Children are much more at risk from serious complications of malaria infection than adults. It is generally recommended that unless absolutely necessary young children do not travel to malaria zones. If they do travel, children need to take the same types of antimalarial tablets/capsules as adults. Fortunately there is a choice of malaria tablets for children.
There is one major exception: children under the age of 12 years should not take doxycycline, as it can cause permanent yellow staining of the teeth in younger children. There is always an alternative to doxycycline, usually atovaquone/proguanil (Malarone) or mefloquine (Lariam).
From Chemist shops
Malaria tablets for children are usually supplied on prescriptions. NHS GPs cannot supply an NHS prescription as travel medicines are not funded by the NHS. Some GPs will provide a private prescription, but a fee will often be charged for this. The private prescription is then taken or emailed direct to a pharmacy/chemist shop. The tablets are then bought from the shop.
Some pharmacies employ an independent pharmacist prescriber who may be able to prescribe malaria tablets for adults and children without a doctor’s prescription.
High street travel clinic
An alternative is to contact a high street travel clinic, where travel vaccinations can be obtained as well as antimalarials. The clinic nurse or doctor will supply the prescription and sell the tablets.
Online supplies
Many people obtain antimalarial tablets online. There are two alternatives, an online doctor service or an online pharmacy.
Online doctor
People in the UK should use only online doctor websites which are registered with the Care Quality Commission. Malaria tablets from regulated online doctors are supplied through e-prescriptions issued after online consultations and sent automatically to their linked pharmacies. Tablets are then posted from these pharmacies which are registered with the General Pharmaceutical Council. Many online doctor services, including Dr Fox, do not prescribe for under 18s.
Online pharmacy
There are now many regulated online pharmacies in the UK which are registered with the General Pharmaceutical Council. They can supply malaria tablets from a GP prescription, often at lower cost than a high street pharmacy. Several of these online pharmacies also offer an independent pharmacist prescriber service for antimalarial tablets.
Prescription medicine for children can be posted from online pharmacies if a child has been prescribed the medicine already, usually by their GP, and the prescription is posted to the online pharmacy. There are many regulated online pharmacies in the UK.
Prices
The cost of tablets dispensed on private prescriptions is set by individual pharmacies. It can be worth shopping around, particularly for atovaquone/proguanil (Malarone), which is an expensive medicine.
Malaria tablets bought through online doctors tend to be lower cost, as online services usually include a consultation and e-prescription.
Private doctors and specialist travel clinics tend to have higher charges.
Which malaria prevention tablets for children?
Recommendations about which tablets are advised for different parts of the world can be found at the NHS Scotland Fitfortravel website. Also see ‘mosquito bite prevention‘ on the antimalarial medical information page.
Parents should supervise their children’s antimalarial medication to ensure it is taken correctly, as even adults can get confused by the different regimes.
NOTE: The doses below are taken from manufacturer’s patient information leaflets supplied with tablets and are based on the standard strength of tablets (November 2021) and the UK malaria prevention guidelines. Tablets should always be taken in accordance with prescription instructions or the instructions supplied with the tablets.
Malarone – atovaquone/proguanil
Atovaquone/proguanil is a proper medical drug name. Malarone is the best known UK brand, although not the only UK brand of atovaquone/proguanil. There is a child’s strength tablet, atovaquone 62.5mg/25mg proguanil. There are different brands of child’s strength tablets the best known of which is Malarone Paediatric.
See link to the full manufacturer’s patient information leaflet supplied with Malarone Paediatric (Malarone for children).
Child strength atovaquone 62.5mg/proguanil 25mg is licenced for children (or small adults) weighing between 11kg and 40kg. Tablets preferably are swallowed whole and taken with food or a milky drink but can be crushed and mixed with food.
Atovaquone/proguanil tablets are taken daily, starting 1-2 days before a trip and are continued for 7 days after leaving malarial areas.
The usual dose to prevent malaria depends on a child’s weight.
