to have children and that one day, those kids would have to get on a very long flight. We welcomed a son in July, and when he was 5 months old, we embarked on the 14-hour flight home for the holidays. Amid our worries about irritating other passengers and maintaining our own sanity, there was of course the question: Was a flight this long even safe or healthy for him ?

I could pack my own sanitizer, wear a mask, and try to keep him from mouthing the seat belt flap and tray table – but there are limits to how much any of that could really help when traveling during RSV, COVID, and flu season . Introducing my baby to my 95-year-old grandmother in New Jersey was intensely important to me, though, so I was determined to figure out how to keep him safe. 

Not everyone might face the stakes (or distance) that I have with my baby, but figuring out when a baby can fly is a common question many parents face. 

There are two aspects to consider before booking a flight with your little one: what an airline will allow and what is actually medically recommended. 

What the airlines say

It's easy to find different carriers' policies on infants by checking their websites. Delta Opens a new window and American Opens a new window will allow newborns under a week old if they travel with a doctor's note, while United Opens a new window has a minimum of 1 week old , and JetBlue Opens a new window and Southwest Opens a new window permit babies 2 weeks old . 

What doctors say

"It's not advisable at all to travel with a newborn, especially on an airplane that is enclosed with so many people," says Karin Nielsen-Saines, M.D. Opens a new window , a professor of clinical pediatrics in the division of infectious diseases at UCLA Children's Hospital. "First, if they get sick, they have absolutely no immunity. And second, if they have any slight illness, or even a low-grade fever , they'll need to be brought to the hospital for a whole septic work-up, which entails being admitted for 48 to 72 hours. It's traumatic for everyone: parents and baby."

That's why you're unlikely to get a doctor's clearance to travel with a newborn unless it's an absolute emergency.

After those first few weeks, the advice becomes a bit more equivocal. "There's definitely some personal decision-making and risk-taking involved with flying with a newborn or an infant, but not a hard-and-fast rule," says Mary Carol Burkhardt, M.D., M.H.A. Opens a new window , a primary care pediatrician with the division of general and community pediatrics at Cincinnati Children's Hospital. "Babies face the same exposures when flying as adults do, but their immune systems are not as developed. Many people may feel more safe flying after a baby is [initially] vaccinated, which typically happens around 2 months of age."

Not all vaccines happen at that 2-month mark, though. "A child would not be really fully, totally protected against the most common pathogens until 7 months of age because then they would have received their primary immunization series – the ones they get at 2, 4, and 6 months," says Dr. Nielsen-Saines. Around 6 months, babies can also get their shots for seasonal illnesses like the flu , COVID , and RSV . "But the truth of the matter is that there's a risk, right? And the risk is potentially higher between September to April," she adds. 

Those two milestones – around 2 months and 6 months – are observed by the American Academy of Pediatrics as well, which recommends Opens a new window rethinking travel with infants under 6 months of age and avoiding any trips with those under 2 months . 

Your baby's health

As noted, flying is particularly dangerous for babies because their immune systems haven't developed enough to fight off the germs potentially found on a flight. That's true of all infants, but if a baby was born preterm or with any significant illnesses, parents should exercise more caution before hitting the skies, Dr. Burkhardt says. 

Beyond the dangers posed by pathogens, flying itself can bother babies. "As the plane climbs or descends, the differences in pressure can cause discomfort or pain to children," says Dr. Nielsen-Saines. "When you have young children or infants screaming when a plane is taking off or landing, it usually has to do with ear pain."

To alleviate that pain, you can have your baby suck on a pacifier, nurse, or take a bottle during takeoff and landing to mitigate some discomfort. Luckily, it's temporary and nothing to worry about long term, but with one big exception: if a baby or child has an ear infection when traveling . Though it's rare, "the pressurization could cause the tympanic membrane to rupture," Dr. Nielsen-Saines says. If you suspect or know your baby has an ear infection and there's a trip on the books, you should consult your doctor and very likely consider postponing to avoid that risk (or a lot of the pain, at the very least). 

Though babies under 2 years of age are allowed to fly seated on their parents' laps – and thus without a seat and ticket of their own – on most airlines around the world, most experts recommend strapping a baby into a car seat or other child-restraining device for air travel. In the event of turbulence, it can be difficult for an adult to maintain their grip on a child, with potentially devastating results. 

Airline-provided bassinets, too, which really only help the comfort of a baby and parent, not their safety; they're not designed to restrain a child, so you'd have to remove your baby from the bassinet and hold them when experiencing turbulence. 

Reserving a bassinet does mean you'd likely end up seated in the bulkhead row, and "bulkhead seats are better because there's more space for the baby at the front, and more space for the parents as well," says Dr. Nielsen-Saines. In case you're wondering, there is no one area or row of the plane that is safer or more dangerous for babies – except for the exit row, where only able-bodied adults are allowed to sit in case of an emergency.

Logistical considerations

Among the biggest stressors of flying is strategizing how and when to take care of your baby's basic needs. Feeding, changing, and sleeping can be terribly difficult on a plane. You have to keep breast milk cold (and then potentially get it warm) or prepare bottles of formula. Even changing a diaper on a plane can require advance planning.  

Plus, travel disrupts a child's (often precious) routines. While it's not inherently damaging to their health, it can end up frustrating both you and your baby. " Changes with time zones are very hard for infants and young kids to reorient to," says Dr. Burkhardt. "Parents should be prepared that the child may act differently: They may sleep slightly less or more, they may eat slightly less or more, because their routine has been interrupted. Give them some grace in that."

A mother's own health

Just as there are many medical reasons why a newborn shouldn't fly, a new mom should also keep her health in mind before traveling postpartum . C-section incisions or perineal tears that still have stitches might make it painful to spend a lot of time in an airplane seat with a seatbelt on, while postpartum bleeding (and the accompanying diaper or pads) can also make things uncomfortable. Additionally, "Moms who have had surgical deliveries tend to have more gas at high altitudes, and with the changes in pressure, you might get more abdominal distension and pain," Dr. Nielsen-Saines says. 

A lack of sleep, too, brought on not only by parenting an infant but also disruptions in routine and potential time zone changes can impact a parent's immune system, she adds. "It takes a toll on your immune system to be fatigued," Dr. Nielsen-Saines explains. "There's an association between [exhaustion] and being more prone to respiratory infections." 

This can ultimately affect your baby: "When the parents get sick, it's more likely the child will get sick. It all goes together."

Even with these concerns in mind, there will always be reasons – and desire – to fly with a baby. Thankfully, there are ways to mitigate some of the risks:

Sanitize everything. Bring some easily accessible sanitizer bottles or wipes to clean off your own hands, baby's hands, tray tables, windows, armrests, and anything else a kid might touch. 

Keep your distance. "Avoid the more crowded places in the airport while you're waiting, to the extent that you can, to decrease exposures whenever possible," Dr. Burkhardt says. When you're on the plane, keep the overhead fan on for extra ventilation. 

Stay hydrated.  "It is easier to dehydrate on a plane, as the environmental conditions are different and the air is very dry," says Dr. Nielsen-Saines. Dehydration can cause health problems including dizziness, fatigue, and headaches, and even a mild case can make an uncomfortable situation feel worse. Make sure both you and your baby get enough fluids while flying.

Layer up. "Dress your child in layers, because temperatures are super variable [on flights]," adds Dr. Burkhardt. 

Consider headphones. The background noise on an airplane won't harm your infant's ears – it might even prove soothing . But if your baby is particularly noise-sensitive, consider using noise-canceling headphones made for infants, Dr. Burkhardt advises. (That said, the need to wrestle them onto a baby's head, and keep them there, might prove another obstacle to peaceful rest. )

One common bit of advice that Dr. Burkhardt urges parents not to take? "Sometimes parents ask us about medicating the baby for a flight , with, say, Benadryl, and that is something that we would recommend against," she says. "That would not be a way to help a baby sleep." Otherwise, buckle up you and your baby, and buckle down – you got this. 

As for my own journey, flying with the little guy was stressful in all the ways I’d imagined, and some I hadn’t (trying to remove him from the carrier while also opening all our bags while also removing my shoes when going through security, for one!). We consulted with our pediatrician, donned masks, sanitized hands and toys and tray tables, nursed often, and ultimately kept every possible finger crossed. Our baby stayed healthy, and getting that moment with my grandmother near a twinkly Christmas tree was absolutely priceless. 

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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organizations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies .

American Academy of Pediatrics. Tips for Traveling with Young Ones this Holiday Season. https://www.aap.org/en/news-room/news-releases/health--safety-tips/american-academy-of-pediatrics-tips-for-traveling-with-young-ones-this-holiday-season/ Opens a new window [Accessed January 2024]

Delta. Infant Air Travel. https://www.delta.com/us/en/children-infant-travel/infant-travel Opens a new window [Accessed January 2024]

American Airlines. Traveling with children. https://www.aa.com/i18n/travel-info/special-assistance/traveling-children.jsp Opens a new window [Accessed January 2024]

United Airlines. Traveling with children. https://www.united.com/en/us/fly/travel/accessibility-and-assistance/traveling-with-children.html Opens a new window [Accessed January 2024]

JetBlue. Traveling with lap infants. https://www.jetblue.com/help/traveling-with-lap-infants Opens a new window [Accessed January 2024]

Southwest Airlines. Traveling with an infant. https://www.southwest.com/help/flying-with-children/flying-with-infants Opens a new window [Accessed January 2024]

Mary Carol Burkhardt, M.D., M.H.A. Opens a new window , a primary care pediatrician with the division of general and community pediatrics at Cincinnati Children's Hospital

Karin Nielsen-Saines, M.D. Opens a new window , a professor of clinical pediatrics in the division of infectious diseases at UCLA Children's Hospital

Kaitlin Menza is a contributing writer at BabyCenter. After over a decade in New York City, she recently relocated to Taipei, Taiwan.

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Traveling with Children

All passengers are required to undergo screening. However, TSA has developed modified screening procedures for children who appear to be 12 years old and younger. TSA officers will consult parents or the traveling guardian about the child’s screening.

TSA standard screening procedures apply for children 13 years and older. Carry-on property of all passengers, regardless of age, must be screened. All passengers who alarm will undergo additional screening.

Children with Medical Conditions, Disabilities, or Mobility Aids

Inform the TSA officer if the child has a disability, medical condition or medical device.

Let the TSA officer know if your child is able to walk through the metal detector or needs to be carried through the metal detector by a parent/guardian. You may carry your child through the WTMD. The TSA officer will not remove your child from their mobility aid, wheelchair or scooter.

Request Assistance

TSA Cares provides information to passengers with disabilities, medical conditions and those that need additional assistance to better prepare for the security screening process. Call  TSA Cares 72 hours prior  to traveling with questions about screening policies, procedures and what to expect at the security checkpoint. You may also call to request assistance at the checkpoint.

Liquid Formula, Breast Milk, Toddler Drinks, and Baby/Toddler food (to include puree pouches)

Formula, breast milk, toddler drinks and baby/toddler food (to include puree pouches) in quantities greater than 3.4 ounces or 100 milliliters are allowed in carry-on baggage and do not need to fit within a quart-sized bag. Formula, breast milk, toddler drinks and baby/toddler food (to include puree pouches) are considered medically necessary liquids. This also applies to breast milk and formula cooling accessories, such as ice packs, freezer packs and gel packs (regardless of presence of breast milk). Your child or infant does not need to be present or traveling with you to bring breast milk, formula and/or related supplies.

