When Your New Child is Sick

I am writing this from the perspective of having received a seriously ill child in one of our adoptions. Alone in Vietnam, with the additional care of a second baby, the stress of trying to diagnose and treat my son's illness was tremendous. Even with all the preparing I had done and the resources at hand, our first stop on arrival in the United States was the hospital, where Ryan was immediately admitted in critical condition. He remained there for two weeks and his health was delicate for many months, but today he is a thriving and healthy toddler.

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I had the advantage during this experience of being an experienced mother with two adoption trips under my belt and the long and devastating illness of one of my children. But what is a new parent to do?

Most babies adopted from China are healthy overall. Quite often, they might have one, or a number, of common institutional problems such as scabies, parasites, diaper rash, malnutrition, ear infection, and upper respiratory congestion. These are temporary and very correctable conditions. More rarely, a child presents with more serious symptoms and concerns and new parents must seek out medical assessment and care in China. If your first experience with a sick child is also your first time at parenting, it can be more than a little intimidating, but you are not alone and there are many resources available to you.

Prepare before you leave for China. Long before you receive your referral, do as much research as possible to find how to recognize common childhood illnesses and parasites you might encounter. There are many pediatric health sites on the internet, as well as baby books and parenting magazines that will get you started. You should also choose a pediatrician as early as you can, preferably one with experience with the health of children adopted internationally. If you find a good pediatrician who does not have experience with international adoption, provide him with copies of some of the excellent medical articles available on the FCC health website (see list of resources at the end of this article). Ask your pediatrician about what medications he would recommend you bring with you to China in addition to those sold in the Texas Medical Kit or recommended by your agency or other adoptive parents. Ask him for advice on how to assess the health status of your new child and if he would be willing to give you a number where you can reach him 24 hours a day in case you need an emergency consult.

Bring medication for the most common problems encountered. Adoption websites teem with packing lists and recommended medications. In addition, you can purchase the Texas Medical Kit (website info) which comes fully assembled. If your pediatrician will not give you antibiotics for a child he has not seen and you feel strongly that you need to have some for your peace of mind, the medical kit includes it. You can also get antibiotics by taking your child to a doctor in China. Be sure to get the correct dosage for your child for each over-the-counter medication before leaving. Do not rely on the package information. Here is a basic list of what is recommended - your own comfort level might have you add or delete as you wish:

· Infant Tylenol and Motrin - know beforehand under what circumstances you would choose which to use.
· Pediatric cough syrup and/or expectorant.
· Syringe-type dropper or medicine spoon.
· Prescription antibiotic in powder form (pharmacist will give you pre-measured distilled water to go with it. Mix exactly as directed).
· Glycerin suppositories for constipation in infants.
· Ask your doctor about prescription anti-emetic infant suppositories in case your child has serious vomiting.
· Pedialyte replacement for dehydration or diarrhea. There is a powdered (packet) brand that you can reconstitute called Kaolectrolyte.
· Lice shampoo and comb.
· Prescription cream for scabies.
· Lotrimin AF for diaper yeast infections. The tube will say it's for athlete's foot (and it is) but it is a non-prescription anti-fungal recommended by pediatricians.
· Hydrocortisone cream ( half or one percent) for rashes.
· Preferred diaper rash cream.
· Thermometer.

Get to know your travel mates. Your groupmates might include people in the health professions or experienced parents. Travel groups share many experiences in China and helping each other is a big part of that. On our first trip to China, our group included two nurses and an emergency room physician - and she was a companion, not a parent! After everyone received their babies, she made the rounds of rooms to give each baby a once over. If your group includes one or two experienced parents, they may be able to offer guidance and assistance if you need it.

What to expect when you finally have your new baby. Ask your agency to arrange for your baby to be brought to you in the morning (or the day before the adoption) so that you can have a few hours to get acquainted and evaluate your child before the adoption paperwork. In the unlikely event that your child is seriously ill or impaired, this will give you the time to seek out a medical evaluation before proceeding with the adoption.

After waiting so long to hold your new baby, the last thing you want to be is objective. But a simple assessment of your child's medical condition can be made as you go through the first steps of parenting.

As you give her a bath for the first time, check the condition of her skin. Look for tiny, reddened tracks that can indicate scabies or rashes that need to be attended to. Don't be surprised to see (or not see) mongolian spots. They are commonly seen on the buttocks but can also be on the back or legs. Infants in China are bundled much warmer than babies in the west so heat rash is possible.

While shampooing and combing her hair, examine her ears for drainage that might indicate an ear infection and watch later to see if she pulls on her earlobes. Look through her hair for lice or their tiny white nits.

When you have her on a blanket to play, note her physical abilities. Developmental delays are expected with institutionalized children so she may not be able to sit up or crawl. Being bundled may have prevented her from even learning how to reach for things, but with encouragement she should respond to stimulation and play.

