Pediatrician Jeffrey Fireman can always tell exactly when his pint-sized patients and their families are heading off on vacation.
"The phones ring off the hook," says the Sherman Oaks, Calif., doctor, and every caller is frantic. It's not that the illnesses are serious. It's just that long-made plans suddenly are going up in smoke. The family is set to leave "in an hour" for the airport, but one of the kids has an earache; they're a thousand miles away from home and the baby has a high fever; they're visiting relatives in Los Angeles and the 10-year-old has a bad flu.
It's no wonder. Kids don't get enough sleep on vacation. They don't eat right. They may have breathed stale airplane air for hours. There are so many concerns, in fact, about air quality on commercial flights that a bill has been introduced in Congress to improve it.
But it's not only airplanes that are the culprit. It can be a change of climate or a frenetic schedule. "No matter where you go on vacation, people are going to get sick," says Dr. Fireman. "And kids are much more susceptible."
It's even happened to him. He recalls one particularly awful weekend in San Diego when both of his kids came down with a stomach virus. Finally, the Firemans packed up and headed home.
"You can't drag sick kids around. They'll be miserable and so will you," he says. "Sometimes there's no perfect solution."
Those are the times when all you can do is make the best of a bad situation. On one ski trip to Taos, N.M., my son Matt started complaining on the first afternoon that his ear hurt. Luckily, we were able to see a doctor right at the ski resort. After Matt got started on antibiotics, we spent the next day relaxing by the fire and playing games. Not all bad in retrospect.
Of course there are other times when the situation can be far more dire and finding a competent doctor isn't so easy. One Chicago child became ill at a Club Med in Mexico and underwent emergency surgery at a nearby clinic. When her condition failed to improve, she was evacuated to a major hospital in Mexico City. Ultimately, she recovered, but the family was out more than $20,000 in expenses.
"When someone tells you an operation is needed immediately and evacuation might be dangerous, it's hard to know what to do," says the father, who requested his name not be used. The resort company said the matter is being investigated. "The highest priority of the club is the health and safety of its guests -- especially children. We do everything possible to ensure that," a Club Med spokesman says.
Wherever you are when your child gets sick, try to reach your own pediatrician. He or she may be able to coordinate treatment XTC and may even know a colleague in your vacation area, says Dr. Fireman.
If you're overseas, call the American Embassy or local consulate. "Tap into the expatriate community. Ask the people at the embassy who they take their children to," advises Dr. Bradley Connor, a gastroenterologist, travel-medicine specialist and father of two young children. He's founder and director of Travel Health Services, a private travel clinic in New York.
Dr. Connor notes that while growing numbers of families are taking young children to exotic locales -- trekking in Nepal, beachcombing on tiny islands -- they need to be aware of the risks involved.
Children can get dehydrated and become very sick quickly. Young children may not be fully immunized against exposure to diseases in developing countries. Older kids can fall and hurt themselves.
To help you better understand those risks -- and what immunizations you and your children may need -- the Centers for Disease Control has established an International Travelers Hot Line that provides information 24 hours a day by phone or fax. The service now logs more than 170,000 calls a year (call  639-8106).
Meanwhile, McNeil Consumer Products Co. (the makers of Immodium A-D) offers a useful "Passport To Travelers' Health" full of advice, such as how to avoid gastric distress when visiting developing countries. Make sure you and your children drink only bottled water or hot beverages; eat only fruits you have peeled yourself and be sure foods are well-cooked and arrive hot. (To receive the free brochure, write Immodium A-D, 1675 Broadway, Drawer Y, New York, N.Y. 10019.)
Even if you're just driving 200 miles from home, it's a good idea to be prepared for emergencies. If your child has such chronic conditions as asthma or diabetes, get the name of a specialist and take your child's records.
And make sure you've got an ample supply of medication. I pack a kit recommended by the American Academy of Pediatrics complete with acetaminophen and thermometer (inevitably, a fever will strike at 2 a.m. when drug stores are closed), bandages, antibiotic cream and tweezers (in case of splinters). The Academy of Pediatrics also suggests carrying syrup of ipecac, which is used to induce vomiting in cases of poisoning (but only use after consultation with your physician or a poison control center).
Most important, try to plan ahead. If you sense your child is coming down with something a few days before a trip, get it checked out right away. If you're at your destination, don't wait until the situation has developed into a teeth-gnashing emergency before seeking medical attention.
"It's a lot less expensive to go to the doctor than having to change all of your family's vacation plans," Dr. Fireman says.