Is flying at 14,000 MSL safe for children without supplemental oxygen?

Question

FAR 91.211(a) requires supplemental oxygen for all passengers above 15,000 feet. Are there any health implications of a 5 hour flight at around 14,000 feet on children without any supplemental oxygen? Obviously the flight crew would be wearing supplemental oxygen as required by the FAA above 12,500 feet.

I've read that babies under 3 months do not have mature enough lungs for altitude stress, so for the sake of this question, let's assume the children are over 6 months with no existing health conditions to worry about.

My question is for a non-pressurized general aviation aircraft.

Answer 1

Let me start out by saying that Aviation Stack Exchange is not a substitute for medical advice. Most of us aren't doctors (though I have medical training I am certainly not a doctor), and even if we were doctors we are not your doctor and we don't know your medical history (or your child's medical history).
If you're going to be flying with your kids in an unpressurized aircraft consult your pediatrician for their recommendation on supplemental oxygen. There are a number of factors at play, and your doctor will be able to consider all of them and give you comprehensive advice.

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That said, let's talk about oxygen in general terms.

There's a lot of good information on supplemental oxygen use out there: AOPA talks about it here, and this website has a very detailed explanation, written by a doctor which get into what's going on as altitude increases (and the partial pressure of oxygen in your lungs decreases).

By regulation you are required to provide supplemental oxygen:

• to the flight crew if you're above 12,500 feet for more than 30 minutes.
• to the flight crew if you're above 14,000 feet for ANY length of time.
• to everyone onboard if you're above 15,000 feet for ANY length of time.

Using the handy chart in the second website that equates to oxygen saturations (SpO2) of roughly 88%, 82%, and 76%, assuming you're breathing ambient air for an extended period of time.

To put this into perspective if you come to the hospital with an oxygen saturation below 90% you will almost universally be put on supplemental oxygen, and most guidelines call for maintaining SpO2 above 92%. (In aviation terms, the partial pressure of oxygen at 10,000 feet usually results in SpO2 around 90%).

So with that information the question now becomes "What is your standard of care for your passengers?" - the FAA sets minimum requirements in the regulations, and they are mainly focused on making sure the flight crew does not become impaired (they are less concerned about your passengers getting loopy, as long as the pilot is OK), but you as a pilot are free to set higher standards based on your own understanding of physiology and aeromedical factors.

I can't tell you what you should do, but I can tell you what I do: On any flight above 10,000 feet I carry supplemental oxygen, I use it, and I provide it to my passengers.
I also carry a pulse oximeter in the aircraft to check oxygen saturation (SpO2) on myself or my passengers as needed (and I set the oxygen flow rate based on having the worst person in the aircraft above 90%).

Answer 2

There are always health implications at higher altitudes, even those approved by the FAA.

Legally you are not prevented from flying at this altitude since the FAA does not stipulate an age for that particular FAR. You SHOULD consult a pediatrician on the specifics of you trip and its effects on children of the age you intend to carry. A 3 month old baby and a 4 year old kid are two very different things. If you have not seen it this AOPA article covers everything nicely. It should also be noted that breathing pure O₂ can also be harmfull when its not needed. You SHOULD NOT assume that a solution to the problem is to provide supplemental 02 to children to counter what ever different effects they see due to their differing bodies.

If you do intend on this you should read up on the signs of hypoxia in both adults and children. You should also carry an O₂ meter (possibly one for every occupant (Im not sure what the regs are on that)). I would also consider carrying something like this as a back up source of O₂. The most important thing that you need to plan for is the ability to divert (or descend substantially) in route should you begin to see signs of hypoxia.

DISCOLURE: I am not a doctor (or medical professional of any kind) and this information should be used a guidance and not taken as hard and fast fact. You should always consult a medical professional in cases like this.