- 11-20 kg: 1 paediatric tablet once a day
- 21-30 kg: 2 paediatric tablets once a day (as a single dose)
- 31-40 kg: 3 paediatric tablets once a day (as a single dose)
- Over 40 kg: 1 ADULT Malarone tablet (atovaquone 250mg/proguanil 100mg) once a day
Atovaquone/proguanil can be prescribed off label for use in smaller children. Doctors take responsibility for this prescribing. Doses are by weight.
- 5-7 kg: ½ of a paediatric tablet daily
- 8-9kg: ¾ of a paediatric tablet daily
- 10-11kg: 1 paediatric tablet daily
Lariam – mefloquine
Mefloquine is the medical name of Lariam. Lariam is the brand name of the medicine.
There is no children’s strength Lariam tablet. Adult tablets are divided to make up children’s doses. The tablets are scored for ease of splitting but it is best to use a pill cutter for accuracy. Lariam can be used in children from 5kg. See the table below for doses. See the manufacturer’s patient information leaflet for Lariam tablets.
Lariam is taken once weekly on the same day each week, started 10 days before travel (first dose 10 days before, second 3 days before) and continued for 4 weeks after leaving malarial areas.
| Weight | Age (approx.) | Weekly dose |
|---|---|---|
| 5 – 19 kg (11 – 42 lbs) | 3 months – 5 years | ¼ tablet |
| 20 – 30 kg (44 – 67 lbs) | 6 – 8 years | ½ tablet |
| 31 – 45 kg (68 – 99 lbs) | 9 – 14 years | ¾ tablet |
Doxycycline
Doxycycline is an antibiotic which can be used for malaria prevention. Doxycycline is the medical name. It is available in a variety of different brand names, of which the best known in the UK is Vibramycin. The adult’s and children’s dose of doxycycline for malaria prevention is the same, except that children under 12 should not be given doxycycline.
Note: Doxycycline is NOT advised for children under 12 years. In younger children it can cause permanent yellow staining of the teeth.
Different brands of doxycycline are supplied with very similar manufacturer’s advice leaflets. See the manufacturer’s patient information leaflet supplied with one of the brands of doxycycline.
The dose of doxycycline in adults and children over 12 years for malaria prevention is one 100mg capsule taken daily, started 1-2 days before travel and continued for 4 weeks after leaving malarial areas.
Bite prevention for children
It is not possible to avoid mosquito bites completely but the less you are bitten, the less likely you are to get malaria.
Mosquitoes can bite at any time of day. Most bites from malaria mosquitoes occur in the evening and overnight between dusk and dawn. In contrast, Dengue fever mosquitoes tend to bite during the day.
- Dress your child in long-sleeved clothing and long trousers, especially if they are out at dusk, dawn, and at night.
- Use insect repellent, preferably containing diethyltoluamide (DEET), on exposed skin and under thin clothing, particularly around the ankles. The best strength DEET is 50%. There is no added benefit to using higher concentrations. Other repellents containing picaridin 20% or lemon eucalyptus 30% are less effective than DEET and must be reapplied very frequently.
- DEET is available in sprays, roll-ons, sticks, and creams.
- Avoid using DEET on the hands and wash hands after application, to avoid your child swallowing any.
- Insect repellent room sprays, mosquito coils, and heating insecticide impregnated tablets all reduce the risk of bites and should be used to kill mosquitoes in bedrooms before going to bed.
- Where possible, sleep in screened rooms or make sure that doors and windows are closed properly. Use a mosquito net, preferably one impregnated with insecticide (permethrin). Mosquitoes are deterred by air conditioning but not fans.
Ultrasound devices, mobile phone apps, garlic, Vitamin B, marmite, homeopathic products, tonic water, alcohol, tea tree oil, and citronella DO NOT prevent bites.
Is DEET safe to use in children?
There were a handful of reports published before 1992 which linked DEET with seizures but in almost all there were other potential reasons for the seizure. A study from 2002 looking at DEET in a large population included over a thousand infants and children and showed fewer issues in the children than in adults.
DEET is the most effective insect repellent available, and as long as it is not swallowed, is the best for your child.