PACKING AND PREPARING 

*Donations for the orphanage or CHI Hope Center (Rehabilitation Center for Children that have had surgery):  Some families want to take supplies, like clothing, toys, games, etc. for the children left behind at the orphanage.  We can find out specific needs of the orphanage in advance, if you wish.  Some families purchase items in China to donate to the orphanage.  CHI will ask St. Louis families to carry over an extra bag packed by CHI with medical supplies, etc. to China and give to the CHI coordinator in Beijing.

Laundry at the hotels can be expensive.  In Guangzhou, walking distance from the White Swan Hotel or Garden Hotel, there are good laundry services available and they are very reasonable.  (i.e. Jennifer?s Place, China Doll, etc.)

Websites with packing list for adoptive parents:

We have listed several websites that have packing lists, but please remember these are just suggestions.  The CHI list above is pretty thorough, but the following will give you ideas.  Remember you can buy many items in China.

http://redthread2004.com/rt/travel/packinglist.asp

http://www.users.fast.net/~dwhitman/packlist.htm

http://www.xiandong.com/packinglist.htm

http://www.geocities.com/baci326/packing.html

http://www.fwcc.org/packtips.htm

 

Helpful Medical Items to Take for Your Child ____by Deborah Borchers, M.D

It is helpful to take at least a ten-day supply of antibiotics.  Several do not need refrigeration, namely Zithromax, Biaxin and Trimethoprim-Sulfa (also known as Bactrim or Septra). Antibiotic coverage may be needed for ear infections, skin infections and pneumonia.  With a prescription, the dry powder of any of these may be obtained from a pharmacist.  Upon request the pharmacist will also put the correct amount of sterile water in a separate bottle to mix with the powder.  Ask your doctor to write down the dosage range based on weights.  (You may be able to estimate your daughter?s present weight by looking a growth charts and plotting known weights, then using the curve to estimate up.) 

Optimally antibiotics should not be used without an examination by a physician. Physicians in developing countries may not look in children?s ears the same way that western physicians do, so you should discuss conditions with your physician that are acceptable for you to start antibiotics without an exam by an MD.  Such symptoms may include a child with a fever for three days, a child with persistent thick discharge from the nose, or an irritable child who is pulling her ear.  If your doctor is reluctant to give antibiotics, ask if an arrangement can be made for you to contact her/him at home or office (remember the time difference!) to discuss if antibiotics are needed.  Often there are physicians traveling with other adoption agencies to adopt children, so an exam by a US physician may be possible.  They will likely not have access to medications as they do in the states, so your physician?s assistance in supplying the prescription will expedite care for your child.

A syringe calibrated in cc or ml (identical) is needed to mix and give antibiotics.  If you do not have water premeasured in a separate bottle, you may safely use the boiled water provided in the rooms once it has cooled down.  That water may be also used for making the baby?s bottles.  If your child has feeding problems and will not suck on her bottle, the syringe may be used to slowly feed your child fluids and prevent dehydration.  A medicine cup may also be useful with the administration of medications, as well as fluids if your child is having problems eating.

Nystatin cream (prescription) or Lotrimin cream (over the counter, in the athlete?s foot treatment area) may be used for diaper rashes that are red and weepy, often caused by yeast infections.  These often occur when children are on antibiotics or kept in wet diapers for extended periods of time.

Desitin cream, Daily Care cream, or A & D Ointment are useful in small amounts for irritant diaper rashes.  You do not need to put any medication on your child?s bottom if there is no rash.  Check with your child?s doctor or nurse practitioner to see if he/she recommends the routine use of baby powder -- most do not.

Elimite cream is a prescription medication used to treat scabies.  This condition, caused by a skin mite (and highly contagious) is characterized by small red bumps that are very itchy.  Consider this diagnosis if all (or most) of the children in the orphanage have a rash, especially on their faces, heads, hands or feet.  Scabies should be diagnosed by a doctor if possible.  Apply the cream from head to toe everywhere (not just where there is a rash).  Leave it on for 8 to 12 hours, then bathe.  All bedding and clothing should be washed after treatment. If your son or daughter has scabies, also wash or dry clean your clothing that came into contact with him/her.  You may wish to put his/her clothing from the orphanage into a plastic bag or two, and wash them in hot water when you get home.

Nix cream rinse is the best (and unfortunately the most expensive) treatment for head lice.  Lice are little hopping bugs about 1/8 inch long.  Often you can only see the nits, the cases of the eggs, which are concentrated behind the ears and at the hairline.  Nix is safe for all children.  After washing the hair you put on the Nix for ten minutes (just as you would a cream rinse), and then rinse the hair.  There is a comb enclosed.  You can use it to comb out the nits.  Often they must also be removed by hand picking them out.  Generic forms of Permethin 1% (the active ingredient in Nix) are just as effective and are cheaper.  Some physicians recommend retreatment for lice in one to two weeks.