Inform the TSA officer at the beginning of the screening process that you are carrying formula, breast milk, toddler drinks and baby/toddler food (to include puree pouches) in excess of 3.4 ounces. Remove these items from your carry-on bag to be screened separately from your other belongings. TSA officers may need to test the liquids for explosives or concealed prohibited items.

It’s helpful to the officers when formula and breast milk are in clear, translucent bottles and not plastic bags or pouches. Liquids in plastic bags or pouches may not be able to be screened by Bottle Liquid Scanners, and you may be asked to open them (if feasible) for alternate screening such as Explosive Trace Detection and Vapor Analysis for the presence of liquid explosives. Screening will never include placing anything into the medically necessary liquid.

TSA X-ray machines are not harmful to food or medicines. However, if you do not want the formula, breast milk, toddler drinks, and baby/toddler food (to include puree pouches) to be X-rayed or opened, please inform the TSA officer. Additional steps will be taken to resolve alarms. You or the traveling guardian will undergo additional screening procedures, to include Advanced Imaging Technology screening and additional/enhanced screening of other carry-on property.

Ice packs, freezer packs, frozen gel packs and other accessories required to cool formula, breast milk, toddler drinks and baby/toddler food (to include puree pouches) – regardless of the presence of breast milk – are also allowed in carry-ons, along with liquid-filled teethers. If these items are partially frozen or slushy, they are subject to the same screening as described above.

Passengers requiring special accommodations or concerned about the security screening process at the airport may request assistance by contacting  TSA Cares  or by phone at (855) 787-2227.

Screening of Children’s Items

• Place all carry-on baggage such as children's toys, bags and blankets on the X-ray belt for screening.
• Strollers, umbrella-strollers, baby carriers, car and booster seats and backpacks must be screened by X-ray.
• Place items in the stroller pockets or baskets, in a carry-on bag or on the X-ray belt for screening.
• Equipment that does not fit through the X-ray machine will undergo a visual/physical inspection by TSA officers.

Screening Technology

Walk-Through Metal Detector

Children able to walk through the metal detector without assistance may do so separately from their parent or guardian. If they alarm, children are allowed multiple passes through screening technologies and may undergo other procedures to resolve the alarm to reduce the need for a pat-down. Infants and small children may be carried through the metal detector. Should the alarm sound, additional screening is required.

Advanced Imaging Technology

If your child is able to remain standing in the required position for 5 seconds, he or she may be screened through the advanced imaging technology. If a child 12 and under goes through the machine and alarms, they have an opportunity to go through again or the TSA officer may use other procedures to resolve the alarm to reduce the need for a pat-down.

You may not be screened by this technology when carrying an infant or child.

Screening your Child

• Children 12 and under can leave their shoes, light jackets and headwear on during screening. For AIT screening, light jackets must be removed and placed on the X-ray belt.
• Children will not be separated from their parent/guardian.
• Remove infants and children from strollers and car seats and carry them in arms through the walk-through metal detector.
• Infants may be carried in a sling/carrier (to include lap baby) through the walk-through metal detector or when being screened in a wheelchair, but may be subject to additional screening
• Modified screening procedures are in place to reduce the likelihood of a pat-down.

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• Section 7 - Travel & Breastfeeding
• Section 7 - Vaccine Recommendations for Infants & Children

Traveling Safely with Infants & Children

Cdc yellow book 2024.

Author(s): Michelle Weinberg, Nicholas Weinberg, Susan Maloney

Children increasingly are traveling and living outside their home countries. Although data about the incidence of pediatric illnesses associated with international travel are limited, the risks that children face when traveling are likely similar to those faced by their adult travel companions.

Compared with adults, however, children are less likely to receive pretravel advice. In a review of children with posttravel illnesses seen at clinics in the GeoSentinel Global Surveillance Network, 51% of all children and 32% of children visiting friends and relatives (VFRs) had received pretravel medical advice, compared with 59% of adults. The most commonly reported health problems among child travelers are dermatologic conditions, including animal and arthropod bites, cutaneous larva migrans, and sunburn; diarrheal illnesses; respiratory disorders; and systemic febrile illnesses, especially malaria.

Motor vehicle and water-related injuries, including drowning, are other major health and safety concerns for child travelers. See Box 7-03 for recommendations on assessing and preparing children for planned international travel.

Box 7-03 Assessing & preparing children for international travel: a checklist for health care providers

☐ Review travel-related and routine childhood vaccinations. The pretravel visit is an opportunity to ensure that children are up to date on their routine vaccinations.

☐ Assess all anticipated travel-related activities.

☐ Provide preventive counseling and interventions tailored to specific risks, including special travel preparations and any treatment required for infants and children with underlying health conditions, chronic diseases, or immunocompromising conditions.

☐ For children who require medications to manage chronic health conditions, caregivers should carry a supply sufficient for the trip duration.

☐ For adolescents traveling in a student group or program (see also Sec. 9, Ch. 8, Study Abroad & Other International Student Travel ), consider providing counseling on the following:

• Disease prevention
• Drug and alcohol use
• Empiric treatment and management of common travel-related illnesses
• Risks of sexually transmitted infections and sexual assault

☐ Give special consideration to travelers visiting friends and relatives in low- and middle-income countries and assess risks for malaria, intestinal parasites, and tuberculosis.

☐ Consider advising adults traveling with children and older children to take a course in basic first aid before travel.

☐ For coronavirus disease 2019 (COVID-19) safety measures for children—including mask use, testing, and vaccination—see Sec. 5, Part 2, Ch. 3, COVID-19 .

Travel-Associated Infections & Diseases

Arboviral infections.

Pediatric VFR travelers with frequent or prolonged travel to areas where arboviruses (e.g., chikungunya, dengue, Japanese encephalitis, yellow fever, and Zika viruses) are endemic or epidemic could be at increased risk for infection. Children traveling to areas with arboviruses should use the same mosquito protection measures described elsewhere in this chapter (also see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods ). Unlike mosquitoes that transmit malaria, the Aedes mosquitoes that transmit chikungunya, dengue, yellow fever, and Zika are aggressive daytime biters; they also bite at night, especially in areas with artificial light. Consider dengue or other arboviral infections in children with fever if they recently returned from travel in endemic areas. Vaccination against dengue, tick-borne encephalitis, and yellow fever could be indicated for some children (see Sec. 7, Ch. 4, Vaccine Recommendations for Infants & Children , for details).

Diarrhea & Vomiting

Diarrhea and associated gastrointestinal illnesses are among the most common travel-related problems affecting children. Infants and children with diarrhea can become dehydrated more quickly than adults. The etiology of travelers’ diarrhea (TD) in children is similar to that in adults (see Sec. 2, Ch. 6, Travelers’ Diarrhea ).

Adults traveling with children should ensure the children follow safe food and water precautions and frequently wash their hands to prevent foodborne and waterborne illness. For infants, breastfeeding is the best way to reduce the risk for foodborne and waterborne illness (see Sec. 7, Ch. 2, Travel & Breastfeeding ). Infant formulas available abroad might not have the same nutritional composition or be held to the same manufacturing safety standards as in the traveler’s home country; parents feeding their child formula should consider whether they need to bring formula from home. If the infant is fed with formula, travelers should consider using liquid formula, which is sterile. Use of powdered infant formula has been associated with Cronobacter infection; infants <3 months old, infants born prematurely, and infants with weakened immune systems are at greatest risk. Parents should take extra precautions for preparing powdered infant formula .

Travelers should disinfect water served to young children, including water used to prepare infant formula (see Sec. 2, Ch. 8, Food & Water Precautions , and Sec. 2, Ch. 9, Water Disinfection , for details on safety practices). In some parts of the world, bottled water could be contaminated and should be disinfected to kill bacteria, viruses, and protozoa before consumption.

Similarly, travelers with children should diligently follow food precautions and ensure foods served to children are cooked thoroughly and eaten while still hot; caregivers should peel fruits typically eaten raw immediately before consumption. Additionally, adults should use caution with fresh dairy products, which might not be pasteurized or might be diluted with untreated water. For short trips, parents might want to bring a supply of safe snacks from home for times when children are hungry and available food might not be appealing or safe (see Sec. 2, Ch. 8, Food & Water Precautions , for more information).

Adult travelers with children should pay scrupulous attention that potable water is used for handwashing and cleaning bottles, pacifiers, teething rings, and toys that fall to the floor or are handled by others. After diaper changes, especially for infants with diarrhea, parents should be particularly careful to wash hands well to avoid spreading infection to themselves and other family members. When proper handwashing facilities are not available, hand sanitizer containing ≥60% alcohol can be used as a disinfecting agent. Because alcohol-based hand sanitizers are not effective against certain pathogens, however, adults and children should wash hands with soap and water as soon as possible. In addition, alcohol does not remove organic material, and people should wash visibly soiled hands with soap and water.

Chemoprophylaxis with antibiotics is not generally used in children; typhoid vaccine might be indicated, however (see Sec. 5, Part 1, Ch. 24, Typhoid & Paratyphoid Fever ).

Antibiotics

Azithromycin.

Few data are available regarding empiric treatment of TD in children. Antimicrobial options for empiric treatment of TD in children are limited. In practice, when an antibiotic is indicated for moderate to severe diarrhea, some clinicians prescribe azithromycin as a single daily dose (10 mg/kg) for 3 days. Clinicians can prescribe unreconstituted azithromycin powder before travel, with instructions from the pharmacist for mixing it into an oral suspension prior to administration. Although resistance breakpoints have not yet been determined, elevated minimum inhibitory concentrations for azithromycin have been reported for some gastrointestinal pathogens. Therefore, counsel parents to seek medical attention for their children if they do not improve after empiric treatment. Before prescribing azithromycin for empiric TD treatment, review possible contraindications and the risks for adverse reactions (e.g., QT prolongation and cardiac arrhythmias).

Fluoroquinolones

Although fluoroquinolones frequently are used for empiric TD treatment in adults, these medications are not approved by the US Food and Drug Administration (FDA) for this purpose in children aged <18 years because of cartilage damage seen in animal studies. The American Academy of Pediatrics (AAP) suggests that fluoroquinolones be considered for treatment of children with severe infections caused by multidrug-resistant strains of Campylobacter jejuni , Salmonella species, Shigella species, or Vibrio cholerae .

Fluoroquinolone resistance in gastrointestinal organisms has been reported from some countries, particularly in Asia. In addition, use of fluoroquinolones has been associated with tendinopathies, development of Clostridioides difficile infection, and central nervous system side effects including confusion and hallucinations. Routine use of fluoroquinolones for prophylaxis or empiric treatment for TD among children is not recommended.

Rifaximin is approved for use in children aged ≥12 years but has limited use for empiric treatment since it is only approved to treat noninvasive strains of Escherichia coli . Children with bloody diarrhea should receive medical attention, because antibiotic treatment of enterohemorrhagic E. coli , a cause of bloody diarrhea, has been associated with increased risk for hemolytic uremic syndrome (see Sec. 5, Part 1, Ch. 7, Diarrheagenic Escherichia coli ).

