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High altitude disease: Unique pediatric considerations

Authors
Peter Hackett, MD
Scott A Gallagher, MD
Section Editor
Daniel F Danzl, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

This topic will review the unique pediatric aspects of high altitude illness (HAI).

The different types of HAI, their pathophysiology, and methods for prevention and treatment are discussed separately. (See "High altitude illness: Physiology, risk factors, and general prevention" and "Acute mountain sickness and high altitude cerebral edema" and "High altitude pulmonary edema" and "High altitude, air travel, and heart disease".)

BACKGROUND

Every year the beauty and recreational opportunities of the mountains attract millions of visitors from lowland elevations to high-altitude destinations worldwide. Resort towns in the Western United States alone attract over 30 million visitors annually, generally to sleeping elevations of 2000 to 3000 m (6560 to 9840 feet). Many more millions visit cities at these elevations, including several large cities in South America and Asia situated above 3000 m (9840 feet) [1]. Most of these destinations can be reached within a day using modern means of transportation. Many of these mountain travelers are children.

Rapid ascents to high altitude place the unacclimatized child at risk for developing high altitude illness (HAI). Clinicians working in mountainous areas must familiarize themselves with the presentation and management of HAI in children, while all health care workers who advise travelers need to understand the best prevention strategies and treatment options. The clinician advising families with children on wilderness and high-altitude trips should offer an organized pre-trip evaluation that evaluates individual risk factors, provides recommendations for measures to prevent HAI, and determines whether prophylactic medication is appropriate [2]. (See 'Patient risk assessment and mitigation' below and 'Prevention and pharmacologic prophylaxis' below and 'Travel advice for parents' below.)

HIGH ALTITUDE PHYSIOLOGY

Diminished inspired partial pressure of oxygen (PIO2) at altitude is the direct result of lower barometric pressure. As PIO2 decreases, so does the partial pressure of alveolar oxygen (PAO2), arterial PO2 (PaO2), and arterial oxygen saturation (SpO2), resulting in tissue hypoxia. This form of hypoxia is termed hypobaric hypoxia, and it represents the initial cause of high altitude illness (HAI). The physiology of HAI is discussed in more detail separately. (See "High altitude illness: Physiology, risk factors, and general prevention", section on 'High altitude physiology'.)

                           

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Literature review current through: Aug 2017. | This topic last updated: May 02, 2017.
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