Should I bring my two year old to China?

I was recently asked this by a young mom in Church. She was agonizing over whether tis nobler to suffer the slings and arrows of bringing a two year old to China, or by opposing, leave her at home in the capable hands of Grandma. One the one hand, leaving the two year old at home allows Mom and Dad to focus exclusively on that critical and difficult bonding with the newly adopted baby, a time that can be challenging. On the other hand, the 2 year old will miss this transition, will miss Mom and Dad and to add insult to injury they come home with a new baby that sucks up all the attention that used to be focused on them.

The background of this discussion stems from recent discussion of this by families on the forums and most -even those who took 2 year olds - agreed that it is better to leave them at home. Rather than take their word for it I asked my China connection who has shepherded 1,000's of family in China through the adoption process for the last 10 years. She suggests that unless the child is a very good traveler and easy going they should be left at home to stay in the same consistent routine with Grandparents until Mom and Dad come home.

A two year old would enjoy a trip to Disneyworld, but in a year would probably not remember anything of meeting Mickey Mouse. A two year old would not remember the cultural experiences of a trip to China. On our trip to China for China 2, we did bring China 1, who was 4.75 years old. Frankly we didn't have anyone to leave her with and a four year old has a level of independence that a two year old does not.

Let's picture this: You are on a bus traveling to the civil affairs office on the other side of the city. Two year old starts to pitch a fit because she wants a toy she left at the hotel. Mom tries but can't console her. Two year old thrashes so much in her fit that she falls to the floor of the bus, because there are no carseats and no seat belts (this is China after all), and bumps her head, and wails even louder. Mom is holding the new adopted baby, who is crying because she wants a bottle, but tries to console Two Year Old. Dad tries to take Baby, but she screams bloody murder if he looks at her and Two Year Old wants nothing to do with him and hits him. Mom tries to mix baby's bottle but it leaks and spills all over her. she gets annoyed with Dad for not being helpful. the screaming gets louder. Dad wishes he had his iPod.

Factors to consider if you bring another young child with you to China:

Does he/she tolerate change?
Does he/she meltdown if on a different schedule? 
Does she need regular naps and bedtimes?
Is he/she a picky eater?

There is just too much to deal with jet lag going both ways, the new child needing  uninterrupted intense bonding time from Mom and Dad, and a toddler who also needs attention. It becomes unfair to the 2 year old who has his/her own exhaustion/emotional issues to consider. Being at home in a consistent routine in a supportive environment will help him better weather the time away from Mom and Dad as well as the transition of the new baby into the home-and all without jet lag. And Mom and Dad can give all their energies to focusing on their new child, a child who will grieve the loss of her familiar environment, who may be anxious, who may act out aggressively, who may have sleep or eating issues. It's a hard enough trip for adults without the added stress of another very young child. So there's my expert opinion.

The funny thing kids will do

Hitting themselves, flapping their hands, rocking and rolling back and forth like they have autism, staring out into space like they aren't there, bobbing, scratching, and biting are some of the thinks that your child did to survive in their mind and body in the orphanage.

Self stimulation is a way that they get to stimulate the developing sensory organs and to sooth themselves since in the orphanage, no one else has the time to. In addition, they may have been deprived of textures, colors or other sensory inputs that we take for granted . China 1 came from a drab orphanage with little amenities shall we say. The babies were in their cribs or in walkers or on those little duck potties. Definitely no toys. To help minimize the sensory overload coming to our home, we minimized the colors in her room (it was painted brown when it was my office, and it stayed brown when it was her nursery) and we packed away the stuffed animals (she was afraid of them). When she first saw a TV she tried to look behind it to see where the funny man in the box was.

It will help your chil'ds adjustment if you put away that X-box, keep a lid on Elmo and tone down the brightly colored baby room and just let them get used to you and the new funny food you are feeding them. Then after a period of time you can start to introduce these new sensory overload items one at a time.

After a couple of months if you child is still doing as much of the self soothing behaviors that they were at first bring it to your doctor's attention.

The Fifteen Commandments of Attachment

I came across a list of attachment issues that I thought it might be helpful to new adoptive families. But I had to put my own spin on it...so here I give the the 15 commandments of creating attachment

1) Thou shalt not shareth your child with multiple caregivers until attachment to you is very secure lest the baby become confused.

2) Thou shalt hold and carry your child as much as possible.

3) Thou shalt not depend on the stroller for it is an abomination which will preventeth bonding.