Antiemetics & Antimotility Drugs

Antiemetics generally are not recommended for self- or family-administered treatment of children with vomiting and TD. Because of the association between salicylates and Reye syndrome, bismuth subsalicylate (BSS), the active ingredient in both Pepto-Bismol and Kaopectate, is not generally recommended to treat diarrhea in children <12 years old. In certain circumstances, however, some clinicians use it off-label, with caution. Care should be taken if administering BSS to children with viral infections (e.g., influenza, varicella), because of the risk for Reye syndrome. BSS is not recommended for children aged <3 years.

Use of antiemetics for children with acute gastroenteritis is controversial; some clinical practice guidelines include the use of antiemetics, others do not. A Cochrane Collaboration Review of the use of antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents showed some benefits with dimenhydrinate, metoclopramide, or ondansetron. Guidelines from the Infectious Diseases Society of America suggest that an antinausea and antiemetic medication (e.g., ondansetron) can facilitate tolerance of oral rehydration in children >4 years of age, and in adolescents with acute gastroenteritis.

A recent systematic review and network meta-analysis comparing several antiemetics in acute gastroenteritis in children showed that ondansetron was the best intervention to reduce vomiting and prevent hospitalization and the need for intravenous rehydration. Routine use of these medications as part of self-treatment for emesis associated with TD in children has not yet been studied, however, and is not generally recommended.

Antimotility drugs (e.g., the opioid receptor agonists loperamide and diphenoxylate), generally should not be given to children <18 years of age with acute diarrhea. Loperamide is particularly contraindicated for children aged <2 years because of the risks for respiratory depression and serious cardiac events. Diphenoxylate and atropine combination tablets should not be used for children aged <2 years, and should be used judiciously in older children because of potential side effects (see Sec. 2, Ch. 6, Travelers’ Diarrhea ).

Fluid & Nutrition Management

The biggest threat to an infant with diarrhea and vomiting is dehydration. Fever or increased ambient temperature increases fluid loss and accelerates dehydration. Advise adults traveling with children about the signs and symptoms of dehydration and the proper use of oral rehydration solution (ORS). Advise adults traveling with children to seek medical attention for an infant or young child with diarrhea who has signs of moderate to severe dehydration, bloody diarrhea, body temperature >101.3°F (38.5°C), or persistent vomiting (unable to maintain oral hydration). Adequate hydration is the mainstay of TD management.

Oral Rehydration Solution: Use & Availability

Counsel parents that dehydration is best prevented and treated by ORS in addition to the infant’s usual food. While seeking medical attention, caregivers should provide ORS to infants by bottle, cup, oral syringe (often available in pharmacies), or spoon. Low-osmolarity ORS is the most effective agent in preventing dehydration, although other formulations are available and can be used if they are more palatable to young children. Homemade sugar-salt solutions are not recommended.

Sports drinks are designed to replace water and electrolytes lost through sweat, and do not contain the same proportions of electrolytes as the solution recommended by the World Health Organization for rehydration during diarrheal illness. Drinks with a high sugar content (e.g., juice, soft drinks) can worsen diarrhea. If ORS is not readily available, however, offer children whatever safe liquid they will take until ORS is obtained. Breastfed infants should continue to breastfeed (for more details, see Sec. 7, Ch. 2, Travel & Breastfeeding ).

ORS can be made from prepackaged glucose and electrolytes packets available at stores or pharmacies in almost all countries. Some pharmacies and stores that specialize in outdoor recreation and camping supplies also sell ORS packets.

ORS is prepared by adding 1 packet to boiled or treated water (see Sec. 2, Ch. 9, Water Disinfection ). Advise travelers to check packet instructions carefully to ensure that the contents are added to the correct volume of water. Once prepared, ORS should be consumed or discarded within 12 hours if held at room temperature, or within 24 hours if kept refrigerated. A dehydrated child will usually drink ORS avidly and should continue to receive ORS if dehydration persists.

As dehydration lessens, the child might refuse the salty-tasting ORS, and adults can offer other safe liquids. An infant or child who has been vomiting will usually keep ORS down if it is offered by spoon or oral syringe in small sips; adults should offer these small sips frequently, however, so the child can receive an adequate volume of ORS. Older children will often drink well by sipping through a straw. Severely dehydrated children often will be unable to drink adequately. Severe dehydration is a medical emergency that usually requires administration of fluids by intravenous or intraosseous routes.

In general, children weighing <22 lb (10 kg) who have mild to moderate dehydration should be administered 2–4 oz (60–120 mL) of ORS for each diarrheal stool or vomiting episode. Children who weigh ≥22 lb (10 kg) should receive 4–8 oz (120–240 mL) of ORS for each diarrheal stool or vomiting episode. AAP provides detailed guidance on rehydration for vomiting and diarrhea.

Diet Modification

Breastfed infants should continue nursing on demand. Formula-fed infants should continue their usual formula during rehydration and should receive a volume sufficient to satisfy energy and nutrient requirements. Lactose-free or lactose-reduced formulas usually are unnecessary. Diluting formula can slow resolution of diarrhea and is not recommended.

Older infants and children receiving semisolid or solid foods should continue to receive their usual diet during the illness. Recommended foods include cereals, fruits and vegetables, starches, and pasteurized yogurt. Travelers should avoid giving children food high in simple sugars (e.g., undiluted apple juice, presweetened cereals, gelatins, soft drinks) because these can exacerbate diarrhea by osmotic effects. In addition, foods high in fat tend to delay gastric emptying, and thus might not be well tolerated by ill children.

Travelers should not withhold food for ≥24 hours. Early feeding can decrease changes in intestinal permeability caused by infection, reduce illness duration, and improve nutritional outcome. Although highly specific diets (e.g., the BRAT [bananas, rice, applesauce, toast] diet) or juice-based and clear fluid diets commonly are recommended, such severely restrictive diets have no scientific basis and should be avoided.

Malaria is among the most serious and life-threatening infections acquired by pediatric international travelers. Pediatric VFR travelers are at particularly high risk for malaria infection if they do not receive prophylaxis. Among people reported with malaria in the United States in 2017, 17% were children <18 years old; 89% had traveled to Africa. Seventy percent of the children who were US residents also were VFR travelers, and 61% did not take malaria chemoprophylaxis.

Children with malaria can rapidly develop high levels of parasitemia and are at increased risk for severe complications of malaria, including seizures, coma, and death. Initial symptoms can mimic many other common causes of pediatric febrile illness, which could delay diagnosis and treatment. Among 33 children with imported malaria diagnosed at 11 medical centers in New York City, 11 (32%) had severe malaria and 14 (43%) were initially misdiagnosed. Counsel adults traveling with children to malaria-endemic areas to use preventive measures, be aware of the signs and symptoms of malaria, and seek prompt medical attention if symptoms develop.

Antimalarial Drugs

Pediatric doses for malaria prophylaxis are provided in Table 5-27 . Calculate dosing based on body weight. Medications used for infants and young children are the same as those recommended for adults, except atovaquone-proguanil, which should not be used for prophylaxis in children weighing <5 kg because of lack of data on safety and efficacy. Doxycycline should not be recommended for malaria prophylaxis for children aged <8 years. Although doxycycline has not been associated with dental staining when given as a routine treatment for some infections, other tetracyclines might cause teeth staining.

Atovaquone-proguanil, chloroquine, and mefloquine have a bitter taste. Mixing pulverized tablets in a small amount of food or drink can facilitate the administration of antimalarial drugs to infants and children. Clinicians also can ask compounding pharmacists to pulverize tablets and prepare gelatin capsules with calculated pediatric doses. A compounding pharmacy can alter the flavoring of malaria medication tablets so that children are more willing to take them. The Find a Compounder section on the Alliance for Pharmacy Compounding website (281-933-8400) can help with finding a compounding pharmacy. Because overdose of antimalarial drugs, particularly chloroquine, can be fatal, store medication in childproof containers and keep out of the reach of infants and children.

Personal Protective Measures & Repellent Use

Children should sleep in rooms with air conditioning or screened windows, or sleep under mosquito nets when air conditioning or screens are not available. Mosquito netting should be used over infant carriers. Children can reduce skin exposed to mosquitoes by wearing long pants and long sleeves while outdoors. Clothing and mosquito nets can be treated with an insect repellent/insecticide (e.g., permethrin) that repels and kills ticks, mosquitoes, and other arthropods. Permethrin remains effective through multiple washings. Clothing and mosquito nets should be retreated according to the product label. Permethrin should not be applied to the skin.

Although permethrin provides a longer duration of protection, recommended repellents that can be applied to skin also can be used on clothing and mosquito nets (see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods , for more details about these protective measures). The Centers for Disease Control and Prevention (CDC) recommends using US Environmental Protection Agency (EPA)–registered repellents containing one of the following active ingredients: DEET ( N,N -diethyl- m -toluamide); picaridin; oil of lemon eucalyptus (OLE); PMD (para-menthane-3,8-diol); IR3535; or 2-undecanone (methyl nonyl ketone). Repellent products must state any age restriction; if no age restriction is provided, EPA has not required a restriction on the use of the product. Most EPA-registered repellents can be used on children aged >2 months, except products containing OLE or PMD that specify they should not be used on children aged <3 years. Insect repellents containing DEET, picaridin, IR3535, or 2-undecanone can be used on children without age restriction.

Many repellents contain DEET as the active ingredient. DEET concentration varies considerably between products. The duration of protection varies with DEET concentration; higher concentrations protect longer; products with DEET concentration >50% do not, however, offer a marked increase in protection time.

The EPA has approved DEET for use on children without an age restriction. If used appropriately, DEET does not represent a health problem. The AAP states that the use of products with the lowest effective DEET concentrations (i.e., 20%–30%) seems most prudent for infants and young children, on whom it should be applied sparingly. For more tips on protecting babies and children from mosquito bites , see  Box 7-04 .

Combination products containing repellents and sunscreen are generally not recommended because instructions for use are different, and sunscreen might need to be reapplied more often and in larger amounts than repellent. In general, apply sunscreen first, and then apply repellent. Mosquito coils should be used with caution in the presence of children to avoid burns and inadvertent ingestion. For detailed information about repellent use and other protective measures, see Sec. 4, Ch. 6, Mosquitoes, Ticks & Other Arthropods .

Box 7-04 Protecting infants & children from mosquito bites: recommendations for travelers

Dress children in clothing that covers arms and legs.

Cover strollers and baby carriers with mosquito netting.

Properly use insect repellent

• Always follow all label instructions.
• In general, do not use products containing oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD) on children <3 years old.
• Do not apply insect repellent to a child’s hands, eyes, mouth, cuts, or irritated skin.
• Adults should spray insect repellent onto their hands and then apply to a child’s face.

Depending on travel destination and activities, animal exposures and bites might be a health risk for pediatric travelers. Worldwide, rabies is more common in children than adults. In addition to the potential for increased contact with animals, children also are more likely to be bitten on the head or neck, leading to more severe injuries. Counsel children and their families to avoid all stray or unfamiliar animals and to inform adults of any animal contact or bites. Bats throughout the world have the potential to transmit rabies virus.

