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.

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.

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.