4) Thou shalt stay close to your child as much as possible for that is the way unto the blessedness of attachment.

5) Thou shalt keep your life low key for six months even thou though livest in a busy and crazy land full of temptations

6) Thou shalt not let family/friends/acquaintances or little-old-well-meaning ladies holdeth /feedeth or nurtureth thoust child lest they confuseth it---includeth herewith is church nurseries

7) Thou shalt provideth high levels of nurture and structure even if thy usual state is chaos!

8) Thou shalt maintain eye contact during bottle feedings with infants and toddlers for food is the way to a baby's heart

9) Thou shalt holdest thy child in thy arms and sing or use loving words, as thy would an infant for it is soothing and is the only time thy can get away with such silly behavior

10) Thou shalt not “Ferberize or commiteth any other crazy sleep method on thy child because adopted children slumber not nor sleepeth well and needeth contact--not crying to adjust. Thou mightest have to sleepeth neareth thou child for a long time until they are secure enough to sleepeth without thou.

11) Thou shalt accepteth without complaint the end of prime time television, sex and other pleasant recreations whilst thou obeyest number 10.

12) Thou shalt looketh with longing for when number 10 and 11 no longer apply!

13) Thou shalt playest baby games (peek-a-boo and patty cake) to break the ice for anyone crazy enough to adopt is crazy enough to play these games

14) Thou shalt taketh every advantage of time like swimming or bathtime to have skin to skin contact

15) Thou shalt tryeth to be thy child's primary caregiver for as long as possible for thy employment isn’t half as wonderful as thoust baby

What on earth IS the BCG??

This is one of the burning questions you will have when looking over your child's immunization record. The BCG is a vaccination for tuberculosis given to babies to help prevent tuberculosis. Tuberculosis itself is a very common and difficult to treat infection spread by coughing, usually involving the lungs but occasionally spreading out to the brain and other organs-- it is one of the number one killers of all time and is particularly dangerous in young children who are even more likely to have it spread out of the lungs if they are malnourished. China is on the WHO (World Health Organization) top 20 lists of countries where tuberculosis is most common.

The BCG is given to prevent any infection from getting out of the lungs and causing the worst types of TB infections in infants. The immunization itself is a live weakened TB bacteria and the children are immunized as infants. In most cases if the child was immunized, you will see a small round scar on their left or right upper outer arm. It protects 80 out of 100 children from TB spreading out of the lungs but isn’t particularly effective at preventing the lung version of TB. 

Young children have weak immune systems and so the effectiveness of BCG wears off with time which then means the child may get lung TB even though they have had the vaccine. In older children and adults here in the US, physicians perform skin testing to see if someone has been exposed to TB. This is done by injecting a small amount of tuberculin (PPD) under the skin and measuring the size of the bump, not the red area at the site in 48-72 hours. All of you adoptive parents had this done for your initial medicals for your dossiers.

If the test is positive we usually follow this with a chest X-ray to see if there is any evidence of TB in the lungs hibernating (called latent infection). In addition, all children at least two years old in China are tested for TB with this skin test before the US consulate can issue a visa. This requires an additional 2-3 days in Guangzhou waiting for the PPD to be read. If the PPD is positive, a chest xray will be required, and this is a US government requirement. It's a good requirement. It protects you, the parents, and your children and everyone one else on the plane breathing the same recycled air for 14 hours.

What confuses things further is that the BCG, because it is tuberculosis, can cause the skin testing for TB  to be positive even if the child doesn’t have real TB! If a child is coming from an area like China where TB is so common and tests positive with the skin test they are assumed to have been exposed and possibly have lung TB and will be required to get the X-ray. The assumption is that the BCG has worn off,  the child was exposed to TB, and has possible become infected.
What if my child had the BCG, had a PPD test and it is negative? Does she have TB? Not likely. The immunity from the BCG has worn off and your child has not been exposed to TB. Exceptions would be if they are very malnourished or the test was interpreted wrong.

What if the PPD is positive? Should she have a PPD in the future? No. Once it is positive, it is considered positive forever and retesting can cause a severe reaction at the test site.

Stay tuned for further discussions of treatment.

Vaccinations: or, is it too good to be true??