When she is sleeping, listen to her breathing. If it is labored, congested or if she is coughing, you may want to begin a decongestant. Remember that the babies are not used to air conditioning so keep her warm in the hotel. If there is no fever, you can hold off on using antibiotics.

Seeking a medical opinion. If you are seeing something that concerns you and that you don't feel able to deal with, the next step is to get a medical opinion. Worrisome symptoms might include a high fever, unresponsiveness to stimulus, inability to focus, very flaccid muscle tone, raw or open sores, or obvious signs of pain without being able to determine the source. If you have previously arranged to call your doctor for a consultation, he can ask you questions and recommend a course of action or treatment.

If you want to have your baby seen by a doctor, ask your guide to take you to the hospital to see a pediatrician there. Chinese physicians are trained in western medicine and utilize the same technology and medicines but conditions in the hospital are very different from what we are used to. If your child needs to be hospitalized, you will want to make sure that only disposable syringes and new IV needles and tubing are used. IVs are frequently inserted in the head (while frightening looking, this is actually the most secure place to put an IV in an infant). Nursing care, as well, is limited so you may want to stay with your child to tend to her needs.

Hotel living with a sick child. Although being confined to a hotel room with a sick child can be claustophobic at times, most of the problems you are likely to deal with do not have to mean misery. Infants perk up quickly with good nutrition and medical care, not to mention the healing power of loving parents. One of the oldest ways to heal diaper rash is to leave off diapers whenever possible with the skin exposed to sunlight. Lay your baby on a towel on the floor in front of the window and play and talk to her. This will not only help her skin heal, but will bring parent and child together in bonding, stimulating play that will encourage development.

Infections respond quickly to antibiotics but until then, your baby may not sleep well and may be very irritable when awake. The most important thing is to stay healthy yourself so that you can give your baby the best care. Sleep when she sleeps. Even during the day, rest and conserve energy when she is napping. Unless she is contagious, leave the room occasionally to distract her. You may not want to take her out for lengthy sightseeing trips but sightseeing was never the point of the trip anyway. Take short walks around the hotel or on the street. Fortunately, children usually bounce back from illness quickly and you will both be out and about again.

If you are a single parent traveling alone, you have to remember that you are not alone. Travel groups are usually wonderfully supportive and friendships are forged through the trip. Don't be afraid to accept offers by other parents to care for your baby for brief periods of time while you shower or enjoy a restaurant meal. The hotels where you will be staying will have room service but they may also be able to provide babysitting services if you need to go confirm tickets or change money or just take a walk to clear your head. The guides assigned to you in China are also able to offer assistance and support.

Medical coverage for your child. Before leaving for China, call your insurance company to find out what they need to add your child to your health coverage. They sometimes ask for a copy of the adoption decree (Chinese) and birthdate. You usually have 30 days from the date of adoption to do this and your child is covered in the meantime but you should make it a high priority to do it as soon as you get home. If your child has been ill in China, you might even want to fax the required information to your insurance company before you get home. I did this in Vietnam with my sons and when we arrived in the U.S. and Ryan was immediately admitted to the hospital, the insurance information was already set.

The flight home. If your child is still sick when you are ready to leave China, you will want to take some extra precautions to make the flight as comfortable for you and your baby as possible. Pack several changes of clothing in your diaper bag in case of diarrhea or vomiting, as well as extra diapers. Keep the medical kit in your carry-on luggage so that you can easily access what you need. If your child has an ear infection, talk to a doctor about when it is safe for your child to fly.

Jet lag is hard on both healthy parents and children. With a sick child, you will be exhausted. If possible, have a friend or family member come in to help out in the first few days to allow you to rest as much as possible. If you are married, you might want to consider alternating nights with the baby. Arrange for your child to be seen by your pediatrician as soon as possible after arrival to make sure she is receiving proper treatment and to run the recommended tests. And relax ... you are home with your new baby at last.

Resources:

Texas Medical Kit ordering information: http://home1.gte.net/cary/iaf/medkits.html or call (888) 820-5967

FCC health website: http://fwcc.org/healthinfo.htm. Recommended articles for pediatricians include An Open Letter to Pediatricians on Chinese Adoption Medical Issues, by Deborah A. Borchers; A letter to Families with Children from China, by Jeri Jenista, M.D.; A Report on the Medical Condition of Children Arrived from China, by Michael Traister, M.D.; A Pediatrician's View, by Nancy Hendrie, M.D.

bio: Evelyne McNamara lives with her husband and family in Northern California. They have nine children, including Mimi, Cai and Grace (all 8, born in China and adopted at ages 6 months, 3, and 6), and Ryan and Jack (4), born in Vietnam and adopted in 99.