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 | Travel Preparations Before Adopting a Child
by Sarah Springer, M.D. |
Traveling internationally to adopt your child can be a daunting proposition, especially if you’ve never traveled internationally. With a little planning and preparation, it can be a safe and healthy trip for all, and a wonderful part of welcoming a child into your family.
Most of the countries from which children are adopted are plagued by a myriad of infectious diseases that are uncommon in the United States, so using common sense and good general travel precautions are paramount. In addition, it can sometimes be difficult or impossible to find reliable medical care for yourself or your child during the trip, so planning ahead is essential.
As soon as you decide to adopt internationally, see your doctor to plan for your travel and update immunizations. If you have any chronic medical conditions plan for any special needs, and make sure that you have an ample supply of your prescription medications in the original packaging, packed in both your carry-on and checked luggage. If you need syringes, for things like diabetes care, pack them on top of your bag, and carry a note from your doctor explaining your medical need for them. If another child is traveling with you, check with your child’s doctor about his or her travel needs. For at least two years after returning from your trip, remind your doctor of your travels should you experience any unusual symptoms, since many infections can show up months or years later.
There are a number of preventable infections about which travelers should be aware, since at best, they can make your trip unpleasant, and at worst, can be life-threatening. Hepatitis A is a contagious virus spread through contaminated water or food, or through the oral or fecal excretions of an infected person. In addition to using good general travel precautions, the Hepatitis A vaccine is safe and effective. A first dose will provide good immunity, and a second dose six months later should provide full, life-long immunity.
Hepatitis B virus is spread through blood or body fluid contact, and can be prevented with a vaccine. Since in-country testing of children for Hepatitis B is not always reliable, it is recommended that all adoptive parents receive the Hepatitis B vaccine before traveling to meet their child. It is a three-dose series, with the second dose given one to two months after the first, and the third dose four to six months after the second. Similar to Hepatitis A, one dose of the vaccine is better than none, so it is never too late to start the series before traveling. Children throughout the United States already receive the Hepatitis B vaccine as part of routine immunizations, and children in some regions routinely receive the Hepatitis A vaccine. If your other child is traveling with you, check with your child’s pediatrician about needed vaccines.
Hepatitis C virus is transmitted, like Hepatitis B, through blood or body fluids. Unlike Hepatitis A and B, however, there is presently no vaccine for Hepatitis C. Good hand washing and caution when handling your new child’s blood or body fluids are prudent until your child has been tested at home for Hepatitis C.
Most adults also need tetanus and polio boosters, as these diseases can still be found in many countries around the world. Tetanus boosters are recommended every 10 years, and after a tetanus-prone wound. Since you may not have access to medical care after an injury, it’s a good idea to have a tetanus booster if it has been more than five years since your last one. In addition, measles, mumps, rubella and chickenpox are still widespread in many areas of the world, and confirmed immunity to these, either by documented history of disease in childhood, blood work or immunization, is recommended. Children in the United States receive vaccines for these diseases as part of their routine immunizations, and parents should check with their child’s pediatrician to confirm that the child is up-to-date before traveling. Finally, it is always a good idea to check with the Centers for Disease Control Travelers’ Health Web site at www.cdc.gov/travel/index.htm to learn of any specific regional health risks or outbreaks such as malaria or Severe Acute Respiratory Syndrome.
Once you have prepared yourself, it’s time to prepare for your child’s health needs. An infant/child CPR and first aid course is worthwhile for new parents, and a small child health and first aid book is worth packing. You will need to add your child to your health insurance, so that he or she will be covered as soon as you return home. You’ll need to choose a pediatrician for your child, and it’s a good idea to consult with him or her ahead of time about your child’s expected arrival, any known health concerns, and concerns related to his or her prior circumstances. Make a plan with your child’s pediatrician, and/or an adoption medical specialist with whom you have consulted, to be able to call or e-mail from overseas should problems or concerns arise.
