Altitude With Kids in South America, Said Plainly

Three numbers to keep in your head. Cusco is 11,150 feet. La Paz is 11,900. Quito is 9,350.

Denver, for comparison, is 5,280. So these cities are not a little high. They are double Denver and then some.

Kids handle altitude about the way adults do, which is to say unpredictably. Jake was fine at 9,000 feet and cranky at 11,000. Nobody can tell you in advance which kid it will be.

What you can control is where you sleep the first two nights.

For Peru, that means the Sacred Valley before Cusco. It is a 90 minute drive from the Cusco airport and about 2,000 feet lower, and it changes the whole first week. Three nights there, then Machu Picchu, then Cusco at the end when everyone is used to it.

For Ecuador, Quito is the airport, so you do not get a choice on arrival. What I do is keep day one to almost nothing. Hotel, a short walk in the old town, an early dinner, bed. The cable car up to 13,000 feet can wait until day three.

For Bolivia, I would not take kids under about 8 to La Paz at all. There is no lower valley to hide in for the first nights. Older kids and teenagers, fine, with the same slow first day.

A few practical things.

Drink more water than feels reasonable. The coca tea the hotels put out is fine for kids and it does help a little. Skip the big meal on night one. And if anyone gets a headache that does not lift with water and rest, tell the hotel. Every hotel in Cusco has oxygen and they use it all the time.

Talk to your pediatrician about acetazolamide before you go. Some families use it, some do not. That is a doctor conversation, not a travel advisor one.

And build a spare day into the plan. If someone is flat on day two, you want a day you can lose without losing Machu Picchu.

Altitude is the reason I route South America trips the way I do. It is also the reason I would rather plan the first one with you than have you copy a 7 day itinerary off a listicle that starts in Cusco.

The South America family guide has the country by country version.