Physician: Traveling to Adopt... with Kids

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I am journeying overseas to adopt internationally. I will hopefully be taking my toddler and adolescent on this trip. What can I do to ensure a healthy and enjoyable trip for my family?

International travel with the entire family unit has become a growing trend among potential adoptive families. Some see this trip as a means to create a new family while bringing the old family unit closer together. While international travel can be a very stressful endeavor, it can also prove to be a life-enriching experience that you may never have had the occasion to encounter if it was not for international adoption.

People travel great distances - to Russia, China, Africa, Guatemala, and Columbia - to formally adopt a child. Some families are fortunate to be assigned industrialized cities like Moscow, while others need to go the periphery of Russia to finalize their adoptions. More concerning are the groups that travel to developing nations. In developing countries, there is a shortage of health care, and poor sanitary conditions, and places where infectious diseases run rampant should be of significant concern to any educated traveler.

Parents need to plan their international travel accordingly. It would be wise to have a conference with a local authority on international travel at least two months before the anticipated travel date. Time is needed to attain an immune response to the advocated vaccinations. Sometimes prophylactic medications may also be required during the trip.


As a group, young children have significant difficulty tolerating extreme heat, dehydration and reduced nutritional intake. Because of the child's decrease in reserve, parents need to carefully prepare in order to be able to identify the signs of medical problem should they arise, and understand how to deal with them appropriately.

Infants in general are more prone to become ill during their trip because of their immature immune system and sometimes-deficient primary vaccination series. From the aspect of adolescents and teenagers, other health and social concerns appear. Because parents may be very busy with their international adoption proceedings, appropriate, consistent and continuous supervision of the teenager may unintentionally be reduced. Adolescents may have opportunities to participate in potentially risky activities such as drug, alcohol, sex and travel in unsafe motor vehicles. As a parent, it is imperative to be knowledgeable about these hazardous behaviors and speak to your youngster frankly with regard to how to deal with them should the event invariably arise.

In order to virtually guarantee a healthy trip for you and your family, good weekend plans on behalf of the parent is strongly suggested. Below is a list of appropriate things to you should thoroughly review prior to embarking on an international trip, particularly if journeying to a developing country.

Tips before you travel:

  1. Review health insurance benefits. Investigate if your plan furnishes coverage to you while you are overseas. Sometimes it may be in your families best interests to obtain supplemental health coverage while traveling should a medical need arise.
  2. Evacuation insurance should a medical emergency appear and a family member needs to be airlifted to another country for medical management.
  3. Locate the names and telephone numbers of travel clinics in the country that you will be visiting.
  4. Parents need to record the telephone numbers of all the household members physicians and pediatricians.
  5. Make sure that your children's vaccine status is up-to-date and obtain any special vaccines as indicated by the particular country. A brief visit to a travel clinic will help determine if you require any particular country specific vaccines, such as Typhoid, Hepatitis A, Rabies, Encephalitis.

Tips for preventive care of children while traveling:.

  1. Provide sufficient entertainment and distractions to effectively keep your child occupied for the duration of the entire plane flight. A portables DVD player, game boy, books, puzzles or their favorite toy are sufficient to keep even the most mischievous youngster busy.
  2. Sedation in most instances is not required for overnight travel, but for children greater than 2 years of age, a parent may choose to administer Benadryl to help the child sleep. It is very important you try a trial dose a few days prior. All children are different, and can metabolize the medicine differently. Some children may have a paradoxical response, and instead of becoming sleepy, become hyperactive and restless.
  3. Changes in cabin pressure can have a painful impact on a child's inner ear. Generally, the act of swallowing - drinking from a bottle - can aid with pressure equalization.
  4. Make sure that the child is adequately hydrated during the air travel. Insensible fluid loss happens in flight and can cause dryness of the child's mucous membranes. They are not dehydrated however.
  5. Try not to overfeed infants because the higher altitudes occasionally cause the stomach gasses to increase and children may encounter tummy distention and physical pain.

During your international trip abroad:

While traveling, particularly to a developing country, the prevention of infectious disease is of the utmost importance. The most common intestinal problem encountered in tourists can be avoided if simple hygiene procedures are followed. Simple hand washing and the avoidance of unsafe foods can avert clinical illness.

Good hygiene is essential to the avoidance of gastrointestinal infections, which are in most cases transmitted via the fecal-oral route. Washing with soap and water, or the appropriate use of antibacterial hand wash is sufficient to furnish protection. When traveling abroad, especially after visiting the orphanages, siblings may find themselves playing with some of the children, on the ground, with dirty toys. Special attention before eating in regards to hand washing before meals is now imperative.