Baby shampoo is useful for washing your child?s hair, as well as to treat mild cases of cradle cap.  At the start of your daughter?s bath, put a small amount of the shampoo directly on the area of dried, crusty hair, which is most commonly over the soft spot on the top of the head.  Wash his/her body as usual, then work in the shampoo with a damp washcloth to loosen the scaly area.  Using the rough side of the washcloth will provide the necessary friction to loosen the dried crusty area, but if that doesn?t work after a day or two, use a moist toothbrush (often provided in the hotel rooms in other countries).  More severe cases may need to be addressed by your child?s doctor upon return home, as fungal infections such as ringworm of the scalp will be less responsive to this treatment.

Acetaminophen drops or syrup (best known as Tylenol, but generic substitutes are just as good) is helpful if your child is irritable or running a fever more than 101 degrees.  The dose is 40 mg (1/2 dropperful or 1/4 teaspoon) for a child under 12 pounds, 80 mg for a child 13-17 pounds, and 120 mg for a child 18-23 pounds.  You can estimate weight from kilograms to pounds by multiplying kilograms by 2.2.  It may also be helpful to take acetaminophen suppositories in the event that your child will not take medications by mouth.

Take a rectal thermometer, either glass or digital.  Ear thermometers are convenient (and expensive), but many doctors question their accuracy when used by inexperienced caretakers or on younger children.  To take a temperature, lubricate with vaseline and insert less than one inch into the rectum while your child is held over your knees.  A glass thermometer should be held in place for five minutes, a digital until it beeps.  If your child has a fever (usually defined as a rectal temperature more than 101 degrees), it lets you know that you should watch your child for other signs of infection.  What is also important when your child has a fever is the way that your child feeds, sleeps and interacts with you and her environment.  A low grade fever without other symptoms is not harmful.  If your child has a temperature more than 104 degrees, the fever itself is unlikely to be dangerous, but the reason for the fever may be.  You may wish to seek medical care to evaluate the reason for the fever, particularly if your child is at all not responding normally or acting ill.  With any fever your child will require an increase in his/her fluid intake to prevent dehydration.

Any over the counter cough and cold medicines may be helpful if those symptoms are present.  Many children have some runny nose and a dry cough after leaving the orphanage.  Most doctors only recommend treating these symptoms if they interfere with sleeping or eating.  Often children with nasal congestion will ?feel? like the congestion is ?in their chest.?  This is merely the sound of the nasal congestion being transmitted into the chest cavity, and is not a sign of bronchitis or pneumonia.  You should be concerned about these illnesses if your child?s breathing is labored and fast (more than 10 to 15 times in 15 seconds of counting).  Medical consultation should be obtained if those symptoms are present, especially with a fever more than 101 degrees.  A safe dose of cold/cough medicines for a child over 6 months old is 1/4 of the dose recommended on the bottle for a six year old child.  Consult with your doctor before leaving home to see if he/she recommends these medicines for children younger than six months old.

Saline nose drops (such as Ocean, Nasal or Ayr) and a small ear (not nose) syringe are also quite useful for nasal congestion.  They may be safely used in children of any age, and are especially helpful when the nose is noisy or wheezy, but not necessarily draining.  Put one drop into each nostril with a dropper before each feed or prior to sleeping, then suction the nose once (not repeatedly) with the ear syringe.  You do not have to obtain mucus when suctioning for these to help.  This may be used frequently, as they help to restore the nose?s natural moisture.

Hydrocortisone 1% cream may be useful for rashes due to bug bites or irritation from new clothing or soaps.  This cream may be used for any rash that remains after treating scabies or for rashes with very dry skin.  Do not use it with any rash that looks infected, namely with blisters, pus or significant redness, as it may worsen infections.

Benadryl (generic name is Diphenhydramine) is an antihistamine with the most potent side-effect being sedation.  It is safe to use 1/4  to 1/2 teaspoon every six hours on the flight home if your child is inconsolable.  Be warned, however, that some children may become more irritable with Benadryl.  It is suggested that you try using the Benadryl one afternoon at nap time to see if he/she becomes more irritable, rather than waiting until the flight home (if you think that your child will not adjust to the airplane conditions well).

