Travelling in Vietnam with a baby or toddler who gets ill

A child who is unwell in an unfamiliar country frightens parents in a way that being unwell themselves does not. That reaction is proportionate rather than silly. Children do deteriorate faster. They also compensate well and then stop compensating suddenly, which is why the usual advice is to lower your threshold rather than to stay calm.

This page is about what to watch, how to get fluid into someone who will not cooperate, and the practical differences that heat and travel make. It is not a diagnosis of your child. A parent's sense that something is wrong outranks anything written here.

Hospital immediately, not in the morning

Call 115 or take the child to the nearest hospital emergency department straight away if any of these appear. With a young child the margin for waiting is narrow:

• A rash of small red or purple spots that does not fade when you press a glass against it
• Floppiness, or difficulty waking the child, or an unusual high-pitched continuous cry
• Breathing that is fast, grunting, or drawing the skin in under the ribs and between them
• Blue, grey or mottled lips, tongue or skin
• A seizure, including one that comes with a fever
• A bulging or deeply sunken soft spot on a baby's head
• Any fever at all in a baby under three months, and a very high fever in one under six months
• Refusing all fluid for hours, no wet nappy for six hours or more, or crying without tears
• Repeated green vomiting, or a swollen abdomen with a baby drawing the legs up

If you are uncertain whether something on that list applies, treat it as though it does. Nobody at an emergency department will mind. The alternative is a decision made at four in the morning on your own.

Why the threshold sits lower

Three facts explain most of it. A small child holds much less fluid in total. The same loss removes a far larger share of it. The surface area of a child relative to their weight is bigger, so heat and evaporation take more out. And a young child cannot tell you they feel faint, dizzy or thirsty — the information arrives only as behaviour.

That is why the questions clinicians ask parents are about behaviour rather than symptoms. Is she drinking? Is she playing at all between bouts? How many wet nappies since this morning? Is this the child you know? The last one carries more weight than any single reading.

What a temperature tells you, and what it does not

How high the fever goes is a poor guide to how serious the illness is, past the age thresholds in the emergency list above. Watch the child, not the number. A child with a very high temperature who is still interested in a toy is usually in better shape than one with a modest temperature who has gone quiet and still.

Treat the discomfort rather than the number: paracetamol or ibuprofen at the dose for the child's weight, as printed on the packaging bought for children. Do not alternate the two on a schedule of your own invention, and never give aspirin to a child. Undressing to a vest and keeping the room cool helps. Cold baths, fans aimed directly at a feverish child and alcohol rubs do not, and make things worse.

One caution specific to here. If dengue is a possibility, ibuprofen is the wrong choice because of the bleeding risk. Paracetamol is used instead. In practice that means a child with a fever in Vietnam is worth a clinical look rather than a guess about which bottle to open.

Getting fluid into a child who refuses

This is the practical heart of it. Almost every gastrointestinal illness in a young child comes down to fluid in versus fluid out.

• Oral rehydration salts, made up exactly as the sachet says. Too concentrated is actively harmful, so measure rather than estimate
• Give it in tiny amounts very often — a teaspoon or a syringe every few minutes beats a cup offered hourly and refused
• Chill it, or freeze it into lolly moulds. A great many toddlers who refuse a cup will accept a frozen one
• Keep breastfeeding, and feed more often than usual rather than less. Breast milk is both fluid and food, and it stays appropriate throughout a gut illness
• For a formula-fed baby, continue the usual formula at the usual strength unless a clinician tells you otherwise. Do not dilute it as a precaution
• Avoid apple juice, cola, sports drinks and sweetened squash. The sugar concentration pulls water into the gut and makes diarrhoea worse
• Carry on offering normal food once vomiting has eased. Starving a child for a day does not rest the gut; it just removes the calories

Counting nappies is the measurement that works

Parents are asked about wet nappies because it is the one objective number available at home. A baby producing substantially fewer wet nappies than usual is losing the argument, whatever else looks reassuring.

Write the times down. Over a bad night, memory compresses and everything feels the same. A list on the back of a receipt turns the question from an impression into evidence. It is the first thing a clinician will want.

Heat and small children

A toddler in a carrier against an adult's chest is being warmed from two directions. A pram with a muslin draped over it for shade can become a still, hot box with no airflow. Both are routine mistakes made by careful parents.

Plan the day around the heat rather than through it: out early, indoors in the middle, out again late. Offer drinks on a schedule instead of waiting to be asked. A small child will not ask. Watch for the quiet phase — a child who stops complaining and goes limp in the heat is further along than one who is whining.

Sunscreen is for over-six-months. Under that age the answer is shade and clothing rather than cream. Vietnamese sun hats with a wide brim are sold everywhere and work better than a cap.

Mosquitoes, and what can go on which age

• Dengue matters for children here. Prevention is bites prevented. The mosquito that carries it bites during the day, so repellent belongs on in the morning, not at dusk
• Repellent containing DEET is accepted for infants from two months in most national guidance, at a lower concentration; check the label against your own country's advice and your child's age
• Oil of lemon eucalyptus is generally not recommended under three years
• A fine mesh cover over a pram or cot is the measure for babies too young for anything applied to skin
• Dress children in long, loose, light-coloured clothing in the hours around dawn and dusk, when biting peaks
• Treat a fever in a child after a few days in Vietnam as something that needs explaining, not as teething

Bottles, formula and water

Make up formula with water that has been boiled and then cooled, not with bottled mineral water chosen at random — some mineral waters carry a sodium or sulphate load that is unsuitable for infants, and the label is often only in Vietnamese. If you are buying bottled water for a baby, look for a low-mineral still water, and boil it anyway.

Your usual formula brand may not exist here. The composition is regulated and an equivalent stage will be available. But the packaging and the scoop size differ, so read the instructions rather than assuming. If your child is on a specialised formula for an allergy or a metabolic condition, bring the whole trip's supply with you and do not plan to buy it locally.

Sterilising on the road is simpler than it looks. Boiling in a pan works, and sterilising tablets in a sealed container travel well. Hotel kettles are fine for the water and not for the bottles.

What a visit at your accommodation involves with a child

• Being examined asleep on a parent's lap, which produces a better examination than a crying child in a waiting room
• Weighing, because every paediatric dose is calculated from weight rather than age
• Hydration assessed properly, which is the judgement parents find hardest to make about their own child
• A rapid test where a fever needs a cause, with dengue the one that most often changes the plan
• Rehydration guided in person — and if drinking has genuinely stopped working, a plain recommendation to go to hospital rather than attempting more at home
• Written instructions and the specific signs that mean call back, because the parent is the one doing the monitoring overnight

The short version

Watch behaviour rather than the thermometer, count wet nappies and write the times down, and get fluid in by the spoonful rather than the cup. Keep breastfeeding. Keep the day away from the midday heat. And if any sign in the second section above appears, go to hospital or call 115 — with a small child, waiting to see is the thing that costs you.