On a trip to South America several years ago I was in a remote village with missionaries and we passed a nice looking van pulled up by the side of the road. I asked “what is that doing out since we  are in the middle of nowhere???” I was told “Oh, that is the vaccination van”- the county health dept gets a lot of vaccinations they need to use up by the end of the month so they send out the van to the villages to give the shots. There were no records of vaccinations being given or taken--the kids just lined up and got whatever shot was being given at the time- never mind that they may have gotten the same shot one month ago or whenever the last time the van was in town.

Although this is not China, this was a vivid illustration for me about the difficulties of knowing whether those shots your child got were really given and were they correct.

There is some sleuthing that can be done by  to get a sense of whether the vaccination record is correct--sort of like determining what the dog did in the nighttime or achieving six impossible things before breakfast. "Watson, the game's afoot!" Here we go:

Several practical questions that come up about vaccinations:

First did the child actually get any of the vaccines that the records said he did?

In 2002 some studies were done on a group of international vaccination records by Schultz (in the Journal Pediatrics 2002) which found that the records were valid in 93% of kids. That being said there are some tip offs that the records may be incorrect. 

First remember in the rest of the world (other than the USA) months and dates are written reversed so 12/1 (Dec 1^st) here is written 1/12 there.

Does the child record show they were immunized before they were born? Yes, believe it or not,  it has been seen.

Are the immunizations in the proper intervals for the series? For example every two months apart rather than one?

Are all the records in the same handwriting and too neat? It is true that some orphanages may have a clinic where the same nurse does all the immunizations but most don't. (on the other hand, can you tell when they are written in Chinese??)

           

If my child got the shots, was she healthy enough to respond to them and get the protection they need? The immune system doesn’t develop good memory if it is malnourished and let's face it, most of these babies are malnourished. If your baby is in the bottom 10% of weight (malnourished kids lose weight first then height and finally head size) then this is a real possibility (but make sure you are looking at the Chinese growth chart, not the US).



How soon do I need to get this evaluation for shots done? Since most kids here in the States have had shots, the chance of your child picking up one of these diseases from another child is low in the short term so a visit within a month of coming home is reasonable unless your child is  around a lot of other children like daycare (the cesspool of pediatrics but oh so good for business) or the church nursery (ditto!)



When we got with  China 1, she was from a small orphanage with bare walls, and bungee elastics holding her diaper on, and even more suspect records; so when we got home and went over the records with our family doctor, he suggested blood tests to confirm whether she had immunity, rather than re-vaccinating  her for the entire lot. I was the lucky parent to pin her down for the blood draw and I wished I had ear plugs. Despite our concerns, her immunizations were confirmed by the blood work and she didn't need any additional shots other than the ones indicated by her current age.



When we got China 2 last month, she was from Beijing Children's Welfare Institute, a large well-funded orphanage with toys, therapy rooms and play rooms that would rival any at a daycare here Stateside, so we were more believing of the records. Even with ,she was due for 5 shots to catch her up to the recommended immunizations for a child of her age, and rather than hitting her immune system with that much excitement (and hitting her and us with that much grumpiness!) we had her get two shots, and will give her a second round after she has forgotten the first. I will admit I am going to draw some bloodwork to verify she got some of the shots they said she did- particularly for diseases that have a high chance of being deadly such as measles, rubella, and HIB. I also recommend having your doctor check for anemia and lead and parasites.

A recent review of this topic provides some help with: the article is Vaccines for Travel and International Adoption by Paul J Lee in The Pediatric Infectious Disease Journal vol 27 (4): April 2008. It yawns to make me even think about reading infectious disease but this was well written, clear, concise and may be worth letting your doctor know about. Out of courtesy to your doctor do not expect the office to be able to decide which and how many immunization your child needs at the time of the visit. Give your physician a copy of the record in advance to look over before you get there or let him get back to you with what needs to be done as these are too complex to figure out in a short visit. 


How to hold a child down for shots or blood work: never a pleasant experience. Our social worker suggests that at this point parents should play a variation of Good Cop Bad Cop: the parent the child has bonded to the best should not be the parent to pin her down for the blood draw or shots. There is an anesthetic cream EMLA available which can be applied an hour before blood is drawn which will help with pain but often just the sight of a needle is enough to send the child over the edge. Explaining what is going to be done may help in older kids but not always. Don't tell a child it won't hurt she is  not stupid! I have seen adults cry like babies about getting blood drawn and 4 year olds hold still for shots (particularly the Amish). As one who has sewn up a lot of lacerations on kids, I have seen a couple of techniques over the years that work well. For shots, the nurses will have their own favorite technique. The key to all of these is to hold tightly-- that is tighter than you are comfortable with. I have learned the trick of applying tremendous pressure with what looks like a gentle hand on the head or arm.

