The expatriate life-style can seem very attractive and it certainly has many advantages. But most expatriates are posted abroad, so may have little choice about where they are sent; some feel they have to choose between what they see as risking tropical diseases and splitting up the family. Yet educational psychologists list several advantage to children who are brought up abroad surrounded by people of other cultures.

Advantages of being brought up an expatriate...

Tolerance and acceptance of difference

Broader vision - global view

Maturity of opinions

Commitment to social services; wanting to do something worthwhile

Ease of communication with adults

Closer bonds within the immediate nuclear family unit

At ease with social diversity

...and disadvantages

There are challenges too. Playmates at home often don't understand (or care) what the child's family has been doing while away. Children can be isolated because of their different experience or may be labelled as 'know-alls'.

Their maturity and sophistication make them different from stay-at-home contemporaries; so new returnees are teased and even accused of lying. Even children need to learn to 'edit' what experiences they talk about or be careful who they tell them to.

Children quickly pick up on all the enticing local stories featuring ghosts, curses and spirits, but sometimes these cause nightmares. Local people will have religious pujas and other defence mechanisms to deal with such fears; but expat kids have no access to such help, especially if the family's own religious affiliations keep them away from local belief systems. Perceptions and prejudices are presumably more important than actual belief bases. It was interesting talking to an American Buddist about all this; spirits and curses posed no threat for her children because their beliefs could deal with anything that their religion raised.

Adjusting to a new country

It is perhaps dangerous to generalise, but some age-groups find up-rooting more difficult than others. Even so, as long as parents feel confident and enthusiastic about a posting then the children too will be keen. The early teens may be one of the hardest ages for moving; children are often in turmoil then, anyway. Also the age of starting primary school can be an unsettled time, with children needing to find their identities and adjust to new social norms. Moving when children are infants or around three to four years is often relatively easy. Ideally, school should start straight after arrival in the new country so that the child is kept busy and quickly starts making friends. Then there's less time for brooding and homesickness.

The adjustment process

There are five transition stages of adjustment to a new country:


Involvement and belonging in own native culture

Leaving the home culture; celebration and excitement, but also distancing and denial

Transition: chaos, anxiety

Interim: superficiality, vulnerability

Reinvolvement, intimacy, belonging: feels like home again

The timescale of this process is highly variable; but knowing that the process happens can help families deal with the stresses of moving. If parents feel lost, insecure and anxious but recognise this as a temporary symptom of adjustment it is easier to cope and look forward.

Being a sedentary parent is a hard job and being a travelling parent is even harder, though it has its rich rewards. Many of us go through times when we might feel inadequate; if those feelings are getting you down be quick to seek help: talk it out with your partner or friends or seek professional counselling. Travel is stressful but the stresses can usually be put into context by talking them through.

Coping Strategies

There are five key strategies for coping with the kinds of changes and challenges when travelling families, and especially expatriate families encounter - the five Cs:

Communication - important for members of the family to talk through conflicts; there should be no taboo subjects

Constancy and predictability - especially if the family is on the move children need reassuring rituals, particularly perhaps when they are settling down in the evening; such rituals as bed-time stories are readily transportable and you can even take them trekking!

Collaboration - involving the children in choices: planning together; consulting the children on what you and they need to take

Closure - when the family is about to move on, allow time for genuine goodbyes and visiting favourite places; and talk about leaving.

Cultural confirmation - particularly when the family is living abroad long term parents need to work on determining their identities and values, and ensuring that the children are similarly self-assured. Children like to know that they are not different from their parents in attitudes, affinities, affiliations. The nuclear (immediate) family is a much closer and more dependent unit when the family is travelling a lot or living an expatriate lifestyle; the children may lack geographical stability and so need more security from stable and predictable parents.

Education

Education and schooling is perhaps the biggest worry to expatriate parents or families travelling for long periods. Most capital cities will have a good international school, although good English-medium schools are not found everywhere. When choosing a school abroad, consider whether your child needs a British, North American or European curriculum.

Many expatriate parents who are living in villages choose to send their children to the local school perhaps during the mornings only and then teach them at home (home school) in the afternoon. This has the huge advantage of the child making local friends and learning the local language yet educationally keeping up with peers at home. The arrangement works well in young children up to the age of about eight, but thereafter the time becomes insufficient for progress both at the local school and in home-school. And, especially in Asia, local schools can impose terrific pressures on children to achieve at very young ages; there are even entrance exams for nursery schools!

One child could read at the age of four but started bed-wetting and became miserable and withdrawn; the parents realised that she was not gaining any skills in problem-solving, but only excelling in areas which were rote-learned. The child became happier on changing schools. In Asia's best schools there is a surprisingly high suicide rate among older children who think they are failing. Parents need to be aware of these additional pressures and support their children as best they can.

