Taking children to a malaria-infested region of the world is a very serious undertaking. Malaria is a deadly disease, sometimes not spotted quickly because the early symptoms resemble flu. It kills maybe nine or 10 travellers returning to the UK every year. Last week, an inquest heard how it took the life of a nine-year-old girl.

Sheba Bayou, who was on holiday for five weeks in the Ivory Coast, was not taking the anti-malaria tablets that had been recommended for the whole family by their doctor. It's the same story in virtually every death. Either anti-malarials were not taken, they were stopped too early or they were the wrong anti-malarials because the malaria-causing parasites of the region had developed such resistance to them that they were about as useful as Smarties. Some families who migrated to the UK from Africa or India think they still have a low level of basic protection from the disease, but after a few years away that is unlikely - and their children certainly do not.

For the last few years, one reason for not taking the tablets has dwarfed all the others: Lariam. The name of this very effective drug strikes fear into many adults travelling to areas such as sub-Saharan Africa where endemic malaria is now highly resistant to choloroquine, once the standard prophylactic treatment.

Reports of the nightmarish side-effects suffered by some travellers on mefloquine - Lariam is the brand name - have received widespread publicity. Some have talked of convulsions, headaches, vertigo or dizziness. Others have described insomnia, vivid and unpleasant dreams, anxiety, agitation, panic attacks, hallucinations and even psychotic episodes. It was once the most useful drug in the armoury against malaria and - at one tablet a week - the easiest to take. Now it's the most feared.

Doctors and public health officials say that any side-effects only affect a small minority. But as the Lariam controversy has raged, some have abandoned all thought of visiting a malarial region, while others have had to confront the appalling dilemma of either dosing their child with a controversial drug or risking a potentially fatal disease.

To everybody's relief, another drug has now been licensed specifically for children as an anti-malarial and can replace Lariam in most situations, although the evidence for its effectiveness is inevitably nothing like as great as for the older drug which has been used successfully by very large numbers of people around the world.

Malarone, a combination of atavaquone and proguanil, has been around for a while for adults but is the first anti-malarial to be tested, licensed and formulated for children. The pills are smaller and coated to block the bitter taste. It can be taken in regions where chloroquine is now useless, such as the southern half of Africa.

The two main problems with it are the cost - it is extremely expensive, at least £15 for a pack of 12 tablets, and a child will have to take between one and three a day depending on body weight, although distressed parents may not care how much they have to pay for peace of mind - and that it cannot be taken for longer than 28 days. It is also only for children weighing more than 11kg, which rules out babies. They probably should be given Lariam, but it comes as an adult tablet that is not supposed to be crushed. The other option for chloroquine-resistant areas - the antibiotic Doxycycline - is only for children over 12 because it affects bone growth. (You cannot get malaria tablets on the NHS; you have to go to a travel health clinic where they can advise you on all the risks and side-effects and possibilities).

But without a doubt Malarone paediatric is a useful advance. "Africa has been a great growth area for travel, but over the last three to four years people have held back," says Richard Dawood, a specialist in travel medicine at the Fleet Street travel clinic in London. "They would choose areas of Africa where there was no malaria. There has been a pressing need for Malarone, as there is generally for more malaria drugs," he said.

However, Jane Zuckerman, medical director of the Royal Free travel health centre, fears parents "still consider everything to be tarnished with the Lariam brush. I think it is terribly, terribly important that they are aware there is a choice to be discussed with a travel health professional."

And drugs alone are not enough, she adds. "Whether they take Malarone or chloroquine or mefloquine, bite-avoidance measures are essential. You can still get malaria even with these. And if you or your child are ill in any way, with diarrhoea or fever or tummy pain, you must see a doctor."

All travellers to malarial regions - and particularly areas like Africa where the deadliest form is to be found - should protect themselves from mosquito bites, especially from dusk to dawn. They should sleep in rooms that are properly screened, with close-fitting gauze over doors and windows and spray the room with insecticide before going to bed. In an unscreened room or a tent, insecticide-impregnated bednets are essential. Long-sleeves, long trousers and light colours all deter mosquitos. Insect repellents can be used on children's clothes, but they should not be smothered in it - keep to the manufacturer's instructions.

None of these is enough without the prophylactic drugs, while the claims made for garlic capsules and the like, says Dr Dawood, are "completely spurious" although understandable after the Lariam scare. "Nobody has proven that these things work and the risks are too great," he said. "If you wish to use them additionally, I don't have a problem, but if you are trying to use these instead or imposing those beliefs on your children, I think it is highly irres- ponsible. Reputable homeopaths I know do not propose any of these as an alternative - only in addition."

· Traveldoctor.co.uk lists all MASTA travel clinics around the UK..

The defence against malaria

Progauanil plus chloroquine

Adult dose is 16 tablets a week. Not effective in sub-Saharan Africa. Dosage for children varies with body weight. Chloroquine comes in syrup form, but adult proguanil tablets need to be broken up and are bitter. The best way to give them is in oily food such as peanut butter or chocolate spread so they do not dissolve and taint the whole mouthful.

Lariam (mefloquine)

One tablet a week. Three doses should be taken at least 2 weeks before travel to allow blood levels to build up and so that if any side effects are felt, there is time to change. Very effective in sub-Saharan Africa where chloroquine no longer works. Not recommended for babies under 6kg. Dosage then rises from a quarter tablet to three-quarters up to 44.9kg.

Doxycycline

One tablet daily. An antibiotic useful in south-east Asia where mefloquine resistance has built up. Can also be taken by those travelling in southern Africa who want to avoid Lariam, but not much trial data from the region. Not suitable for children under 12. Excessive exposure to sun should be avoided.

Malarone (atovaquone and proguanil)

The adult dose is one tablet a day, to be started the day before travel and continued one week after return. Malarone paediatric, specially fomulated for children, comes in smaller pills and the dosage varies from one to three a day according to weight. Very effective in southern Africa.

Maloprim (dapsone and pyrimethamine)

Used with chloroquine in areas where resistance to chloroquine is not serious, such as Oceania. Dose for adults is one tablet a week of Maloprim and two of chloroquine. Not recommended for babies under 6kg, and then the dose is a quarter tablet rising to three-quarters at 44.9kg.