Travelers should clean all bite and scratch wounds as soon as possible after the event occurs by using soap and water, or povidine iodine if available, for ≥20 minutes to prevent infections, (e.g., rabies). Wounds contaminated with necrotic tissue, dirt, or other foreign materials should be cleaned and debrided promptly by health care professionals, where possible. A course of antibiotics might be appropriate after animal bites or scratches, because these can lead to local or systemic infections. For mammal bites and scratches, children should be evaluated promptly to assess their need for rabies postexposure prophylaxis (see Sec. 4, Ch. 7, Zoonotic Exposures: Bites, Stings, Scratches & Other Hazards ; and Sec. 5, Part 2, Ch. 18, Rabies ).

Because rabies vaccine and rabies immune globulin might not be available in certain destinations, encourage families traveling to areas with high risk for rabies exposure to seriously consider preexposure rabies vaccination and to purchase medical evacuation insurance, depending on their destination and planned travel activities (see Sec. 7, Ch. 4, Vaccine Recommendations for Infants & Children , and Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Soil & Water Contact: Infections & Infestations

Children are more likely than adults to have contact with soil or sand, and therefore could be exposed to diseases caused by infectious stages of parasites in soil, including ascariasis, hookworm, cutaneous or visceral larva migrans, strongyloidiasis, and trichuriasis. Children and infants should wear protective footwear and play on a sheet or towel rather than directly on the ground. Clothing should not be dried on the ground. In countries with a tropical climate, clothing or diapers dried in the open air should be ironed before use to prevent infestation with fly larvae.

Schistosomiasis is a risk to children and adults in endemic areas. While in schistosomiasis- endemic areas (see Sec. 5, Part 3, Ch. 20, Schistosomiasis ), children should not bathe, swim, or wade in fresh, unchlorinated water (e.g., lakes, ponds).

Noninfectious Hazards & Risks

Although air travel is safe for most newborns, infants, and children, people traveling with children should consider a few issues before departure. Children with chronic heart or lung problems might be at risk for hypoxia during flight, and caregivers should consult a clinician before travel.

Ear pain can be troublesome for infants and children during descent. Pressure in the middle ear can be equalized by swallowing or chewing; thus, infants should nurse or suck on a bottle, and older children can try chewing gum. Antihistamines and decongestants have not been shown to be of benefit. No evidence suggests that air travel exacerbates the symptoms or complications associated with otitis media.

Travel to different time zones, jet lag, and schedule disruptions can disturb sleep patterns in infants and children, just as in adults (Sec. 8, Ch. 4, Jet Lag ).

Safety Restraints

Travelers also should ensure that children can be restrained safely during a flight. Severe turbulence or a crash can create enough momentum that an adult cannot hold onto a child. The safest place for a child on an airplane is in a government-approved child safety restraint system (CRS) or device. The Federal Aviation Administration (FAA) strongly urges travelers to secure children in a CRS for the duration of the flight. Car seats cannot be used in all seats or on all planes, and some airlines might have limited safety equipment available. Travelers should check with the airline about specific restrictions and approved child restraint options. FAA provides additional information .

Altitude Illness & Acute Mountain Sickness

Children are as susceptible to the deleterious effects of high elevation travel as adults (see Sec. 4, Ch. 5, High Elevation Travel & Altitude Illness ). Slow ascent is the preferable approach for avoiding acute mountain sickness (AMS). Young children unable to talk can show nonspecific symptoms (e.g., loss of appetite or irritability, unexplained fussiness, changes in sleep and activity patterns). Older children might complain of headache or shortness of breath. If children demonstrate unexplained symptoms after an ascent, descent could be necessary.

Acetazolamide is not approved for pediatric use in children aged <12 years for altitude illness but is generally safe for use in children for other indications. Some providers prescribe acetazolamide to prevent AMS in pediatric travelers <12 years of age when a slow ascent is not feasible. The dose is 2.5 mg/kg every 12 hours, up to a maximum of 125 mg per dose, twice a day. No liquid formulation is available, but tablets can be crushed or packaged by a compounding pharmacy for a correct dose.

Drinking Water Contaminants

Drinking water disinfection does not remove environmental contaminants (e.g., lead or other metals). Travelers might want to carry specific filters designed to remove environmental contaminants, particularly for travel where the risk for exposure is greater due to larger amounts of water consumed (e.g., long-term travel or when living abroad). Filters should meet National Science Foundation (NSF) and American National Standards Institute (ANSI) standards 53 or 58 .

Accommodations: Hotels & Other Lodgings

Conditions at hotels and other lodgings abroad might not be as safe as those in the United States; adults traveling with children should carefully inspect accommodations for paint chips, pest poisons, inadequate balcony or stairway railings, or exposed wiring.

Adult caregivers should plan to provide a safe sleeping environment for infants during international travel. Caregivers should follow general recommendations from the AAP task force on preventing sudden infant death syndrome (SIDS) and other sleep-related causes of infant death. Cribs in some locations might not meet US safety standards. Additional information about crib safety is available from the US Consumer Product Safety Commission .

Motor Vehicles

Vehicle-related injuries are the leading cause of death in children who travel. Whenever traveling in an automobile or other vehicle, children should be properly restrained in a car seat, booster seat, or with a seat belt, as appropriate for their age, height, and weight. See information about child passenger safety . Car seats often must be brought from home because well-maintained and approved seats might not be available (or limited in availability) in other countries.

In general, children ≤12 years of age are safest when properly buckled in the rear seat of the car while traveling; no one should ever travel in the bed of a pickup truck. Advise families that cars might lack front or rear seatbelts in many low- and middle-income countries. Traveling families should attempt to arrange transportation or rent vehicles with seatbelts and other safety features.

All family members should wear helmets when riding bicycles, motorcycles, or scooters. Pedestrians should take caution when crossing streets, particularly in countries where cars drive on the left, because children might not be used to looking in that direction before crossing.

Water-Related Injuries & Drowning

Drowning is the second leading cause of death in young travelers. Children might not be familiar with hazards in the ocean or in rivers. Swimming pools might not have protective fencing to keep toddlers and young children from accessing pool areas unattended. Adults should closely supervise children around water. An adult with swimming skills should be within an arm’s length when infants and toddlers are in or around pools and other bodies of water; even for older children and better swimmers, the supervising adult should focus on the child and not be engaged with any distracting activities.

Water safety devices (e.g., personal flotation devices [lifejackets]) might not be available abroad, and families should consider bringing these from home. In addition, adults should ensure children wear protective footwear to avoid injury in many marine environments.

Sun Exposure

Sun exposure, and particularly sunburn before age 15 years, is strongly associated with melanoma and other forms of skin cancer (see Sec. 4, Ch. 1, Sun Exposure ). Exposure to ultraviolet (UV) light is greatest near the equator, at high elevations, during midday (10 a.m.–4 p.m.), and where light is reflected off water or snow.

Physical, also known as inorganic, UV filters (sunscreens) generally are recommended for children aged >6 months. Less irritating to children’s sensitive skin than chemical sunscreens, physical UV filters (e.g., titanium oxide, zinc oxide) should be applied as directed and reapplied as needed after sweating and water exposure. Babies aged <6 months require extra protection from the sun because of their thinner and more sensitive skin; severe sunburn in young infants is considered a medical emergency.

Advise parents that babies should be kept in the shade and dressed in clothing that covers the entire body. A minimal amount of sunscreen can be applied to small, exposed areas, including the infant’s face and hands. For older children, sun-blocking shirts made for swimming preclude having to apply sunscreen over the entire trunk. Hats and sunglasses also reduce sun injury to skin and eyes.

If both sunscreen and a DEET-containing insect repellent are used, apply the sunscreen first and the insect repellent second (i.e., over the sunscreen). Because insect repellent can diminish the level of UV protection provided by the sunscreen by as much as one-third, children should also wear sun-protective clothing, reapply sunscreen, or decrease their time in the sun, accordingly.

Other Considerations

Identification.

In case family members become separated, each infant or child should carry identifying information and contact numbers in their clothing or pockets. Because of concerns about illegal transport of children across international borders, parents traveling alone with children should carry relevant custody papers or a notarized permission letter from the other parent.

As with adult travelers, verify insurance coverage for illnesses and injuries while abroad before departure. Travelers should consider purchasing special medical evacuation insurance for an airlift or air ambulance transport to facilities capable of providing adequate medical care (see Sec. 6, Ch. 1, Travel Insurance, Travel Health Insurance & Medical Evacuation Insurance ).

Travel Stress

Changes in schedule, activities, and environment can be stressful for children. Travelers can help decrease these stresses by including children in planning for the trip and bringing along familiar toys or other objects. For children with chronic illnesses, make decisions regarding timing and itinerary in consultation with the child’s health care providers.

The following authors contributed to the previous version of this chapter: Michelle S. Weinberg, Nicholas Weinberg, Susan A. Maloney

Bibliography

Ashkenazi S, Schwartz E. Traveler’s diarrhea in children: new insights and existing gaps. Travel Med Infect Dis. 2020;34:101503.

Fedorowicz Z, Jagannath VA, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. Cochrane Database Syst Rev. 2011;2011(9):CD005506.

Goldman-Yassen AE, Mony VK, Arguin PM, Daily JP. Higher rates of misdiagnosis in pediatric patients versus adults hospitalized with imported malaria. Pediatr Emerg Care. 2016;32(4):227–31.

Hagmann S, LaRocque R, Rao S, Jentes E, Sotir M, Brunette G, et al.; Global TravEpiNet Consortium. Pre-travel health preparation of pediatric international travelers: analysis from the Global TravEpiNet Consortium. J Pediatric Infect Dis Soc. 2013;2(4):327–34.

Hagmann S, Neugebauer R, Schwartz E, Perret C, Castelli F, Barnett ED, et al. Illness in children after international travel: analysis from the GeoSentinel Surveillance Network. Pediatrics. 2010;125(5):e1072–80.

Han P, Yanni E, Jentes E, Hamer D, Chen L, Wilson M, et al. Health challenges of young travelers visiting friends and relatives compared with those traveling for other purposes. Pediatr Infect Dis J. 2012;31(9):915–9.

Herbinger KH, Drerup L, Alberer M, Nothdurft HD, Sonnenburg F, Loscher T. Spectrum of imported infectious diseases among children and adolescents returning from the tropics and subtropics. J Travel Med. 2012;19(3):150–7.

Hunziker T, Berger C, Staubli G, Tschopp A, Weber R, Nadal D, et al. Profile of travel-associated illness in children, Zurich, Switzerland. J Travel Med. 2012;19(3):158–62.

Mace K, Lucchi N, Tan K. Malaria surveillance—United States, 2017. MMWR Surveill Summ. 2021;70(2):1–40.

Niño-Serna LF, Acosta-Reyes J, Veroniki AA, Florez ID. Antiemetics in children with acute gastroenteritis: a meta-analysis. Pediatrics. 2020;145(4):e20183696.

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Home / Parenting, Kids & Teens / Air travel with an infant

Air travel with an infant

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Your first flight with your child will likely be a lot different from your previous flights. Instead of worrying about whether you have enough reading material, you may now be worried about entertaining your baby or toddler. While there’s no telling how your baby will react to his or her first time on an airplane, careful planning can go a long way toward calming you and your child’s nerves.

