Questions received answered by our high altitude experts CHILDREN GOING TO HIGH ALTITUDE Dear Drs Zubieta- I need your assistance. There is a current controversy regarding the safety of an 11 month old traveling from Lima to 3800m directly. I maintain that the child should go more slowly to that altitude, with a stop for acclimatization at 3000m or so, but if this is not possible, then he can be treated with Diamox, or just go through the symptoms of AMS and get medical help if it becomes necessary. My colleagues in the states are more conservative. Some recommend this child not be allowed to travel to La Paz at all! They worry about HAPE, HACE, heart failure, etc. Obviously, there are many lowland children traveling to La Paz with their families. Do many get into trouble? What is your advice? Thank you, and best wishes Peter GOING TO PIKES PEAK (14110 ft) Hello, I'm am sending this email because I'm having difficulties finding research of the effects of high altitude on small infants and pregnant women. Where I work is a tourist spot and there is two ways to come up the mountain: the Pikes Peak Highway or Manitou and Pikes Peak Cog Railway. The Pikes Peak Highway made a law that no infants 4 months or younger and no women over 7 months gestation are allowed to summit the mountain. The Cog Railway is the opposite they inform everyone it's safe to summit the mountain at any age. In my time on the mountain I have notice that small infants and pregnant women have extreme medical difficulty on this mountain. I recently asked the Cog Railway to limit its passengers like the Highway does, due to the adverse effects of the tourist. The company responded with a small sign that's a caution but that was it. The ticket office for the Cog Railway still tells everyone that it's completely safe. Without proper research or a lawsuit against them they will continue to refuse to limit the passengers. I have seen many blue babies and extremely dehydrated mothers to be, I just want to prove to the Cog Railway that it is a danger and get them to give more warnings. The Cog Railway is a business and thinks like a business. They are doing some to precaution tourists; I just want to show them why to do more. If the effects of Altitude on infants and pregnant women were nothing to worry some much about I would like to know that as well. Another factor I have difficulties with is that 87% of the people visiting the summit a year have come from sea level or lower in less than 24 hours prior to summating the mountain.

CHILDREN GOING TO HIGH ALTITUDE Dear Drs Zubieta- I need your assistance. There is a current controversy regarding the safety of an 11 month old traveling from Lima to 3800m directly. I maintain that the child should go more slowly to that altitude, with a stop for acclimatization at 3000m or so, but if this is not possible, then he can be treated with Diamox, or just go through the symptoms of AMS and get medical help if it becomes necessary. My colleagues in the states are more conservative. Some recommend this child not be allowed to travel to La Paz at all! They worry about HAPE, HACE, heart failure, etc. Obviously, there are many lowland children traveling to La Paz with their families. Do many get into trouble? What is your advice? Thank you, and best wishes Peter Dear Peter: It is nice to hear from you again. Children younger than 2 years old tolerate high altitude hypoxia very efficiently. They are probably able to tolerate the hypoxia at the altitude of the summit of Mt. Everest, better than adults, because as you know, while in utero as embryos, they live with a very low oxygen saturation. During birth they are exposed to long hypoxic conditions, particularly in difficult delivery and can handle it quite well (except, of course in the very extreme cases). Besides they have gradually decreasing fetal hemoglobin until around 2 years of age. Children have fast heart rate and respiratory frequency. Many are coming from sea level to La Paz constantly. I don't find it convenient to use Diamox in children, as they can become unnecessarily dehydrated. If they come to high altitude where supplemental oxygen is readily available, it will be more than sufficient. The best procedure is to bring them to the high altitude adaptation chamber (with their father or mother) at our institution, where they are in a well controlled, temp, humidity and adequate oxygen concentration for a speedy and safe adaptation. This way the risk of AMS is very very low. We assume that the child is healthy and in normal condition. We will be happy to collaborate further if it is needed. All the best, Gustavo Sr. and Jr.

GOING TO PIKES PEAK (14110 ft) Hello, I'm am sending this email because I'm having difficulties finding research of the effects of high altitude on small infants and pregnant women. Where I work is a tourist spot and there is two ways to come up the mountain: the Pikes Peak Highway or Manitou and Pikes Peak Cog Railway. The Pikes Peak Highway made a law that no infants 4 months or younger and no women over 7 months gestation are allowed to summit the mountain. The Cog Railway is the opposite they inform everyone it's safe to summit the mountain at any age. In my time on the mountain I have notice that small infants and pregnant women have extreme medical difficulty on this mountain. I recently asked the Cog Railway to limit its passengers like the Highway does, due to the adverse effects of the tourist. The company responded with a small sign that's a caution but that was it. The ticket office for the Cog Railway still tells everyone that it's completely safe. Without proper research or a lawsuit against them they will continue to refuse to limit the passengers. I have seen many blue babies and extremely dehydrated mothers to be, I just want to prove to the Cog Railway that it is a danger and get them to give more warnings. The Cog Railway is a business and thinks like a business. They are doing some to precaution tourists; I just want to show them why to do more. If the effects of Altitude on infants and pregnant women were nothing to worry some much about I would like to know that as well. Another factor I have difficulties with is that 87% of the people visiting the summit a year have come from sea level or lower in less than 24 hours prior to summating the mountain. We consider that Pikes Peak as a Touristic environment with short visits should inform of potential risks of high altitude effects but not completely prohibit anyone from going. Many years ago, when I was a visiting Professor at Tulane Medical School, I went up to Pikes Peak and felt the effects of hypoxia. Pikes Peak has the advantage of going down very fast in order for people to recover. We strongly agree that small children and pregnant women should avoid unnecessary risk for touristic reasons. Frequently we have been consulted by people from around the world if they can come to La Paz (between 10000 and 14000 ft) from sea level. But they come to live here, and as any other stress, high altitude can affect some very dangerously. It is not necessarily related solely to the infants or pregnancy. We tell people not to be afraid of high altitude. Providing expert assistance in high altitude problems we solve these risks and we even have a high altitude adaptation chamber that allows for gradual adaptation with the end result of a pleasant and safe life at high altitude. Consequently, we treat the severe cases of HAPE and HACE in such a way and we have never had a fatal outcome. Incidentally, we have yearly courses on high altitude medicine that would be of great benefit to those going to high altitude http://altitude-course.zuniv.net/

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