Fitness to fly in the paediatric population, how to assess and advice

The number of children on commercial aircrafts is rising steeply and poses a need for their treating physicians to be aware of the physiologic effects and risks of air travel. The most important risk factors while flying are a decrease in partial oxygen pressure, expansion of trapped air volume, low cabin humidity, immobility, recirculation of air and limited options for medical emergencies. Because on-board medical emergencies mostly concern exacerbations of chronic disease, the medical history, stability of current disease and previous flight experience should be assessed before flight. If necessary, hypoxia altitude simulation testing can be performed to simulate the effects of in-flight hypoxia. Although the literature on paediatric safety of air travel is sparse, recommendations for many different situations can be given. Conclusion: We present an overview of the most up to date recommendations to ensure the safety of children during flight. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00431-018-3119-9) contains supplementary material, which is available to authorized users.