Identification

  For domestic travel, consider bringing a copy of your child’s birth certificate with you. If leaving the country, your child will need a passport. If you know you’ll be traveling outside of the country with your child in the future, consider applying as soon as possible. The application process can typically be expedited for a fee.

Seat safety

  Although airlines typically allow infants to ride on a caregiver’s lap during flight, the Federal Aviation Administration recommends that infants ride in properly secured safety seats. Most infant car seats are certified for air travel.

  In order for your little one to travel in a car seat on the plane, your child will need his or her own seat. Though airlines typically will let you use an empty seat if available, the only way to guarantee a seat for your child is to purchase a ticket. When booking your flights, check if there are any discounts for infant children.

Keep in mind that car seats must be secured in a window seat so other passengers will be able to exit the row. If you purchase a seat for your child, FAA strongly encourages that your child remains in the seat with the seatbelt firmly fastened during the duration of the flight. This can be a challenge if your child is crying and you want to hold him or her, especially during takeoff and landing. Airlines typically allow a child under 2 to be held on your lap, but the policy varies by airline.

If you don’t bring a car seat for your child on the plane, ask the flight attendant for instructions on how to hold your child during takeoff and landing. If you sit in an aisle seat with your child, be sure to protect your child’s head, hands and feet from getting bumped by service carts or other passengers.

Many traveling families seek out the bulkhead of the plane, which offers extra space. Others prefer the back of the plane, which is typically noisy enough to drown out crying and may even lull a baby to sleep. Do what makes the most sense to you.

Getting through the airport

If you plan to bring a car seat on the plane, a stroller that allows you to attach the car seat to it is a smart investment. You’ll be able to wheel your child in his or her car seat until you board the plane, at which point you can collapse the stroller base and check it at the gate. You will, however, have to take your child out of a car seat and carry him or her through security while the stroller is screened.

While the Transportation Security Administration limits the amount of fluids you can bring on a plane, exceptions are made for baby-related items, such as medications, formula, baby food and breast milk. Be sure to notify security officials about what you’re carrying and expect it to be inspected. Also, let security officials know if your child is using or has any special medical devices.

Many airlines offer families priority boarding. However, some families prefer to board last to minimize the amount of time spent on the plane.

Keeping baby happy

Dress your child in comfortable, easy-to-remove layers. This will help you keep him or her warm or cool enough and make diaper and clothing changes easy.  Bring extra clothing in a plastic, sealable bag for accidents that might occur or if your child becomes sick and vomits on the plane. Consider bringing an extra change of clothing accessible for yourself, too, in case you’re part of the accident.

Nursing or sucking on a pacifier or bottle might ease discomfort during takeoff and landing, since babies can’t intentionally “pop” their ears by swallowing or yawning to relieve ear pain caused by air pressure changes. Having extra pacifiers on hand will be helpful in case the pacifiers fall or get lost. A sippy cup of water can help a toddler with the same issue.

If your child is restless, consider taking an occasional break to walk up and down the aisle — as long as the crew approves moving throughout the cabin.

If your child is old enough to snack, have different types of snacks available and bring them out at different times during the flight. Also, consider bringing several little toys to keep your child occupied, introducing a new toy as your baby’s interest in the current toy wanes.

Although parents often joke about giving a child a sedating over-the-counter medication to induce sleep during the flight, this isn’t recommended. In some cases, the medication could end up producing the opposite effect and make your child agitated.

If your child does cry during the flight, do your best to figure out what’s wrong — just as you would at home — and try to stay calm. Chances are that many passengers on the plane have been in your situation before and likely sympathize.

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Seating Option 1: Lap for Free

Seating Option 2: Giving them their own Space

If you do decide to purchase a seat for your child, keep in mind that kid's airline tickets are often not discounted on many travel Web sites. You may need to call and ask if discounts are available when traveling with children.

Additionally, the Federal Aviation Administration (FAA) requires that children in their own seats must be in an FAA approved Child Restraint System (CRS). The FAA recommends all children fly seated in a CRS, but does not mandate that children under the age of two do so. So, as parents weigh the safety issues carefully. 

More Help & Tips on Flying with Kids

• Keeping Kids Entertained In-flight
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Traveling with children and infants.

We are committed to caring for people on life’s journey and want you and your children to have a safe and positive travel experience. To allow enough time for check-in, arrive early and be sure to have any required travel documents. You may have to present proof of age like a birth certificate for any children under the age of 18.

• Families with children under 2 years old can ask to board early at the gate.
• Only 1 carry-on diaper bag per child is allowed.

You can travel with a breast pump and small, soft-sided cooler of breast milk in addition to your carry-on or personal item. These items don’t have to be checked and are allowed even when you’re not traveling with a child. Also, most airports have nursing rooms and stations available for your convenience.

If you’re a family traveling with children under 15, we want to help make sure you’re seated together on your flight. Here are some tips for when you book:

• Be sure to book everyone in the same reservation.
• The farther in advance you book, the better. (Seats become limited closer to the day of travel.)
• On the seat map, choose seats for your entire family or skip seats for that flight.
• It’s better to skip seats than to choose just a few seats or seats scattered throughout the cabin. Our gate agents can try to reseat you but getting seats together the day of travel is difficult.

If you skip seats

If you’re unable to choose seats, don’t want to pay for seats, or chose a Basic Economy fare, our system will detect that you’re a family traveling. The system will search for seats together automatically before the day of departure. We’ll try our best to keep you together, but if seats are limited, we’ll assign seats so children under 15 are next to at least 1 adult.

Children and adults traveling in separate reservations

If you and your children are traveling together but have separate reservations, call Reservations so we can note it in each reservation.

Contact Reservations

Children 2 or older are required to have their own seat, a ticketed adult fare. Children under 5 can’t travel alone under any circumstances.

If you don't choose seats in Main Cabin or Basic Economy, we’ll assign seats a few days after you buy your tickets so children under 15 are next to at least 1 adult they’re traveling with.

We welcome infants as young as 2 days old, but infants under 7 days old must have a doctor's letter stating that they are medically cleared to travel.

Keep in mind:

• Only 1 infant may be seated in the lap of each ticketed accompanying adult and the infant must be included in the reservation.
• Additional infants under 2 years old must be ticketed and occupy an infant safety seat or in a separate aircraft seat.
• The infant must be under 2 years of age for the duration of the trip. If they turn 2 during a trip, they will need their own seat for the remainder of the trip.

Adding an infant to your trip

If you’re traveling within the U.S., including Puerto Rico, you can add an infant to your trip when you book on aa.com, or later once it is ticketed. You only need to contact Reservations if you’re traveling with an infant who is under 7 days old; or if you’re traveling outside of the U.S. (taxes and a percentage of the adult fare may apply on international trips).

Book a new trip

• Book your trip on aa.com
• Enter your information on the ‘Passenger details’ page
• Select ‘add infant in lap’

Book a trip

Update an existing trip

• Find your trip on aa.com
• Scroll to the ‘Passengers’ section

Find your trip

Call Reservations if:

• You’re traveling with an infant who is less than 7 days old
• You’re not traveling within the U.S., and Puerto Rico

Reserved seat

If your infant will travel in their own seat, you must buy a ticket. The infant must either travel in a safety seat approved by the Federal Aviation Administration (FAA) or be able to sit upright in their seat without assistance and have their seatbelt securely fastened during taxi, takeoff, landing and whenever the 'fasten seatbelt' sign is on.

Bassinets and changing tables

• Changing tables are available in the lavatories of all wide-body aircraft.
• Bassinets are available on a first come, first serve basis at the gate for travel only on 777-200, 777-300 and 787 aircraft.*
• Bassinets are not available in First / Business cabins.

*Infants using bassinets must be younger than 2 years old and weigh no more than 20lbs (9kg)

Acceptable safety seats

Most safety seats that are approved for use in motor vehicles are acceptable for use in aircraft. The seat must have a solid back and seat, restraint straps installed to securely hold the child and a label indicating approval for use on an aircraft.

The label may include:

• These notes: 'This child restraint system conforms to all Federal Motor Vehicle Safety Standards' and 'this restraint is certified for use in motor vehicles and aircrafts' or 'this restraint is certified for use in motor vehicles and aircraft.'
• Approval of a foreign government or a label showing that the seat was manufactured under the standards of the United Nations.
• The safety seat can't be used in an exit row or in the rows on either side of an exit row; window seats are preferred.
• Install the seat in the direction appropriate for the size of the child and according to the instructions on the label.
• The child must remain in the safety seat with the harness fastened during taxi, takeoff, landing and whenever the 'fasten seatbelt' sign is on.
• To carry on a safety seat, you must have bought a seat for the child, or a seat must be available next to you. If an unoccupied, adjoining seat is not available, the gate agent will check the safety seat to your final destination.

Review seat dimensions before your trip.

Safety seats are not allowed in First or Business on select planes due to the seat angles.

Airbus 321T

• Boeing 777-200
• Boeing 777-300
• Boeing 787-800
• Boeing 787-900
• Any device without an approval label
• Booster seats with no approval label or shoulder harness
• Vest and/or harness-type devices, except Aviation Child Safety Devices (ACSD) showing the FAA aircraft approval label
• Belt extensions that attach to the parent or the parent's restraint
• Any device that positions a child on the lap or chest of an adult

Carry-on and checked bags

If you’re flying internationally with an infant on your lap, we’ll issue the infant a ticket. You may check 1 bag for the infant at the same rate as the adult’s first checked bag.

• Each ticketed customer is allowed 1 stroller and 1 car seat to be checked free of charge
• Strollers over 20 lbs / 9 kgs must be checked at the ticket counter
• All other strollers should be checked at the gate before boarding
• If you have a stroller and a car seat only 1 can be checked at the gate
• Breast pumps and a small, soft-sided cooler of breast milk don’t count as your carry-on or personal item
• Play pens, wagons, cribs and 'pack and play' count as regular bags
• If any of these exceed carry-on limits they’ll be checked and incur regular fees

International documents

Children or infants traveling outside the U.S. are required to have the same documentation as an adult. If anyone under 18 is traveling internationally without both parents, they may be required to present a Letter of Consent.

International travel

Traveling during pregnancy

If your due date is within 4 weeks of your flight, you must provide a doctor’s certificate stating that you’ve been recently examined and you’re fit to fly.

Special assistance throughout your trip

For domestic flights under 5 hours, you won’t be permitted to travel within 7 days (before and after) your delivery date. If you need to travel within this time frame:

• Approval from your physician and a special assistance coordinator is required.
• Your physician will be required to fill out a passenger medical form before your flight. A special assistance coordinator will send the form directly to your physician.

Clearance from a special assistance coordinator is required for international travel or travel over water:

• Within 4 weeks of your due date (travel also requires a physician's note stating that you’ve been examined within the past 48 hours and you’re fit to fly)
• 7 days before or after your delivery (travel also requires a passenger medical form to be completed by your physician)

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Air travel safe for healthy newborns when parents take precautions

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Karl Neumann; Air travel safe for healthy newborns when parents take precautions. AAP News March 2002; 20 (3): 134–135. 10.1542/20.3.134

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Healthy newborn infants can travel safely by air. Physiologically, they are fit to fly. And major airlines have removed all restrictions that formerly banned such travel in the first few weeks of life. The restrictions stemmed from the early days of aviation and were based on the facts that the aircraft of that day were not pressurized, that oxygen was sometimes required during flights, and that little was known about newborn physiology and how infants would fare in flight. The old regulations often are still cited in travel medicine, pediatric literature and the lay press.

