At what age is it safe for a newborn to fly on a plane?

When is it Safe for a Newborn to Fly on a Plane?

For healthy full-term infants, it is generally safe to fly after 1 week of age, while preterm infants without bronchopulmonary dysplasia (BPD) should wait until at least 39 weeks corrected gestational age before flying. 1

Age Considerations by Infant Category

Healthy Full-Term Infants

• Healthy term infants can typically fly after the first week of life 1
• These infants generally maintain adequate oxygen saturation during flight, though they may experience a 4% drop in saturation that is usually asymptomatic 2

Preterm Infants

• Preterm infants without BPD should wait until at least 39 weeks corrected gestational age before flying 1
• Preterm infants less than 12 months corrected age who were born with neonatal lung disease are at high risk of requiring in-flight oxygen 3
• A study showed that 81% of infants with a history of neonatal lung disease desaturated below 85% during hypoxia testing 3

Infants with Bronchopulmonary Dysplasia (BPD)

• Infants with BPD have significantly higher risk of oxygen desaturation during flight 1
• 69.3% of preterm infants with BPD failed hypoxia challenge testing, with a median drop in oxygen saturation of 16% 1
• These infants should undergo fitness-to-fly testing before air travel regardless of age 3

Physiological Concerns During Air Travel

Cabin Pressure Effects

• Commercial aircraft cabins are pressurized to an altitude of 6,000-8,000 feet 4
• This reduces the fraction of inspired oxygen to approximately 0.15 (compared to 0.21 at sea level) 2
• The reduced oxygen environment can lead to hypoxia in susceptible infants 2

Feeding During Flight

• Feeding during flight can cause further drops in oxygen saturation 5
• Studies show a median additional drop of 2-4% in oxygen saturation during feeding in a reduced oxygen environment 5
• This drop is usually transient but should be considered when planning air travel with infants 5

Pre-Flight Testing

Hypoxia Challenge Testing (HCT)

• HCT involves exposing the infant to 14-15% oxygen for 20 minutes to simulate aircraft cabin conditions 3
• Current British Thoracic Society guidelines recommend supplemental oxygen if the child's oxygen saturation falls below 90% during testing 2
• However, research suggests 85% may be a more appropriate cut-off level 2

Who Should Be Tested

• Routine pre-flight testing is not indicated for healthy term infants or ex-preterm infants without BPD who are at least 3 months corrected age 5
• Testing is strongly recommended for:
  • Infants with a history of respiratory disease
  • Preterm infants with BPD
  • Infants requiring home oxygen

Practical Recommendations for Air Travel with Infants

Before Flying

• Consult with the pediatrician before planning air travel with a newborn
• For infants with special health needs, contact the airline well in advance to arrange for supplemental oxygen if needed 4
• Try to book direct flights when possible to minimize travel complications 4

During Flight

• Monitor the infant for signs of respiratory distress
• Ensure the infant is properly positioned to maintain an open airway
• Feed the infant before boarding when possible to minimize the need for feeding during the reduced oxygen environment

Safe Sleep Practices During Travel

• Maintain safe sleep practices during travel 6
• Avoid allowing the infant to sleep in car seats, carriers, or other devices not designed for sleep 6
• If the infant falls asleep in a car seat or carrier, transfer to a flat, firm surface when practical 6

Important Caveats

• Individual responses to the reduced oxygen environment can vary significantly, even in the same infant on different flights 7
• The hypoxia challenge test may not accurately predict in-flight hypoxia in all infants 7
• Infants under 1 year of age are more susceptible to hypoxia than older children, especially if they were born preterm 2

Remember that these guidelines focus on respiratory safety during flight. Other considerations such as ear pain during takeoff and landing, exposure to infectious diseases, and disruption of sleep schedules should also be discussed with your pediatrician before travel.