You’ll also want to assemble a small medical kit for your child before you go. You can buy prepared kits, but assembling your own allows you to customize for your child’s needs. Pack your supplies in a small box so that they are readily available should you need them. Consult with your child’s doctor or your adoption medical specialist about the specific needs of your child. Don’t forget to pack the phone and fax numbers, and e-mail addresses of your doctors.
Basic wound care supplies such as adhesive bandages, sterile gauze and swabs, bandage tape and an elastic bandage are always good to have on hand. An over-the-counter antibiotic cream, such as Neosporin, can be helpful for minor skin infections or to prevent cuts and scrapes from becoming infected. A calibrated medicine dropper or cup can be used to dose most medications, however, when medications come with their own calibrated dropper they should be used. A thermometer is also a must. A glass or digital rectal thermometer works best for infants and toddlers, and a glass or digital oral model for older children. Ear thermometers are accurate when used correctly, but more costly, and they take up more room.
Acetaminophen drops for young infants, liquid for toddlers, or chewable tablets for older children, are helpful for pain or the irritability that comes with fever. Carry the dosing chart with you, so that you can adjust the dose to your child’s weight at the time. Fever itself is not harmful to children, but it lets you know to watch your child for other signs of infection. Fever is treated to make the child more comfortable, and while Acetaminophen will not always bring the temperature down to normal, reducing it by a few degrees will help the child be more comfortable. Fevers higher than 104 degrees are not necessarily serious, but the reason for the fever can be. If your child has a persistently high fever, seek medical care. Ibuprofen can also help reduce pain and fever, but can be hard on an empty stomach. Since most children decrease their intake when not feeling well, Acetaminophen is often better tolerated.
Over-the-counter cough and cold medicines can be helpful for some children, although many studies suggest that they are less helpful than once thought. Doses vary depending on which preparation you buy, and you should consult with your child’s pediatrician regarding dosing based on your child’s weight. Children’s liquid Benadryl can be helpful for treating allergic reactions and insect bites. Benadryl is also sometimes used to make children sleepy for travel, although many young children become agitated instead of sleepy. If you think that your child will have a difficult time with the flight home, try a dose of Benadryl in your hotel room before traveling to see your child’s reaction to the medication. Most children will do well on the flight with frequent feedings and exchange of toys.
Oral rehydrating solutions such as Pedialyte, KaoLyte and others, can be helpful for children having vomiting or diarrhea. The most important thing in this situation is to keep children from becoming dehydrated, usually by frequently offering small volumes of fluids. Infants and toddlers with diarrhea but not vomiting can continue to drink infant formula, but older children may benefit from being off of dairy products or fruit juices until the diarrhea subsides. Children who are vomiting may need to be spoon-fed small volumes of rehydrating solutions until the vomiting subsides. If you think your child is dehydrated, seek medical attention. On the opposite end of the gastrointestinal scale, children who are constipated can be helped with a glycerin suppository, and in the longer term, by increasing the fiber in the diet.
Whether or not to take antibiotics with you remains controversial. It is always better to have a child seen by a physician prior to using antibiotics, yet in some adoption travel circumstances, this will not be possible. It is always advisable to check with your agency about the medical resources available in the country and region where you will travel. When there will be reliable health services accessible, taking antibiotics will not be necessary. On the other hand, when far from any healthcare providers, having an antibiotic that will treat both respiratory and skin germs can be helpful for your child. Talk with your child’s doctor, and ask him or her to write a dosing plan based on your child’s anticipated weight range, and under what circumstances to use the antibiotic.
Common reasons to use an antibiotic include a child with a fever who is pulling on the ear or who has pus draining from the ear, a child with a fever for several days and a severe cough or labored breathing, or a child with a badly infected skin rash. Many pediatricians will be reluctant to prescribe an antibiotic for a child whom they have never met. If you explain what your circumstances will be, and develop a plan to reach your child’s doctor by phone if your child is ill, then many will agree to prescribe the antibiotics. When choosing an antibiotic, remind your pediatrician that you will not have reliable refrigeration, so an antibiotic that does not require refrigeration would be best — Zithromax, Cefzil and Omnicef are good options. Once you are home with your child, your pediatrician will want to see your child before prescribing an antibiotic. If the circumstances are such that you need to take antibiotics for your child, you may also want to have the same discussion with your own physician about taking some for yourself.