Visiting Friends and Relations

Families who have settled in another country often return home to stay with relatives and friends in the country of their birth. Or they may leave their adopted country to return home after decades away. From the point of view of illness, children of such resettled families are Westerners. The trip may involve,say, a British-born child going to stay with relatives in a big tropical city or in a remote and steamy village. The visitors will be welcomed back into the family and expected to behave like locals. With experience only of British illness patterns, they will have no resistance to local diseases. Despite this, the visiting child will be expected to sleep out on the back verandah or in a bed with his cousins, will drink unsafe water or east unsafe food perhaps, and will be bitten by malaria mosquitoes. For these reasons, this group of travellers are at much higher risk of going down with TB, dysentery or malaria after returning to their adopted home than those without family links abroad. What little immunity people do acquire to malaria wanes within a year.

In Southeast Asia there are unpleasant and very dangerous strains of dengue haemorrhagic fever, people who were brought up in the region and return in late childhood or adulthood are at the same risk as locals.

The inescapable fact is that whatever one's ethnic origins, adults returning 'home' after a long absence or children visiting grandparents have as much or even more risk of suffering local diseases than casual tourists. Visiting friends and relations need to be extra careful, get all their immunisations, take malaria prophylaxis, avoid mosquito bites and take all the precautions other travelling families have to take.

Returning Home after Travel Abroad

Medical symptoms

There was a vogue for returning travellers to go for a medical check-up after returning from an exotic trip or period of work overseas. As a general rule, however, such routine check-ups are unnecessary. The reason for this is that almost all problems will cause some symptoms; there are very few illnesses which lurk unnoticed and then suddenly burst out and overwhelm the body. The very few exceptions to this reassuring fact are detailed below:

Malaria

Malaria is a dangerous disease which can kill rapidly, especially children and pregnant women.

The severe and rapidly progressing illness is increasingly being imported into temperate developed countries. If you have been in a malarious region within the last three months any unexplained fever could be serious malaria and you should mention this fact to the doctor you consult. Malaria which as been partially treated or is one of the more benign forms may take up to a year to manifest itself. There is no screening test which can diagnose the problem so it is important for travellers and doctors to be aware of possible exposure. And don't forget to continue taking antimalarials for a month after return.

Rabies

Rabies is acquired from the bite of a dog, monkey or warm-blooded animal, or from a rabid animal licking broken skin. There are no symptoms initially and no screening test. Any suspect bite must be treated with a course of injections. Once the symptoms of rabies emerge the disease is untreatable and invariably fatal.

Bilharzia

The African lakes are the commonest place to acquire this troublesome worm. Many travellers will get some symptoms but a few may not and a blood test more than 6 weeks after your last possible exposure will tell you whether you have a problem or not. The disease is readily curable at present.

Chagas disease

Chagas is a risk if the family has been staying in villages in South or Central America and has been bitten by assassin bugs; infection is most unlikely unless you have been sleeping on the floor in very poor wattle-and-daub type ramshackle huts. If you are worried, there is some sense in getting a blood test to determine whether you have been exposed to the Chagas parasite. Very few travellers will have been exposed and it would probably be best to ask your family doctor to make enquiries at a specialist tropical diseases centre.

Worms

A large roundworm may be passed as much as 18 months after stowing away in your child's intestine. They are harmless although revolting. It is worth having a stool check before treating worms since sometimes the infestation comprises on lonely individual. If the thought of tropical worms really makes you feel squeamish you may want to send a stool sample off to the laboratory; otherwise do not bother. Unlike threadworms these large worms are not directly transmissible from one family member to another.

Psychological Symptoms

Reverse culture shock can hit children, especially if the family has been abroad long term; and readapting to your own culture can cause problems, especially for adolescents who may be going through their own identity crises. One important areas to be aware of is the need for closure, that is allowing a comfortable separation from familiar places and friends when the family is about to move on.

Goodbyes need to be said to both people and favourite haunts, and it is healthy to talk a little about leaving. The longer you have been based in a place the longer the closure rituals should be; but even after a holiday, children like a 'last go' on this slide or a 'last visit' to that favourite rocky cove. Ensure they know it is a last visit. And when you get 'home' be prepared for all the adjustments problems you may have noticed when you first went abroad; these processes are mentioned above. Travel is stressful so allow all members of the family time to adjust.

Finally be aware that children are treasured and protected in developing countries in a way that we have forgotten at home. Returning children who are not shy of strangers may be exposed to possible new hazards or even abduction. Expatriate children are more mature in many ways but they also may have been sheltered from the obscene aspects of 'civilised' countries.