Preparing for International Travel to pick up adoptive child

We will be traveling to Russia to pick up our beautiful baby boy. What specifics in regards to travel do I need to know about in order to make it a safe and pleasant experience?

Preparing for travel

Traveling to another country can have its own hazards. Your own health changes all the time and it is a good idea to get a checkup before you go on a long trip where it will be difficult to get medical care.

It is also important to consult the centers for disease control website www.cdc.gov for information on infections that may be ongoing in your destination country. It will also provide you up to date information on any vaccines you may need and also things you may need to bring with you.

If you do get sick abroad personal physicians worldwide 1-888-657-8114 & international association for assistance to travelers 1-716-754-4883 are resources you can use as well as your adoption agency.

There are clinics available in most large cities, which specialize in persons traveling abroad, and they can be a valuable resource to you and you physician about what you can expect. Also speaking with the adoption agency and with other people who have made the same trip is useful.

Preparation for travel with children
Antibiotics and respiratory infections
In this country, with ready access to quality healthcare it is not advisable to treat overly simple colds and coughs. Being abroad with a child who is malnourished, living in an institution without thorough knowledge of their recent health however it is advisable to bring with you antibiotics for illnesses, which seems to be overly affecting the child.

Consulting with your child’s future pediatrician is the ideal way to handle this situation before giving any antibiotic but because of time delay sometimes this is not possible. Many experts suggest bringing with you an antibiotic such as zithromax in a powdered form with sterile water premeasured by the pharmacist so that all you have to do is mix them together. The dose is 10mg for every kilogram given once a day for three days for most simple infections.

Bacitracin/Topical Antibiotics
It is useful to bring with you an antibiotic ointment and bandages because having a child means having bumps bruises and cuts. Any decent first aid kit is invaluable.>

Conjunctivitis
(contemporary pediatrics 1997 Wagner)
If you are confronted with a child whose eyes look like these, an antibiotic drop such as polytrim placed in the affected eye(s) three times a day for seven days usually effects cure.

These drops should be acquired ahead of time and require a prescription.

Atopic dermatitis
This is a common condition among children who are being internationally adopted it appears and is treated as the pictures/table below. Normally Dove unscented is the soap most recommended by pediatricians for all children, but especially for children with sensitive skin.

TABLE I

Treating atopic eczema

Keep the skin at a high, even level of humidity

Apply 1% hydrocortisone cream as needed

Apply liberal amounts of a topical moisturizer such as Vaseline many times a day<
Sources: Bigby M: A thorough systematic review of treatments for atopic eczema.

Arch Dermatol 2001;137:1635; Oranje AP, De Waard-Van Der Spek FB:

Atopic dermatitis: Review 2000 to January 2001.

Curr Opin Pediatr 2002;14:410

Cradle Cap
Cradle cap is a normal finding in infants and is easily treated with nizoral shampoo, which is available over the counter.

Care should be taken not to get the shampoo into the eyes but otherwise it is fairly safe to use. It appears here in its worse form, normally it is not so terrible but it can get as bad as this.

Diaper Care
Diaper rash commonly appears as below but it can be erosive with bleeding or with small bumps or pimple, which usually means superinfection with either a fungus or a bacteria. Normally most diaper rashes can be taken care of as outlined in the table below.

(Source Shwayder July 2003 contemporary pediatrics)

TABLE 2

Preventing and treating diaper rash

Keep the child’s bottom clean and dry; change the diaper frequently
Clean the perineum gently when changing the diaper
If the skin is red, use 1% hydrocortisone cream twice a day mixed with lotrimin cream, which is an antifungal foot cream available over the counter. Cover the cream and the diaper area with zinc oxide paste or desitin ointment.
Scabies

Scabies are caused by a round mite that is 0.4mm long has four legs and is spread by direct contact. It is incredibly itchy with pustules and burrows on the skin. Treatment is with elimite commonly and needs to be prescribed by your pediatrician.

(Source Shwayder July 2003 contemporary pediatrics)

Allergic reactions
Use of benadryl liquid 12.5mg/5ml(one teaspoon) usually is a safe medicine to use for acute allergic reactions associated with hives.

The dose is approximately 1mg/kg. It is not used in infants, follow the package directions.

Some kids respond to benadryl by becoming extremely active. It should not be used to provide sedation.

(Schmitt cont peds 2003)

Lice
Sometimes with lice there can be no signs or symptoms and they are discovered when cleaning the child’s hair.

As with scabies this is commonly found in institutionalized children and is treated with an over the counter preparation called nix most commonly/effectively.

Follow the package directions.

(Source Shwayder July 2003 contemporary pediatrics – picture)

Tylenol/Motrin
Tylenol or Motrin is invaluable when the child has fever or sick and appears off. The dose for Tylenol and Motrin is 10mg/kg; both can be given every 6 hours. It is easier to travel with the children’s formulation and if dosed appropriately can be given at any age.

It is a good idea to bring a dosing syringe available at any pharmacy so you can dispense these medicines.

Nasal congestion
Plain nasal decongestants are usually all that are needed if a child has a stuffy nose and cannot sleep. Plain pedicure nasal decongestant for kids 3 months to one year and plain Sudafed for children are commonly used.

Dosages depend on the formulation and can be obtained from your pediatrician.

Diarrhea

Diarrhea and vomiting can occur at any time in children and it is advisable to be prepared. Pedialyte or powdered electrolyte solutions, which can be reconstituted with boiled water as needed, are usually brought. These are usuallly given if the child is having excessive vomiting or diarrhea. Normally most pediatricians try to feed through bouts of diarrhea in infants with small amounts of formula given more frequently. However if there is decreased tears/urine output or saliva and oral rehydration solution and consultation with a professional is advisable.

Constipation

The opposite end of the spectrum is constipation and certainly with a change of diet this can be seen. Most constipation is treated effectively by increasing fruit intake especially prunes/prune sauce. Instant relief can nearly be provided through the use of glycerin suppositories although regular use is not advisable it is very helpful in a pinch.

Feeding
What to feed and bring with you depends on the health background and age of the child you are adopting and it is advisable to consult your pediatrician.

You may also ask the adoption agency to provide information as to what the child is currently eating and use this as a guideline for what types of foods your child will accept. For example if the child is not eating from a spoon then the time to start will be back in the states.

The Academy of Pediatrics puts out a book called “Caring for Your Young Infant and Child.” It has almost everything that you ever wanted to know and perhaps things you do not want to know about children. If you want a definitive source for childcare, this is it. It goes into great depth about how to feed children and to take care of them.

by James Reilly, M.D.