Be prepared!

To prepare for your trip, I would advise that you should see your regular doctor a month before you think the ever elusive TA will arrive. This will give your doctor time to change meds, get immunizations and prepare.

Immunizations: the Centers for Disease Control (your Federal tax dollars at work) has a great site where your doctor can look up what immunizations you need per country and whether there are additional ones needed, if you are traveling to a rural location. Although the routine immunizations (tetanus, influenza, etc.) are at your doctors office some rare ones may not be, so it is best to see your doctor early. The site is also full of travel tips that are worth the read.

If you have any health problems see your doctor early: as an example, my wife has asthma and spent ten weeks of last fall with bronchitis and pneumonia. She was worried about the smog of Beijing since she already had breathing problems. Her allergist upped her inhalers and put her on Spiriva which completely took care of her asthma despite the Beijing smog (visibility 4 blocks). Her medicine, like many needed, took several weeks to become fully effective making it well worth her while having that appointment early. 

MEDS to take: 

Imodium: for mild diarrhea without fevers. 1 tablet after each stool up to 8 a day 1 box.

Cipro 250mg  for diarrhea: to take twice a day for 7 days if you get diarrhea and adding Imodium to this will help slightly. The CDC give guidance on this but the Cipro should be started if there is any heavy diarrhea or fevers. Pack enough for 1 round of all the travelers ideally, but it is not indicated for children under the age of 16.On our last adoption trip, we had a five hour “trip from Hell” between Guangzhou to Hong Kong on a bus (another story in itself and truly defined "Chinese Fire Drill") with a young adoptive parent who would have almost given the baby away for cipro given all the belly pain and diarrhea he was having. Ironically, of all things he was Chinese American!

Ibuprofen or Tylenol :  for multiple aches and pain. Also, take tylenol an hour before you land in China, since they have those pesky temperature scanners and a lovely quarantine area where they would love to put sick Americans.

Amoxicillin  or Azithromycin for the baby/child who will have a good chance of having an ear or sinus infection. The big guns (Augmentin, Cefzil, etc) are usually not needed because for Chinese children many of their prior ear infections were not treated so they have had little opportunity to develop resistance to the first line agents. Naturally, if your pediatrician or family physician thinks otherwise do what they suggest but I saved the hefty co-pay and did something nice for my wife with it-- like help to pay adoption fees! 

Have your doctor specify for the pharmacist to give you dry powder with instructions to mix just the right amount of sterile water which they can measure and put in a separate bottle- but be sure that bottle is less than 3 oz or it may get thrown out going through security.

Children's Tylenol or Advil: for the flights/ ear infections /aches and pains whatever. liquid or chewable.

Benadryl: Because you never know when you or your child might have an allergic reaction to something, like maybe the unusual food (eel, sea cucumber, silkworm cocoons, duck brains, pig intestines...) 

On giving a child medicine they don't want: If you've tried the mixing it with food (without them seeing you do it of course) or giving small amounts at a time along the gums and have had no success there are several  advanced techniques available. None of these techniques  include coaxing, cajoling or trying to talk your baby into it because it "is good for them" - you are now beyond that. None of this coaxing they will understand anyway since you don't speak Chinese! All techniques involve holding them down firmly and pinning the arms since their natural response will be to reach for the med, their mouth, or hit you! It is not for the faint of heart but nurses that work in ER's aren't faint of heart and this is what they do.

The first is just shove the dropper in and squirt the medicine in your child's mouth while the baby is lying down on their back on a hard surface - the beds in China more than fulfill that requirement in our experience. Holding the nose shut simultaneously sometimes helps as well. Yes they may cough and choke (in which case, sit them up) but the med will go down! Don't do this if your child has a known swallowing problem. The other method is to hold the child down as before with someone else holding his/her head and blow on his/her face just as you give the medicine. A pediactric nurse on our first adoption trip gave us this tip and it worked for us.