On a similar note, it can occasionally be wise to take along several sterile syringes and needles. Under most circumstances you will not need these, but if you will travel to a remote area with limited medical care available, the healthcare facilities that you do find may be forced by limited resources to re-use needles and syringes. Again, discuss this in advance with your agency and doctor. If you do travel with needles, be sure to have them visible in your suitcase, and carry a note from your doctor verifying that they are for medical purposes.
Skin rashes are a common problem among newly adopted children. Skin that is dry and scaly may be irritated from harsh soaps, and will usually begin to improve with an unscented, mild moisturizing soap and liberal use of a good unscented moisturizing cream. To calm down severely irritated areas, 1 percent Hydrocortisone cream can be used twice daily for two or three days. Diaper rashes are also common, and can be treated with a zinc oxide diaper cream like Desitin or Balmex. A red, bumpy, itchy diaper rash that spreads across the diaper area is likely a yeast diaper rash, which can be treated with Clotrimazole cream like Lotrimin and others, often found in the athlete’s foot section of pharmacies. Use the cream three to four times daily until a week after the rash has cleared, and avoid using any powder or cornstarch. Wash your hands carefully, as this is the same yeast that can give a woman a vaginal yeast infection — one way to ruin a trip.
A red rash that is extremely itchy may be scabies, which will require the prescription Elimite Cream to treat. Scabies is a rash caused by a microscopic skin mite, and is typically worse in the crease areas like armpits, behind knees and between fingers, but in severe infestations, can be all over the body. You can sometimes see small burrow lines where the mite has tunneled beneath the skin. Again, you should talk with your child’s pediatrician if you will be far from a medical facility, and get a prescription to take with you. Some doctors may suggest that you wait to treat the infestation after you return home, but your child will be more comfortable if you treat him or her right away. You will also be happier if you don’t catch the mites yourself. After a bath, gently rub the cream into your child’s skin from head to toe — not just on the rash — being careful to avoid the eyes and mouth. Leave it on for 8 to 10 hours, then rinse thoroughly. The rash may take several weeks to clear, but the itching should improve within a day or so. If you do believe your child has scabies, seal all of her clothes and blankets in a plastic bag. Either wash them in hot water once you return home, or leave them sealed for six weeks, in order to kill all of the mites.
Permethrin lice shampoos, such as Nix and others, are a safe treatment for head lice for children of all ages. Lice are small bugs that infest the hair, creating severe itching. Often all you can see in a child’s hair are the nits, or eggs, which look like small white knots at the base of the hair shafts. They are often concentrated at the hairline and behind the ears. After washing your child’s hair, rub in the cream, leave it for 10 minutes, then rinse it out. Use the comb provided with the cream to comb out the nits. Many children require a second treatment two weeks later, so if you’ll be gone that long, it’s wise to take two bottles. Wash clothes and brushes in hot, soapy water, or bag them as for scabies.
Traveling to adopt your child can and should be a wonderful experience. With advanced preparation, most illnesses or injuries will be little more than bumps in the road, and you can spend time enjoying your child’s country and culture, and falling in love with your child.
Dr. Sarah Springer is a general pediatrician, practicing in Pittsburgh with the Southwest Division of Pediatric Alliance. She is the medical director of International Adoption Health Services of Western Pennsylvania, and has provided specialty health services to domestically and internationally adopted children since 1995. Springer is the chairperson of the Section on Adoption and Foster Care for the American Academy of Pediatrics, collaborating with pediatricians around the country to advocate for the needs of children in foster care and who have been adopted. She has spoken on numerous occasions about adoption-related health concerns to parent groups, adoption professionals and health professionals. Springer is the mother of two transracially adopted children.
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