Dr. Neumann

Present day commercial jet airliners generally cruise at altitudes between 30,000 and 40,000 feet. The aircraft are not totally pressurized, resulting in a simulated cabin atmospheric pressure of between 5,000 and 8,000 feet. At this atmospheric pressure, the arterial blood oxygen saturation of healthy passengers of all ages decreases from near 100% at sea level to about 90% to 92%, a saturation level that is well tolerated by healthy newborns and infants. (And also is well tolerated by older children and adults. Passengers, for the most part, sit and do not exert themselves. Even flight attendants who push heavy carts up and down the aisles rarely become short of breath.) The oxygen dissociation curve is very helpful in maintaining oxygen saturation at a high level at all ages. Healthy newborns have well-developed lungs and usually have high hemoglobin levels, which may be an additional safety factor.

When contacted by phone, the seven largest U.S. airlines and the four largest foreign airlines that serve the United States indicated they do not have lower age restrictions for infants to travel by air. Four of the U.S. airlines suggest that parents of infants less than a week old “check with their doctor,” or “have a note from a doctor” saying that the infant is in good health. However, such a note is rarely, if ever, asked for by check-in and boarding gate attendants. Other information that spokespeople and reservation agents read from their computer listing include: only one infant per row because of oxygen mask considerations; parents should consider using an infant safety seat; and exposure to infection aboard the aircraft could be a problem for infants of this age. Nevertheless, airline rules change frequently, and parents should consult airlines shortly prior to travel.

Air travel may not be safe for an infant with severe anemia, congenital heart disease (especially abnormalities of the right side of the heart) and poorly or abnormally developed lungs. It is important to note that some of these conditions may not be present or recognized at birth, and may become symptomatic during flight or while the family is visiting a high altitude destination. Children and adults with sickle cell disease, for example, may do poorly at the atmospheric pressure existing at cruising altitudes, but infants with this condition may not be symptomatic in the first few months of life.

Individuals with sickle cell trait generally have no problems, but there appears to be rare exceptions, and the parents of such children should be aware that their child could become symptomatic. Despite one article in a major medical journal stating that a history of recent air travel is a risk factor for SIDS ( BMJ . 1998 ; 316 : 873 -874 ), the consensus of experts is that there is no such association.

There are no data to determine whether newborns and infants are at increased risk of infectious diseases during air travel. Many adult frequent flyers claim that they experience more upper-respiratory infections after flights than at other times. Speculation implicates prolonged and close togetherness in an enclosed space, recirculating cabin air, exposure to travelers from distant parts of the world where different strains of organisms circulate, changes in the immune system due to the stresses of travel, and the extreme dryness in the cabin air. Dry air results in a lack of moisture in the nasal passages. This may facilitate organisms passing through. Saline nose drops may alleviate this.

There are several documented cases of adults acquiring tuberculosis during long flights and acquiring influenza in an aircraft standing on the tarmac for many hours with no operational ventilation system. In one tuberculosis incident, the passengers who acquired the disease were all sitting near an infected, heavily coughing passenger. The U.S. Centers for Disease Control and Prevention believes that such incidents are exceedingly rare.

Currently, there is debate about air quality in the aircraft cabin. In recent years, to save fuel, airlines have changed the method of supplying air to aircraft in flight. Under the old system, air was exchanged every few minutes. Under the new system, half the air in the cabin is passed through sophisticated systems and re-circulated. The result is that the air that passengers breathe is about half re-circulated air.

Fresh air is taken in from the outside and is virtually sterile; there are no microorganisms in the air at 30,000 feet. Moreover, the outside air passes through the very hot engines killing any organisms, and is then cooled. This is a very expensive process. Recirculated air passes through sophisticated filters, making it virtually as microorganism-free as fresh air. But some experts question whether the filters in use eliminate all viruses. The consensus appears to be that the risk of acquiring infection in-flight is small but that it does exist.

Parents have few options for protecting their infants from risks of exposure to microorganisms in flight. These options are largely unproven and impractical, and include:

• flying at off-hours when there tend to be fewer passengers;

• traveling first class where there is less crowding and, therefore, more air per passenger;

• flying early in the day when aircraft are cleaner;

• changing seats when a nearby passenger coughs and sneezes;

• washing hands frequently ; and

• bringing one’s own pillow or headrest cover.

Aircraft are cleaned thoroughly only before the first flight of the day. Presumably, the air in the morning is cleaner. On most airlines, pillows and headrests are replaced only at the time of that cleaning. Lately, many major airlines exchange pillows and blankets only when they are visibly soiled — sometimes once every several weeks.

Dr. Neumann is a member of the AAP Section on International Child Health.

Article reprinted with permission from the section newsletter.

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3 Essential Airplane Rules When Flying With a Newborn

Intro   |  Newborn Flight Safety | International Vs Domestic  |  TSA 3.4 Ounce Rule Exemption | Free Packing List   | FAQ   | COVID Update

Air travel with a baby - especially a newborn - requires a lot of careful planning, from booking your seats to every necessary inflight detail. Some airlines provide special equipment for passengers with newborns, such as baby bassinets and car seats. These privileges should be arranged early on since some of the these are not typically carried on board. If you're planning on flying with a newborn, here are some things you definitely should consider:

1. NEWBORN FLIGHT SAFETY

Some airlines admit newborns as early as 2 weeks old while others only allow 2 month old babies and above. Traveling with your newborn usually requires a medical release form before airlines accept you onto the flight. Unless completely necessary, pediatricians do not advise parents to travel with a newborn 1 month old and under.

The most important reason being that the mother needs postpartum rest and the baby needs a stable environment right after birth. In-flight conditions such as noise, cabin temperature changes and pressure maybe very uncomfortable to the newborn. Also, the baby's immune system is still fragile and could be affected by the germs carried onto the plane.  Air Canada and United Airlines do make cut-offs at 7 days old while Southwest Airlines requires medical releases for infant under 2 weeks old .

It's always a good idea to bring a birth certificate to verify your baby's age. Verify with your airlines for their specific rules. 

COVID-19 Update (2020): In light of recent events, the CDC recommends to avoid all non-essential travel with your baby. Please visit the CDC website for more travel tips and COVID-19 updates.

2. INTERNATIONAL FLIGHT VERSUS DOMESTIC?

There is no "blanket fare rule" for flying with a newborn. Most airlines allow newborn babies to fly for free (on a domestic flight) as long as they are seated on the lap of the mommy or daddy (or the paying passenger). As a general rule, only one infant should remain in the lap of an adult. While it is free for domestic flights, be prepared to pay 10-25% of a full adult fare when flying internationally, depending on taxes and other conditions.

Air Canada , for example, flies lap-seated infants for free when traveling within Canada or between United States and Canada, but requires a 10% of adult fare payment when flying with your newborn internationally. United Airlines charges regular fare for infants regardless of seating for international flights. Others like Qatar Airways, Singapore Airlines and Emirates charge 10% of adult fare even when flying with your newborn for a domestic flight. Although some airlines do not allow children below 2 years old to occupy their own seat, others would ask you to buy an additional seat for safety. Turbulence might cause serious injury to a lap-seated newborn without a fastened safety belt. When buying additional seats for your baby, most airlines like Air Canada would charge depending on the route and length of travel. Other airlines automatically charge 50% -75% of an adult fare.

You may also request for baby bassinets or sky cots that provide a miniature bed for infants 8 months and under . Make sure to confirm availability of a baby bassinet prior to your scheduled flight because not all airlines carry this inflight. Should you decide to bring your baby’s own car seat, always check with your airline beforehand if your car seat is allowed inside the plane. Only target FAA approved car seats or restraining seats are allowed inside a plane. If an airline requires you to purchase a ticket for your infant, make sure to: Reserve two seats together , ideally near the aisle so changing diapers and using the restroom are easily accessible. As general tip, first row seats and emergency exit row are not suitable for passengers with infants.

3. TSA 3.4 OUNCE RULE EXEMPTION

For breastfeeding mothers, remember that the regulation on liquids that limits you to 3.4 ounces does not apply to breast milk . Formula, breast milk, and juice in quantities greater than 3.4 ounces or 100 milliliters are allowed in carry-on baggage and do not need to fit within a quart-sized bag.   Ice packs, frozen gel packs and other accessories required to cool formula are also allowed in your carry-on. If these accessories are partially frozen or slushy, they may be subject to additional screening. You may also bring gel or liquid-filled teethers, canned, jarred and processed baby food in carry-on baggage.

Remove these items from your carry-on bag to be screened separately from the rest of your belongings. Use our clear toiletry bag for packing TSA approved liquids (other than breastmilk).

IMPORTANT: You do not need to travel with your newborn to bring breast milk.

As soon as you get on board, place your baby bag under the seat in front of you for easy access to things you might need during the flight such as diapers, extra clothes and tissues and wet wipes. The next tip will keep all your essentials in check (and organized)!

Make your life easier by organizing your essential baby items neatly inside a travel packing cube so you can easily grab them during the flight. Use a small cube for items such as tissues, wet wipes and extra diapers . Use a medium size cube   for a change of clothes, diaper kit and feeding bottles. If you happen to bring along a sling-type baby carrier, make sure you place it in a specific place to avoid clutter in the baby bag, making it easy to grab once the plane lands.

Flying with your newborn baby might happen earlier than expected, because well, life happens, but it doesn’t have to be a hassle for you. Just be certain to stay updated with the specific rules of the airline you are flying with to ensure a smooth travel experience.

Always keep in mind these 3 important items:

1. Newborn flight safety 

2.  Booking the Best Seat / Baby bassinet / FAA Approved Car Seat

3. TSA 3.4 Ounce Rule Exception

Plus, staying calm and organized  for your little one is important for your sanity!

You want to create a safe and happy environment when you're flying with a newborn! 

Enjoy your trip!

P.S. Click here for our post on The Best Flying Tips for Airplane Travel. 

FREQUENTLY ASKED QUESTIONS (FAQS):  

How early can you fly with a newborn baby.

Airlines have varying regulations about how early they allow a newborn to fly. It’s best to check with the specific airline you’re flying with. In general, most airlines allow babies at least 2 weeks old to fly.

Here’s a list of popular US airlines and their newborn regulations as of October 2018 (make sure to check again in case of any changes):

Do I need an ID for my baby to fly?

It’s better to be prepared when you’re flying with a newborn. On domestic flights, you’re not required to bring an identification proof. BUT since you’re technically flying with a lap infant, you might be asked to present your baby’s proof of age. This could be in the form of your baby’s birth certificate, passport or immunization records. Traveling internationally? Your baby is required to present an identification proof or passport.

Is it safe for a newborn to fly?

When it comes to the safety of flying with a newborn, two issues come up. Health is one of those. Newborns just don’t have a developed immune system yet! They could get germs from the air or things around them. This is one of the risks of taking a flight with a young baby. Another issue is injuries or turbulence. Most newborns fly as lap infants meaning they are held by either mom or dad during the flight. The Federal Aviation Administration (FAA) advocate against this. No matter how good your grip is, it’s hard to securely hold your newborn in times of turbulence or worse, accidents.  

