Doctor Eric Anderson, a charter diplomat of the American Board of Family Practice and a former president of the New Hampshire Academy of Family Physicians, is a regular contributor to Travel Tips 'n' Tales. He is widely traveled and published, having written a travel health column for Travel 50 & Beyond and a weekly online column, Ask The Doctor, for The New York Times Syndicate.

Dr. Anderson invites you to send your questions regarding travel health issues to ericmd@lorrypatton.com

Eric Anderson MD

Dear Doctor.

Many sources tell how to avoid food-borne illnesses when traveling, but not many give tips for dealing with stomach trouble once it starts, especially for kids. We live in Mexico and travel with a child, and well, we are careful, but it isn't a perfect world, so our daughter does get sick sometimes. We've been here for five months and my husband and I haven't had too much trouble, but our daughter occasionally does. I think it may be unpasteurized milk products, as she likes to order plain spaghetti in restaurants and it usually comes with cream. Or it could be anything, I suppose. She gets stomach aches that last for up to 7 days, sometimes with a low fever. No diarrhea, no vomiting, not a lot of gas, just intestinal pain. It never seems quite bad enough to see a doctor (seeing a doctor is kind of a big deal, since we are still learning Spanish), but it is unpleasant for several days.

Question: How can we encourage quicker healing when our daughter gets these stomach events here in Mexico?

K. G. S, Chiapas

Answer: Wow! I can understand your concern given your location and language problem but it's a complicated question. I'm not sure I'm going to be able to help you much. If we are talking about an infant or small child I'd be more worried because little ones can get into health complications fast, and I'd be more disturbed, too, if this was a first time because then anything could be going on; however, I am reassured, to a degree, by the fact that it has happened before. A "grumbling appendix" is not common but we still see patients where attacks of less severe pain preceded the florid appendicitis that finally followed.

So what could be going on? Let's assume for the moment she's not old enough to be having bladder or gynecological problems that are giving her abdominal symptoms. Let's remember, too, that significant unrelenting belly pain always needs to be seen by a doctor and only the parent who is there can sense how bad things are. The problem may be important if your child becomes listless or develops other symptoms like being short of breath; or if her belly becomes swollen and the pain or tenderness localizes to one area only; or if she is unable to tolerate simple liquids.

But to come back to your situation: First, your child may have lactose intolerance, a personal idiosyncrasy to dairy products. Prove it by keeping a food diary. Challenge her with cheese, butter, cream, ice cream and milk on different occasions. Give her adequate time between each challenge so she is back to normal before you try again. If she has lactose intolerance your provocations should prove it. Get some Lactaid tablets that contain the enzyme, lactase, that helps the body digest milk. If she takes this before she eats a meal of dairy products and her symptoms don't occur, you've made the diagnosis.

Second, she may be suffering recurrent infections from contaminated foods such as the cream itself, or water, ice, salads, whatever. Because you eat the same foods without trouble and are OK is not necessarily significant. She could be more vulnerable to germs than her parents. The risk of infection is everywhere in some countries even to the tap water used for your toothbrush. "Don't open your mouth in the shower!" is good advice in Egypt, for example. If this turista infection is the problem those attacks should lessen as your time in Mexico increases and she builds up immunity.

Third, she may have picked up a parasitic infection. This is hard to prove. It often requires a hot, fresh stool specimen and a microscope but that can be done when you are in the States visiting.

Finally, she may have food allergies to, for example, sauces or flavoring agents although the presence of fever suggests otherwise. Again a food diary may clarify. In fact careful notes written up when each attack happens may well be the data a doctor needs to make the diagnosis whether the physician is in Mexico or the United States.

Good luck and please let us know how it all worked out.

more articles by Dr. Anderson

NOTE: Lorry Patton's Travel Tips 'n' Tales would like to remind you to always consult with your personal physician before following any medical advice and to please read the Travel Tips 'n' Tales "Terms of Use" found on the bottom of each page of this website. Dr. Anderson's opinions are not necessarily the opinions of Lorry Patton or Travel Tips 'n' Tales.