Children at altitude

Posted by Alex Messenger on 19/07/2013
A kid with altitude

As more young people travel to altitude for recreational, economic and environmental reasons, understanding the development, incidence and management of altitude-related conditions becomes increasingly important.

Dr Suzy Stokes MBChB (Hons), DiMM, FAWM, MCEM discusses current guidelines and recent research.

The International Society of Mountain Medicine (ISMM) consensus guidelines (2001) provide a comprehensive review, designed mainly for medical professionals. What this means in practice is different for each child. Increasingly, families are taking holidays to more remote, high altitude and adventurous regions that weren’t previously accessible. Planning must therefore assess the safety and implications for any junior members of the group.

As with all mountainous and wilderness travel, planning and preparation are vital to maximize safety. However, we must acknowledge that as a past-time / sport, these activities are not without risk. Acceptance and mitigation of risk, by taking on board advice, research and guidelines is paramount.

The following text summarizes an article that was published in a medical journal, following the analysis of data comparing a group of teenagers with their adult counterparts. For original text see:

[Stokes SHM, Kalson NS, Frost H et al. Adolescents with Altitude: Young people do well on Kilimanjaro. Arch Dis Child 2009; 94: 562-563]

Thousands of young people travel to high altitude annually. Medical problems encountered range from relatively benign Acute Mountain Sickness (AMS) to potentially fatal High Altitude Cerebral and Pulmonary Oedema (swelling/fluid on the brain and lungs respectively). Compared to adults, there is limited information on how often they occur, what symptoms develop and what happens to children who do have these conditions.

In our study, we looked at physiological measurements (blood pressure, heart rate, oxygen saturations etc) and AMS incidence in tourist trekkers attempting the summit (Uhuru Peak) of Mount Kilimanjaro in Tanzania (5895m). Measurements were taken on ascent over four, five or six days, reflecting the various ascent profiles. The Lake Louise Score (LLS) was used to indicate the severity of AMS based on a number of different symptoms such as headache, vomiting, dizziness and poor sleep.

We compared 295 adults (177 males, range 18-70) with 16 children (9 males, 11-17). We found no significant difference in the incidence of AMS (defined as LLS >3) between young people and adults on any day. The proportion of subjects reaching the summit was not different between the two groups; 110/181 adults and 6/12 children summiting.

Although physiology results did suggest some differences between adults and children (e.g. oxygen saturations at 2700m 94.1% vs 95.7% p=0.02 [Mann-Whitney Test]), similarities in heart rate and respiratory rate suggest that adults and children have a similar response to high altitude. However, the usefulness of this data is limited by the variation of normal range with age and under-powering of the study (small number of children involved).

Although this is a small research study, it suggests that older children are not at higher risk of altitude related disease than adults, and can cautiously enjoy high altitude adventure. There is a caveat; rapid rate of ascent is a risk factor for AMS possibly making younger children more at risk if they undergo extreme exertion in order to keep up with their adult companions. To what extent this is true for very young children is unknown. Another important consideration is developmental stage – each child matures physiologically and psychologically at a different age.

It is important that adult supervisors accompany children at altitude. Leaders should be familiar with signs and symptoms and take prompt action on diagnosis, which may be assumed if a child becomes unwell >2500m. Adequate travel insurance is another necessity as high altitude regions also tend to be remote from help and expedient evacuation / descent is part of the management of all altitude problems. A well prepared and comprehensive medical kit are strongly advised to manage more common ailments (mild AMS, gastroenteritis) and initiate treatment for more severe problems whilst planning descent.

More detailed information on the topic of children in the mountains can be found by reading the following articles.

  • Pollard AJ, Murdoch DR, Bartsch P. Children in the mountains. BMJ 1998. 316, 873-4.
  • Imray CH et al. Self-Assessment of Acute Mountain Sickness in Adolescents: A Pilot Study. Wild Environ Med 2004; 15: 202-206.
  • Pollard et al. Children at High Altitude: An International Consensus Statement by an Ad Hoc Committee of the International Society for Mountain Medicine. High Alt Med Biol 2001. 2 (3), 389-403.

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Is the Mann Whitney a robust enough test for small small samples being a non-parametric test?

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