The first is the Bear hug - if the child is older whomever is strongest takes the child in his arms chest to chest with the both arms pinned under the arms--a free arm is going to move to wherever it hurts and usually hit someone. The other technique is to lie the child down on a firm table and literally lie over top of his abdomen with the arms pinned (but beware this won't work unless you really put some weight on him that will prevent movement). The third method, often used for blood work, is the Papoose which is a Velcro board which the child lies down on and is strappen in by velcro into it. It is currently less in favor because it appears to be "mean:" but a flailing child isn't kind either particularly if it results in multiple attempts to draw blood. My favorite for the older kid is the "Superman Cape" with the child standing -you put a pillow case (or wrap a bedsheet around him) on his back with his arms (one arm in the case of blood work) in the pillow case. Once you have him down on the bed, have someone hold the free arm tightly. I always recommend taking the child out for ice cream or some treat afterward a painful experience such as shots or bloodwork.

So here is the summary by vaccine (lab test needed in parenthesis) the whole issue of how many shots we’re giving kids and whether it is good for them is another topic too hot for me to handle. The following is a bit deep and confusing if you aren't  medically trained but your doctor or nurse would understand it if you want to copy, paste and print this list.

Diphtheria/tetanus – if the baby is at least 6 months old check blood work because over-immunization can cause local reactions (diphtheria antitoxoid Ab, Tetanus antitoxoid Ab)

Pertussis- do not check levels because blood levels are often inaccurate. If the tetanus and diphtheria levels were normal you can assume they have immunity to this

Polio- check (Polio  neutralizing AB ( types 1,2,3) if more than 6 months old

Measles/Mumps,Rubella- if the child has records of having had it check titers and reimmunize if not immune to all  (Measles IgG Ab, Mumps IgG AB, rubella IgG AG)

Varicella (Chickenpox) check titers if 12-15 months (Varicella-zoster IgG Ab)

Hepatitis A- check titers if >6 months (Hepatitis A total Ab)

Hepatitis B- Always check to access Hep B chronic infection, carrier state and immunity (Hepatitis BsAg, HB Core Ab, HBsAb) – Hepatitis B is endemic and widely spread in China all children should be checked

Meningococcal- age appropriate vaccination (no titers available)- your baby may have “epidemic cerebrospinal meningitis" on her records – this is for group A and C and is either a tetravalent or bivalent vaccine.

The next two are suggested as no testing just immunize since they are not usually given at young ages but with more and more kids being older many of them did have them listed in their Chinese shot records so I would consider testing if they were listed as having received them

H. Influenza- no testing recommended just immunize if age appropriate or accept records-(H. Influenza type B IgG) – although our baby had this listed as a vaccine so I think they are now giving it.

Pneumococcal- testing not recommended just immunize if age appropriate

Others: if there is a vaccine missing the doctor should use the catch up schedule.

JEV- Japanese encephalitis vaccine may also be given but isn’t usually needed here in the US.

BCG will be covered in a future post- too complex and confusing for this one.

Always note any adverse reactions and report them to your doctor. So there you have it the final word on the alphabet soup of immunizations. Ouch!!!

No Exit...or, the medical exam

One of the keys to being able to provide emotional support for you child while bonding is being rested and controlled yourself-- the medical exam given in Guangzhou will test that to the limits! On our first adoption trip, my wife missed out on the experience of taking our daughter to the medical exam. I was happy to pass that duty off to her on this trip since one of us had to watch our older daughter and our guide recommended as few people as possible go to the clinic (ha, dodged that bullet!).  Expect to sit in a hot room with up to 70 crying babies and their impatient exhausted American parents for 3-5 hours! It will seem like nothing is happening, and you will never get closer to getting through the line but you will get out before dark!

While at the clinic, you have to first stop at three stations: your child must be weighed and measured at station 1; you see the ENT at station 2; and the doctor for the medical check at stop 3. Now, if your child is Special Needs, the doctor will ask for the medical report. We did not know this and hadn't brought it. So before you leave for China, print off your child's referral including any medical information and pack it with the rest of your important paperwork. Fortunately our guide smoothed things over with the doctor for my wife and baby, and our baby didn't have a very complicated special need (the short arm and missing thumb are, after all, pretty obvious).