Babylax or Glycerin suppositories are useful to have in the event that your child has constipation.  Constipation is usually defined as hard, infrequent bowel movements (less than one every two or three days).  Normal bowel movements for infants are soft and mushy (usually requiring two to three baby wipes to clean up).  Some children have problems with constipation in the change to different baby formulas.  The suppository or Babylax should be put in only about 1 to 2 inches using your finger.  Do not push further into the rectum if resistance is met.  If your child has severe abdominal pain with drawing up of the legs, vomiting or bloody bowel movements (more than just a small streak of blood), obtain medical care IMMEDIATELY.  It may also be helpful to take one or two small cans of apple juice to help keep your child?s stools loose if a suppository is needed.  Ask your pediatrician about her/his recommendation, but a good mix is 1 ounce of juice to 1 to 2 ounces of water, given once a day.

Pedialyte or KaoLectrolyte is a helpful formula substitute to use in the event of diarrhea, defined as frequent (more than 2 or 3) water loss bowel movements.  Pedialyte comes premixed; KaoLectrolyte is a new formulation that comes in pre-measured powder packets, takes up less luggage room, and is cheaper.  If unavailable in your home stores, you can take rice cereal and salt to make up a substitute for these water-based solutions.  Use 2 cups of water, add 1/4 teaspoon table salt (the amount of salt in two packets from your favorite fast food place), and dissolve the salt into the water.  Gradually add 1/2 to 1 cup infant rice cereal to the water until the mixture is as thick as is drinkable.  Mix well.  Give this solution or the Pedialyte or the KaoLectrolyte solution to your child after each diarrhea-like stool, giving infants a half cup and older children a full cup.  The rice cereal solution should be discarded after 6 to 8 hours.  If your child is vomiting, offer the mixture in amounts of 1 teaspoon or less.  If your child fails to urinate, a medical evaluation is needed.

Feeding Suggestions While Abroad  ________by Deborah Borchers, M.D

Before leaving home, talk to your child?s doctor or nurse practitioner about what formula he/she recommends.  Many pediatricians recommend taking a milk based formula, such as Similac with Iron or Enfamil with Iron.  Others recommend Lactofree (a milk with no lactose sugar, but also also no soy protein), as many people of Asian descent have a lactose intolerance.  This often does not manifest until the children are older, however.  In my experience, Lactofree seemed to be the closest in taste to the Chinese formulas used in most orphanages, but the milk based formulas were tolerated just as well.  The soy formula can sometimes constipate the children, and many have already been on a milk based formula.  You can safely use the water provided in the thermos supplied in your hotel room.  Take your own thermos (preferably stainless steel so as to avoid accidental breakage) with a narrow spout or lid from which it will be easy to pour while in dining rooms, on buses and on planes.  A funnel is also helpful for transferring hot water into your thermos without burning yourself.

To ease the transition to US baby formulas, some people mix the formula in a lesser strength for a few days.  This avoids some problems with constipation and stomach aches.  Usually powdered formula in the US is mixed at a ratio of one scoop to 2 ounces of water.  You may wish to mix it for a day at a ratio of one scoop to 4 ounces of water, then one scoop to 3 ounces of water for a day.  If your child refuses the change in formula, Chinese baby formula (actually made by American companies) is easily available from Friendship Stores.  The same is true in many other countries.  We figured that one scoop of Chinese formula to one ounce of water was the correct ratio, but double check this ratio if you need to use Chinese formula (1 ounce is about 30 cc of fluid).  After one or two days of feeding the Chinese formula, start mixing in gradually the American formula.  Friends who have traveled to other countries for adoption have said that they were also able to easily obtain baby formula.

It does not matter if you take disposable or washable bottles, but take ones that have interchangeable nipples.  Different babies prefer different types (standard versus nuk) and different openings(regular holes versus cross-cut), as well as different textures (latex versus silicon).  Although it sounds crazy, some babies are that picky.  My younger daughter stopped eating after two days because she preferred a different nipple, so it is worth the trouble to bring the variety.  If you need to enlarge the holes in the nipples for your daughter once you are in another country, do not enlarge all of the nipple holes.  Sometimes children will prefer the formula fast flowing at first, then want to slow down.

Some children in orphanages are used to the formula being given at temperatures that are outrageously hot by our thinking.  Try to use water temperatures that are comfortable to your touch.  If your daughter refuses to eat, use water that is a little warmer or cooler.  The children adjust easily to a gradual decrease in the water temperature once you are comfortable with their eating habits.

While at the orphanage, ask what other foods your child is being fed.  It may be helpful to ask your physician before you go his/her recommendations regarding other solid foods to be fed while abroad.  Some useful foods for children more than six months old include Cheerios, Kix, goldfish crackers, graham crackers, fruit bars, and other finger foods.  Jar foods should probably not be taken abroad due to the increased risk of breakage in your suitcase.  Most children will be able to eat limited food from the table if cut up into very tiny pieces, so as to avoid the risk of choking.