Solving these issues:

✓ Health - First off, make sure your baby is in perfect health condition before even booking that flight! If in doubt, a trip to the pediatrician is not a bad idea. In fact, as mentioned above, some airlines require a health certificate from a physician for babies under certain ages. Once you board, sanitize any surface or object that your little one can be in contact with! This lessens the chance of acquiring germs or bacterias and the baby getting sick.  

✓  Injury / Turbulence - The FAA advises the use of child safety restraint systems. Here’s a guide on what the FAA considers as safe restraint systems for aircraft use. You’re also allowed to bring your own FAA-approved car seat on board. The problem is if the baby is a lap infant. Ask ahead, the airline might be able to give you a vacant seat to secure your baby during the flight!

Do newborns need a passport?

Any child under 2 years of age might be required to present a proof of age. A passport is one form of proof of age, along with a birth certificate or immunization record. For domestic travels, what matters is that you have a proof of age, not necessarily a passport. For international travels, babies are required to present a passport, no matter the age.

Do newborns fly free?   

Babies under 2 years old (without a seat) can fly free for domestic flights within the US. For international flights, lap infants are required to pay a certain percentage of the adult fare and/or taxes. Planning to buy a separate seat for your newborn? You’ll have to pay a part of the full adult fare (sometimes even the full adult fare) for his or her seat.  

Here’s a breakdown of the different airline ticket costs for newborns as of October 2018:  

Can you take a carseat on a plane?

If you’ve purchased a seat for your newborn, you’re allowed to bring a carseat with you at no additional charge. However, make sure that it’s FAA approved and fits within the seat dimensions of your airline.

How to fly safely with a newborn during a virus outbreak?

Again, the CDC recommends to avoid non-essential travel (especially with babies and children) due to the COVID-19 pandemic. But if you’re in a situation where you can’t avoid to travel with your newborn, here are some precautions you can take to stay safe:

1. Consult with the baby’s pediatrician - The doctor can advise you on how to stay safe and healthy if you can’t avoid traveling during a pandemic. 

2.  A First Aid Kit is a must - Pack a first aid kit with all the medications your baby might need during an emergency. This includes cough, anti-allergy, pain reliever meds, etc. It’s also a good idea to pack a travel, digital thermometer (so you can quickly catch a fever).

3.  Don’t forget the Hygiene Kit - Use an Extra Small Cube to organize your sanitizing essentials like wipes, tissue, alcohol, etc. In light of recent events, the TSA is allowing passengers to bring up to 12 oz of hand sanitizer. But it needs to be screened separately from your other liquids. 

4.  Pack some snacks - Most airlines are limiting the in-flight food service to avoid contact between passengers and flight attendants. If you’re a breastfeeding mom, eat a hearty meal before you leave for the airport and pack some snacks as well in case you get hungry while flying.

5.  Select a window seat - This 2018 study suggests that the window seat is the safest place on a plane to minimize contact with other passengers. If you do have the budget, try to book a window seat in premium economy or business class which definitely has more space and can limit you and your baby’s contact with other people.  

6.  Do not cover your baby’s face - Children younger than 2 years old are more prone to suffocation and hence, not recommended to wear masks or any kind of face covering. If you’re bringing an infant carrier, you can place a blanket instead over the carrier (make sure that it’s within your view all the time).  

7.  Sanitize everything - Once you’re on board, wipe down everything you’ll get in contact with. This includes your seat, the armrests, the windows and especially the tray tables!

Of course these tips are in addition to the ‘new normal’ safety precautions that we are all required to take. This includes wearing a mask (for moms and dads), maintaining a safe social distance with other passengers, washing your hands often and minimizing touch points as much as possible.

Have a safe trip!

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Rules for Flying with a Baby: What you Need to Know

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In this article, we tackle the question: What are the rules for flying with a baby? Even as a seasoned – lap infant and kids in tow – traveler, I still refer back to the rules and airline policies.

You wouldn’t know it, but I can be a nervous traveler with the kids. Who isn’t? I go over all the preparations and questions even as I’m walking out the door. For my sake, and yours, I am writing up this comprehensive guide on rules and ailine policies for flying with a baby.

The rules and policies can be a little confusing because different countries, TSA and each airline all have slightly different rules.

I created a table of the general rules that apply for flying domestic and international with a baby. Further on in the article, you can find detailed information from TSA, different counties and examples of airline policies.

I hope this will make your flight smoother and safer.

Cheat Sheet of Rules for Flying with a Baby

** Note: read each section of the article for more information and the references for each conclusion in the chart.

The cheat sheet above will help you get an overview of the rules for flying with babies. Since the airline policies for infant travel differ you will need to check with your airline. Let’s dive a little deeper into questions you are likely asking.

Questions that arise during booking and ticketing a baby for your next trip.

How old does a baby have to be to fly?

How soon can you travel with a newborn? The answer actually varies depending on which airline you are flying. The general rule in the industry is that you can fly when your newborn baby is between 7 days and two weeks old , depending on the airline. Many airlines also have an exemption to travel earlier with a medical release.

For example, Air Canada , Delta Airlines , United Airlines , and American Airlines allow infants 7 days old without a medical release. Japan Airlines allows babies to be 8 days old. Other airlines require the baby to be at least 2 weeks old.

Other airlines require the baby to be at least 2 weeks old. Southwest Airlines and Jet Blue requires babies to be 14 days old before flying with them.

So I can technically fly with a newborn, but when is it safe to fly with a baby? Although a baby is allowed to fly within days or a week of birth, doctors recommend waiting a bit longer. Studies have shown flying with an infant ( especially in your lap) can be dangerous.

Pediatricians generally suggest waiting until an infant is 2-3 months old before flying ( source ). By this time the baby has developed a stronger spine, has more head control and a stronger immune system.

We suggest talking to your pediatrician if you plan to fly with a new baby.

How much does it cost for a lap infant?

If you want to save money on domestic air travel, you will likely consider traveling with your child as a “lap infant.”

Although there is still much debate about the issue , many parents choose to have a baby on their lap and avoid the fees.

For a child to qualify to fly on the lap of their parent, they must be under 2 years of age.

Many airlines will allow a lap child for free or a small fee when you are flying domestically (United, American, Delta, Southwest, and Frontier all do). International airlines similarly offer a lap infant for free within their own region. If the ticket is not free, the fees are generally 10% of the full fare.

Plus, if you fly at during low traffic, the airlines will likely seat you next to a free seat. Your lap child is generally welcome to use that seat.

International fees for a lap child flying between the different countries vary . Generally, the fee will be 10% of the full fare plus fees and surcharges ( for example, Delta ). What the airline defines as full or applicable fare makes a big difference in the price of the ticket.

Note: If you’re using miles to calculate the ticket for your lap infant, the cost will vary depending on the airline. For example, Air Canada fixes a flat fee of 50% for economy tickets, while others like Cathay Pacific will require you to pay 25% of the standard charge in addition to taxes and fees.

We like to take advantage of this period when our babies and toddlers can be included in a family vacation with free airfare.

How much does it cost to buy a separate airplane seat for a baby?

For both comfort and safety, buying a separate seat for your baby is a good option. You will likely have to pay for the seat but some airlines still offer an infant or child discount.

Unfortunately, many US carriers will charge between 90% and full fare for the extra seat. Delta, United Airlines, JetBlue Airways, Alaska Airlines, Spirit Airlines, Frontier Airlines, Allegiant Airlines, and Virgin America all charge full fare for an infant with a separate seat.

Southwest has a baby and a child fare that is a percent of the full fare. With their huge discounted fares, you may or may not save money.

American Airlines also offers both domestic and intentional fares for infants; you’ll also have to call 800-433-7300 to book.

Hawaiian Airlines only offer special infant fares for international flights.

Here’s where some of the carriers outside the US become more family-friendly. Child fares for a seat on carriers outside the US vary from 10% plus fees to full fare . For example, Brussels Airlines charges 25% to 30% plus fees, Air France charges 20% plus fees, Qantas charges 10%.

From Norwegian Air “ International long haul , children aged between 2 to 11 years on the date of their return flight …travel on a child ticket, at 90% of the adult fare, plus any airport taxes. “ Norwegian Air

Note: For children older than two years, you have to pay for the seat on the flight. If the baby turns 2 years while on your trip, they have to get a separate seat from their parents as they can’t travel as lap infants.

The good news is that many airways charge reduced fares for children aged between 2-11 years. Child fare tickets can be 25-50% cheaper. So contact the airlines directly to get information on whether they offer discounted rates for children on international flights.

Do I need an ID for my baby to fly?

When flying with a baby, the identification and documents that you will need are dependent on where you are going and the airline that you are traveling on.

Traveling within the US will not require much documentation. In fact, you can see from the TSA website that you do not need identification while traveling domestically .

“TSA does not require children under 18 to provide identification when traveling with a companion within the United States. Contact the airline for questions regarding specific ID requirements for travelers under 18.” TSA Identification

However, if you have a lap infant, the airline will likely need proof of the baby’s age. A birth certificate or passport will need to be presented to the airline at check-in.

What documents do I need for flying with a baby internationally?

When traveling internationally, the amount of documentation increases to the same amount as required for adults. Depending on your destination you will need a passport plus possibly a visa, proof of vaccination, and a Letter of Consent (if required) . The passport must be v alid for at least 6 months after the date you enter a foreign country.

Note: To apply for an American passport follow these directions for applying at the USPS. You will require the following documents when applying for a passport for your minor:

• REQUIREMENTS TO APPLY FOR PASSPORT
• Evidence of U.S. citizenship(e.g., a birth certificate)
• Photo identification(for the parents)
• Proof of parent relationship(such as an adopting decree or birth certificate)
• Passport photo
• Passport fee( apparoximately$100)
• Application forms( available on https://travel.state.gov/)

In addition to a passport, some countries require a visa to enter. For more information on passport requirements for various countries the travel center website has a great search engine .

Vaccines may be required depending on where you are traveling to and from. In order to enter some countries, you will be required to bring proof of vaccination. Check the CDC website for vaccines that are required for your destination.

The documentation required for international travel becomes more complicated if the infant is traveling with a guardian or one parent. The solo parent or guardian must get written consent from the biological parents of the child alongside their child’s original birth certificate.

American Airlines: ” If you’re traveling internationally with anyone under 18, you may be required show documentary evidence of your relationship and a Letter of Consent or permission for the child’s travel from the parent(s) or legal guardian not present.” American Airlines

Getting through TSA Security

Getting through security with your child can be stressful but knowing the rules will make everything go much smoother. When traveling with a baby it’s essential to arrive early, at least 2 hours for domestic and 3 hours for international flights.

TSA has developed a thorough procedure for screening children 12 years or younger. These guidelines are a security measure to ensure all passengers and crew is safe during the flight.

The TSA agents will check all the boarding passes including for the lap infant. So make sure you have a boarding pass even if your baby does not have a seat.

Knowing the procedure at the screening area will help you.

All equipment and items you’ll use for your baby while on the flight must be screened at the airport. This includes strollers, carriers, toys, etc. are screened either by the use of x-rays or checked manually.

If you have breast milk, formula, or juice excess of 3.4 ounces, you need to inform the security agent before the screening. These items must be X-rayed or screened for explosives.

Can I wear my baby through security?