After the three stations, things get really fun for those of you who are Hague families, under the I-800 immigration. Your kids need to get shots. It could be a lot of shots. And children over age two need a TB skin test, and you'll need to return to the clinic in a couple of days to have the test read. 

You should be getting the idea here that this clinic visit is long, unpleasant and painful.

While at the exam, a friend of mine saw an excellent example of a parent who was not prepared and then wasn’t able to care for her child when needed. After a several hour wait, sweating in the hot un-air conditioned waiting room with a toddler who became grumpier once lunchtime came and passed, the mom who was also feeling frazzled and irritated.  After the exam the child needed 7 (yes 7- it wasn’t a typo) shots and was crying in exhaustion and pain. The mother, herself exhausted, told the child she was just too hot to hold him and that he would need to walk back to the hotel because she was too hot! Not a good bonding moment.


In thinking about this unfortunate situation several simple things came to mind.

1) Bring food, water, a bottle for a baby, and toys for the child. Bring water and snacks for yourself. Bring a stroller.

2) Have a time when your spouse will come to the clinic to help out if you haven’t returned to the hotel.

3) Give the baby Tylenol or children’s Advil before you go to the appointment and take some with you in case it wears off before the shots.

4) Know what to expect -and if you aren’t a patient parent or don’t handle stress well let your partner take them.

5) If you both don’t handle things well, take turns waiting. This principle is one every couple with kids learns early on. With the first child, both parents try to stay up in the middle of the night to support each other and comfort the sick child. By the time child number two comes along that commitment to emotional support vs survival has changed to the much more practical one of taking shifts tending to baby, with a much more rested couple ready to deal with the day shift which comes hard on the heals of the night shift! My wife denies we ever did this - something about me being away at the Hospital whenever one of the kids was sick!

6) Be realistic- this is China not America. The staff doesn't have to work efficiently and in a timely manner like we have learned to expect in America- and this from a Doctor who is always running behind. If I had to see 70 kids in a day I would be exhausted and working slowly. Try to control your uber-entitled American attitude when you're tired and waiting for the day to be over. It's part of the process and the only way you are going to bring your child into the US. As my wife's Grammie used to say, "Be a brave soldier."

To bathe or not to bathe?

To bathe or not to bathe- that is the question. Tis it better to look the babe over or suffer the misfortune of a missed medical problem?

We’ve gone both ways on this one. On our first gotcha day, we took our daughter upstairs to our room where I insisted (being a cautious doctor) we undress her immediately and plop her in the tub to wash off anything that might be clinging or living on her from the orphanage. She screamed and clung to a rubber ducky for dear life; then my wife dressed her in the adorable pink outfit she brought from home for this momentous day. This was definitely not what our China guide recommended and was quite traumatic for the poor little thing. So we did the opposite a month ago with our newly adopted 17 month old. We took her upstairs and gently peaked under whatever clothes we could lift up. We let her stay in her orphanage clothes for a few hours while we played. Bathing was with a sponge like in the orphanage with a viewing session of her sister taking a tub for ten days before we put her in the tub with 1 inch of water. She is now officially a fish! Warning they are often scared of running water so fill the tub while they are in the other room.

 What I think this illustrates is what I call “Oh my God I’ve been taken by Martians” experience of “Gotcha” day. If you think about it these little kids have been uprooted from everything they are familiar with and given to people who look, smell, sound, act and even eat funny. They are rightfully terrified, and although the older child may be able to intellectually understand it the emotions of loss, fear and anxiety still remain.

The best way to weather this transition for them and you is let them keep as much of the things that provide them comfort as possible. This will require a great amount of flexibility on your part. The transition will go much easier if you don’t get rigid except on absolute safety issue. They don’t need to be little American kids right away--it will come.

Another example: lets face it by the end of two weeks most of us are dying for American food – or the Chinese version of the same. Some adoptive parents may feel quite stressed and challenged by the dining options in China and might prefer KFC, MickeyD's and Pizza Hut over searching for Chinese restaurants with picture menus with English. But realize, your child has never eaten a fry or a chicken nugget and may be very uncomfortable with both the taste and texture of those foods. This only increase the stress on both the child and the parents creating more conflict and emotional turmoil in the midst of perhaps the most major transition in both the parents and childs life. Let them eat Dumplings! My newest daughter would only eat dumplings for 5 days- she started to smell like a dumpling but it was much easier letting her eat them than fighting over something that in the long run will not make a difference. Save your energy for battles that really count: like when they are teenagers!

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.

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.