Choosing safe foods for you and your children during your voyage can become a full time job. Getting children to eat in general is a difficult task, introducing a different cuisine to their diet can make it even more challenging. Water is the most common vector for the transmission of illness. Travelers, particularly to developing nations should effectively avoid the consumption of the local tap water. When dealing with children, parents should be on the lookout for juices mixed with tap water, ice cubes, and even when brushing your child's teeth with water should be avoided. Families should automatically make it a practice of consuming only bottled water. Make sure that the bottle is sealed because sometimes-unscrupulous vendors might recycle old bottles and stock them with tap water, and successfully sell it to the unknowing traveler. If bottled water is not available, then boiling the water is regarded safe before consumption.

Often foods that are unsafe for consumption can be detected without too much difficulty.

Below is a list of unsafe food and drinks.

  1. Uncooked fruits or vegetables from which the outer skin have not been removed.
  2. Undercooked meats or seafood.
  3. Fruit drinks and frozen popsicles
  4. Any food washed with water should be cooked before consumption.
  5. Milk should be avoided unless it is pasteurized.

Unsafe foods can come in mysterious packages:.

  1. Sandwiches that have been topped with lettuce or tomatoes
  2. Fruits that have been skinned at outdoor markets (mangos, pineapples, papaya) are often dipped in water to keep them moist.

Food and snacks at the local market can seem appealing to your children. Parents should be prepared by traveling with safe snacks in order to prevent purchasing contaminated snacks for your children.

Safety and injury prevention:

Advice about safety and injury prevention during your adoption journey, is along the lines of the anticipatory guidance that one would receive during your well childcare visits with your pediatrician. Accidental injury is the leading cause or death in children that travel internationally. Standard safety measures and extra common sense during your voyage can aid to reduce the potential risk of accidental injury.

Seat belt safety while traveling in vehicles is still the most important means of preventing accidental death in children. Unfortunately, seat belts may not consistently be available in the automobiles that they will be traveling in during their adoption journey. In cases when there is no seatbelt in the automobile, carefully positioning the child traveler in the rear seat is safer than in the front seat.

Unless you are staying at the local Hilton 5 star hotel, the physical environment can be more dangerous than some families realize. Children are explores by nature and are guaranteed to detect potential dangers before the parents do. Unfortunately, when this happens, it is generally too late. Parents should inspect the child's environment during their travel continuously. They should watch for exposed electrical wires and outlets, and broken glass. Some of the building that you may visit may be older type, with decaying construction, inadequate guardrails and lack of window guards.

The most devastating feeling that a parent can experience is when they turn around and they no longer see their child. Children can become accidentally separated from their families during their adoption journey. The commotion of visiting the orphanage, conversing with facilitators doctors and successfully completing millions of forms, can lessen the parents supervision of their other children. It takes just a split second for your naive child to get lost. Personal information, containing the child's name, address where the child's family are staying and contact telephone numbers should be put into the child's pocket. It should never be displayed in plain view.

Protection against insects pertains to traveler to developing countries. Mosquitoes can frequently transport life-threatening illness such as Malaria, dengue, Filariasis and Japanese encephalitis. Barrier protection with sufficient clothing cover-up, protective nets and personal insecticides are essential to preventing exposures to such diseases.

Your adoption journey should be a memorable experience for you and your family. Careful preparation and extensive guidance before you travel can effectively make this trip an enjoyable event, and not a remembrance laden with medical illness, hospitals and physicians.

by George Rogu, M.D.

Resources:
Contemporary Pediatrics, March 2006 “Hitting the dirt road: How to prep families for travel to developing countries” By Miriam K. Laufer M.D.

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Disclaimer

The information and advice provided is intended to be general information, NOT as advice on how to deal with a particular child's situation and or problem. If your child has a specific problem you need to ask your pediatrician about it - only after a careful history and physical exam can a medical diagnosis and/or treatment plan be made. This Web site does not constitute a physician-patient relationship.

This material has been provided by AdoptionDoctors.com, an innovative adoption medicine private practice and educational service, dedicated to helping parents and adoption agencies with the complex pre-adoption medical issues of internationally adopted children. All medical interactions are performed via, e-mail, express mail, telephone, and fax. There is no need to make a live appointment or travel outside of your hometown. For more information, visit AdoptionDoctors.com or call 631-499-4114.

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