Children are particularly at risk from malaria since symptoms can be especially severe and can develop rapidly. Deterioration is related to rapid increases in parasite density, which probably relate to the lower red blood cell mass and immunological immaturity in children.1 Symptoms may differ from those in adults and, as children often have febrile illnesses, malaria may not be suspected. Young children may be less likely to report specific symptoms and are more likely to have higher fevers and greater vomiting and hypoglycaemia than adults. The occurrence of side effects of antimalarial drugs is also different in children2 and they can have greater difficulty in retaining drugs given by mouth, partly because of the bitter taste of some antimalarial drugs. Cases of imported malaria in children are increasing and it is timely to consider the background to this problem and to review approaches to prevention and management.

From 1 January to 31 December 1995 there were 2055 cases of imported malaria in the UK reported to the Malaria Reference Laboratory, of which 306 (14.9%) occurred in children less than 15 years of age (personal communication, 1996). For comparison, in the Netherlands a lower proportion of all cases of imported malaria between 1991 and 1994 occurred in children (26/280; 9.3%).3 Figure 1 shows the number of children with malaria in the UK over the past five years grouped into three age categories. There is little difference in occurrence between these age groups, although there were fewer cases in younger children (1–5 years) for three of the five years shown. It is not known how many of the infants had congenital malaria. Most cases of malaria in children since 1991 have been due to Plasmodium falciparum (56.0%), with P vivax accounting for 35.7% (table 1). Overall the ratio of …