Yes, according to the TSA rules, “infants may be carried in a sling” I have successfully worn my babies through security in an Ergo.

After walking through the metal detector, the security wipes my hands and maybe a pat-down.

Note: you cannot get through the security checkpoints with your child in a carrier or a stroller. You must first get them out and hold them in your arm as you go through screening.

In the screening process, your child can have their shoes, diapers, belts other appropriate clothing.

Children 12 and under can leave their shoes, light jackets and headwear on during screening. Children will not be separated from their parent/guardian. Remove infants and children from their carriers and carry them in arms through the walk-through metal detector. Infants may be carried in a sling through the walk-through metal detector but may be subject to additional screening. Modified screening procedures are in place to reduce the likelihood of a pat-down . TSA

Can I take breastmilk, formula, or other liquids on the plane?

Yes, you can take milk on a plane for your baby and as much as you need, within reason. Don’t worry, take what you need for your baby to drink, it is exempt from the 3.4 oz rule.

In addition, you are allowed to take with you cooling packs to ensure the milk remains fresh.

From TSA “Formula, breast milk, juice in quantities greater than 3.4 ounces or 100 milliliters are allowed in carry-on baggage and do not need to fit within a quart-sized bag. Remove these items from your carry-on bag to be screened separately from the rest of your belongings. You do not need to travel with your child to bring breast milk. Ice packs, freezer packs, frozen gel packs and other accessories required to cool formula, breast milk and juice are allowed in carry-on. If these accessories are partially frozen or slushy, they are subject to the same screening as described above. You may also bring gel or liquid-filled teethers, canned, jarred and processed baby food in carry-on baggage . .” TSA

Can I take a stroller through security and to the gate?

Yes, you are allowed to take a stroller through security and to the gate with you.

Actually, you have quite a few options for traveling with a stroller.

In the age of paying for bags and everything else, you get some relief here. Most airlines will check a stroller and car seat for free.

You can check them through with your luggage at the ticket counter.

Or.. you can take a stroller through security (see the section getting through security above) and checked it at the gate. When you get to the gate ask the agent for a gate check tag for your stroller. Then set it on the jetway before entering the plane.

With new small collapsable strollers, some airlines allow you to take it on the plane with you. For example, this is United’s policy:

“ Strollers and folding wagons may be checked to your final destination free of charge, in addition to your normal baggage allowance. This also applies to customers who are traveling on a Basic Economy ticket. Feel free to use your child’s stroller or folding wagon throughout the airport, but please keep in mind that most strollers and wagons must be checked at the gate. If you have a compact folding stroller, like the gb Pockit Stroller, you can bring it on board in addition to your carry-on bag and personal item. “ United Airlines

Can I bring a ca r seat on the plane?

Yes, you can bring a car seat on the airplane for your child. In fact, if bought a separate seat for your infant, you may be required to have a car seat to safely use on the plane.

If you have a lap infant, you have a couple of options. You can bring your car seat through security and out to the gate, in hopes of getting an open seat next to you. When you arrive at the gate, check in with the agent if there will be room on the plane for an extra seat for the baby.

If there are no extra seats, you can gate-check the car seat . The agent will give you a tag to place on the handle. When you board the plane, leave it on the jetway before the door.

The other option is to check your car seat with the luggage at the ticket counter. This way you do not need to carry to through the whole airport and will be waiting at your destination.

Car seats are always free to check. (I have yet to see otherwise, but you are welcome to tell me your story in the comments.)

When I travel with a lap infant, I choose to check the car seat with the luggage.

Final Thoughts on Flying with a Baby

To sum everything up, although rules for flying with a baby differ between airlines, some general guidelines that apply include:

• Infants may travel without medical approval provided them if they are over 7 days old (some airlines require 2 weeks).
• For domestic U.S. flights, a child under 2 years of age can travel without a ticket while sitting on the lap of a paying adult.
• If you decide for the baby to fly in a car seat you’ll pay for a ticket regardless of the age of your child.
• All children over 2 years of age must have a ticket.
• When flying with your baby, you must prove the age with a birth certificate or passport.
• Any child under 2 years must be accompanied in the flight by a passenger who’s at least 16 years of age.
• An adult passenger can only travel with a maximum of 2 infants and only one on their lap.

One last thought. You should keep copies of the TSA guidelines and the rules for the airline that you are flying on. I have heard of stories where TSA or gate agents are misinformed. Having a copy of the rules in hand will help you navigate the situation.

We have many resources for you if you are planning a vacation with your baby. You may find these articles helpful:

• How to get the cheapest flight for your family
• Step by Step guide to planning the perfect family vacation – with printable template
• Family Packing Checklist – special section for baby
• Check for the cost of the flight to the destination you are dreaming of on

What has your experience been traveling with a baby? Do you have more questions about the rules for flying with an infant?

Ease your flight travels by checking our Etsy Store, In there I have a packing checklist to make sure you wont forget essentials for your flight trip.

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I need information on traveling with an infant or child under 2

One child over 14 days and under two (2) years of age, not occupying a seat, may be carried as a Lap Child when traveling with an adult (12 years of age or older). Each adult may travel with one Lap Child. Although a boarding pass is not required for the infant, you will need a Boarding Verification Document, which can be accessed after check-in online or via the mobile app or can be printed at the airport on the day of travel at a kiosk or the ticket counter.

A Lap Child may be carried free of charge domestically. For international travel, applicable government-imposed taxes and fees must be paid, and a ticket will be issued for each person, regardless of age.

Original or photocopies of government-issued identification (e.g., passport, birth certificate, government-issued photo identification card) are the only acceptable forms of proof of age. Electronic screen shots, phone images, or immunization records are not acceptable.

We may ask for age verification at any point within your journey, so you should travel with the documentation. If asked to provide proof of age and unable to do so, Customers will be required to purchase a ticket for the child.

Alternatively, you may choose to purchase a seat so your child can travel in a child restraint system (CRS).

Learn more about accepted CRS .

Related Articles

Search our help options and faqs.

Safety & Prevention

Tips for safe & stress-free family travel.

Traveling with children can be a delight and a challenge. Here are some tips for safe and stress-free family travel.

Traveling by car

• Always use a car seat for infants and young children. All infants and toddlers should ride in a rear-facing car seat as long as possible, until they reach the highest weight or height allowed by the car seat manufacturer. Once your child has outgrown the rear-facing height or weight limit, she should ride in a forward-facing car seat. Find updated recommendations on safe travel here .

Most rental car companies can arrange for a car seat if you are unable to bring yours along. However, they may have a limited selection of seats. Check that the seat they provide is appropriate for the size and age of your child, that it appears to be in good condition, and that the instruction manual is provided before accepting it.

A child who has outgrown their car seat with a harness (they have reached the top weight or height allowed for their seat, their shoulders are above the top harness slots, or their ears have reached the top of the seat) should ride in a belt-positioning booster seat until the vehicle's seat belt fits properly (usually when the child reaches about 4' 9" in height and is between 8 to 12 years of age).

All children under 13 years of age should ride in the rear seat of vehicles.

Never place a rear-facing car seat in the front seat of a vehicle that has an airbag.

Set a good example by always wearing a seat belt, even in a taxi.

To help keep children from becoming restless or irritable on a long road trip , point out interesting sights along the way. You can also bring soft, lightweight toys and favorite music for a sing-along.

Plan to stop driving and give yourself and your child a break about every two hours .

Never leave your child alone in a car, even for a minute. Temperatures inside the car can reach deadly levels in minutes, and the child can die of heat stroke. See Prevent Child Death in Hot Cars for more information.

In addition to a travelers' health kit , pack some other essentials for the trip: safe water and snacks, for example, along with child-safe hand wipes, diaper rash ointment, and a water- and insect-proof ground sheet for safe play outside.

Road travel can be extremely hazardous in developing countries. Make sure each passenger is buckled and that children use the appropriate car seat. Let your driver know you are not in a hurry, ask that there be no cell phone use, and emphasize that you will reward safe driving.

Traveling by plane

Allow your family extra time to get through security at the airport, especially when traveling with younger children.

Have children wear shoes and outer layers of clothing that are easy to take off for security screening. Children younger than 12 years are not required to remove their shoes for routine screening.

Strollers can be brought through airport security and gate-checked to make travel with small children easier.

Talk with your children about the security screening process before coming to the airport. Let them know that bags (backpack, dolls, etc.) must be put in the X‑ray machine and will come out the other end and be returned to them.

Discuss the fact that it's against the law to make threats such as "I have a bomb in my bag." Threats made jokingly (even by a child) can delay the entire family and could result in fines.

Arrange to have a car seat at your destination or bring your own along. Airlines will typically allow families to bring a child's car safety seat as an extra luggage item with no additional luggage expense. Check the airline's website ahead of time so you know their policy before you arrive at the airport.

When traveling on an airplane , a child is best protected when properly restrained in a car safety seat appropriate for the age, weight and height of the child. Children who weigh more than 40 lbs can use the aircraft seat belt. The car safety seat should have a label noting that it is FAA-approved . Belt-positioning booster seats cannot be used on airplanes. However, they can be checked as luggage (usually without baggage fees) for use in rental cars and taxis.

Although the FAA allows children under age 2 to be held on an adult's lap, the AAP recommends that families explore options to ensure that each child has her own seat. If you're not able possible to purchase a ticket for a small child, try to select a flight that is likely to have empty seats where your child could ride buckled in their r car seat.

Pack a bag of toys and snacks to keep your child occupied during the flight.

In order to decrease ear pain during descent, encourage your infant to nurse or suck on a bottle. See How to Nurse on an Airplane for more information. Older children can try chewing gum or drinking liquids with a straw.

Wash hands frequently, and consider bringing hand-washing gel and disinfectant wipes to prevent illnesses during travel.

Consult your pediatrician before flying with a newborn or infant who has chronic heart or lung problems or with upper or lower respiratory symptoms. Also talk with your pediatrician if flying within 2 weeks of an episode of an ear infection or ear surgery.

International travel

If traveling internationally , check with your doctor to see if your child might need additional vaccines or preventive medications, and make sure your child is up-to-date on routine vaccinations. Bring mosquito protection in countries where mosquito-borne diseases such as malaria are present.

In order to reduce jet lag, adjust your child's sleep schedule 2-3 days before departure. After arrival, children should be encouraged to be active outside or in brightly lit areas during daylight hours to promote adjustment.

Stay within arm's reach of children while swimming. Pools may not have safe, modern drain systems and both pools and beaches may lack lifeguards.

Ensure that your child wears a life jacket when on smaller boats, and set an example by wearing your life jacket.

Conditions at hotels and other lodging may not be as safe as those in the U.S. Carefully inspect for exposed wiring, pest poisons, paint chips or unsafe stairway or balcony railings.

When traveling, be aware that cribs or play yards provided by hotels may not meet current safety standards. If you have any doubt about the safety of the crib or play yard, ask for a replacement or consider other options. (Also applies to travel in the U.S.)

More information

Car Seats: A Guide for Families

Flying With Baby

Ask the Pediatrician: Is it safe for my baby to travel in a car seat a few hours at a time?

Road Trip Play Ideas for Backseat Fun

Hotel Dangers That Put Baby's Safety at Risk

Traveler's Health (CDC.gov)