The Changing Picture of Adoption in China

Last month, while enjoying that wonderful White Swan American Breakfast buffet, and  looking around the dining room, that the face of Chinese adoption sure looked different than in April of 2006 when we got our oldest Chinese daughter. Still the same tired stressed parents, the babies highchairs surrounded by circles of food on the floor, the excellent staff and the soul-satisfying pancakes and French toast (oh for French toast after two weeks of congee, dumplings and mystery breakfasts in the provinces)- but the children were older, male and with a lot more special needs. In fact while waiting to be seated for breakfast, a woman behind us said, "You must have been a non special needs family" noting we had what appeared to be our completely healthy appearing infant girl-- until we pulled up her sleeve revealing her short arm and missing thumb.

Recent changes in the Chinese government allowing more domestic adoptions within China has dried up the number of healthy babies causing many of us to switch to specials needs children vs waiting till we are too old--either by their government standards or our own body standards (boy I'm feeling all sorts of new things as I approach 50. This is really a boon for the special needs children since now they have a much better chance of coming stateside where they can get the surgeries and therapies to help them reach their potential, and given a loving home and family. But it also places special stresses on parents adopting older children or those with multiple needs. It will be interesting to see how this new generation of Chinese internationally adopted children and their parents fare in the future.

H1N1 and travel

Currently the H1N1 is alive and well in China with 100,000 cases (vs. 22 million in the US) being reported by the Xinhua news service. Today's edition of the China Daily mentioned 800 severe cases in Beijing itself. In general this illness has been mild except in the elderly with medical problems (thing about any elderly relatives who may be accompanying you to help out on your trip), the very young and pregnant women.

Without a doubt the safest way to avoid H1N1 is to get vaccinated here stateside at least two weeks before you travel to allow your body time to develop the immunity needed to fight the H1N1 virus off. Frequent hand washing with soap and water or hand sanitizer (hanitizer as my daughter calls it) also helps. Also don't forget the regular flu shot.

Last month when I traveled to China I took two full courses of Tamiflu with us -1 for my wife who refused (read "stubborn") to get vaccinated and one for either my 4 year old traveling with us or the baby we were adopting. We didn't need to use either but were ready and no one I ran into seemed to need it as well. To help at all Tamiflu needs to be started within two days of the first symptoms appearing. The other thing you will note is a lot of Chinese wearing face masks even when they are well to prevent getting an infection. Although I think this is a hold over from the SARS epidemic of several years ago and has been shown in US studies to be fairly worthless. That being said, if it gives them peace of mind, let them wear masks. Given the level of smog in all the cities we traveled in, perhaps that is the real reason for the masks.

Speaking of peace of mind, last week I saw a gentleman in our Emergency Room who was worried about having H1N1 from what really seemed like a cold. I tried to reassure him that it wasn't but he was still anxious. Finally I asked what was driving his concern. It turns out a pregnant cousin of his had died a week ago in Puerto Rico of H1N1. So I got him the flu test (even though the test itself if only 60% accurate) since no amount of talking would provide him the peace of mind that the test would. It was negative--he went home to take Tylenol and push fluids.

Introduction

Congratulations on joining what I call the “great adventure” of becoming an adoptive parent. You are truly brave and amazing – don’t think otherwise – in taking on the unique opportunity of adopting a child. As I remember our our two “Gotcha days” I think that it is indeed a rare and unique moment when you can change a child’s life forever by bringing them into your home and making them yours!

Here's a little bit about me: I'm a family doctor teaching in a residency program in PA-think TV show "House" without the attitude and drugs. I do all aspects of family medicine- newborns, kids, pregnancy, obstetric deliveries, adult and elderly patients and as a family doctor I get lots of time explaining to patients what the h*** their specialist actually said to them. For fun, on my day off I work in the ER snatching patients from the jaws of death or at least I'd like my friends to think so. (Warning: I will occasionally lapse into funny or strange stories from my experience in the ER and elsewhere- I used to think that the TV show writers made up all the bizarre stuff until I started working in the ER.)

I've adopted two girls (one with special needs) from China, have read research of adoption and given a few lectures on international adoption. With the residency position I have access to look up just about everything in the Medical literature written- a big advantage when trying to figure complex issues like attachment disorders etc.

What I intend to do with this blog is offer my suggestions and advice pertaining to adoption from my personal and professional experience. What I'm not intending is to replace anyone's personal physician's advice or diagnosis. That being said, many families' personal physicians may be unaware of the unique medical aspects of internationally adopted children.