This is a handy list of medical resources in China for travelling families, graciously shared by Todd Ochs, MD. 

Anhui Province

Hefei - Anhui Provincial Hospital
No. 1 Lujiang Road
0551-2652797
(VIP section for foreigners)
Hu Yunwen, MD

Anhui Provincial Children’s Hospital
No. 39 East Wang Jiang St.
230051 Hefei
Shan Hua, MD
0551-367103-3035 (off.)
13966681963 (cell)
<hua888@mail.hf.ah.cn>

Beijing - International SOS Clinic
No. 1 North Road, Xing Fu San Cun
Chaoyang District
8610-64629117 (clinic)
8610-64629100 (alarm)

Click to read more ...

The topic of what formula to use when breast milk is not an option generates a lot of smoke and heat, and is one of our more frequently-asked-questions ... so here it comes, folks, 2 level scoops of science mixed with 4 ounces of opinion.

I usually recommend a cow-milk-based formula at first. "But aren't all (insert-ethnicity-here) children lactose intolerant?" Actually, inborn lactose intolerance is extremely rare. Since lactose is the main sugar in breast milk, infants are born with the enzymes to digest it. While lactose intolerance may show up earlier in non-Caucasian children, you probably have at least 1-2 years of good ability to digest lactose. Also, an internationally adopted child has most likely already been receiving a cow-milk-based product, quite possibly sweeter, more dilute, and less nutritious than Western formulas. If you really really want to avoid lactose, and stay with a cow milk formula, there are lactose-free formulas, but they swap in corn syrup for the lactose.

Soy formulas are also an option, but in my mind you should have a compelling reason to switch. The longterm effects of a mostly soy-formula diet are not well-described; in the decades they've been in use, we've not seen obvious hormonal impacts from soy's phytoestrogens, and one retrospective study seemed reassuring, but we can't know that there aren't subtle effects. Also, certain minerals may not be as well absorbed from soy products, and children can get constipated on soy formula, neither of which is what you want in the first few weeks. I'm not at all anti-soy (I drink it myself), and do feel that cow milk itself is a bit overrated as a nutritional source ... but for infants I need a good reason to go with soy.

For toddlers, where the soy is just part of a healthy diet, and lactose intolerance is a more real possibility, a soy formula would be fine. I do recommend organic brands when it comes to soy products - too much genetically modified "Frankensoy" out there getting doused in Roundup and other pesticides.

You won't see goat milk on my list of recommended formulas. Goat milk is well and good as a substitute for cow milk, but I've just seen a few too many infants starving on goat milk formulas. Perhaps it's that "make-your-own-formula" isn't the safest way to go, perhaps it's that people don't realize that truly cow-milk-allergic infants are also likely to be allergic to goat milk (and soy) ...

I also never recommend a low-iron formula, but luckily they're hard to find. Adequate iron is essential for cognitive development, and international adoptees are frequently iron-deficient.

As for DHA/ARA, which are omega fatty acids present at varying levels in breast milk that are felt to help brain and eye development, I will say that they make good theoretical sense, but the research outcomes have been more mixed than the advertising would have you believe. For international adoptees, there is no research on this topic, but it would make sense that they'd be deficient in essential fatty acids, so I do have a preference for formulas with DHA/ARA.

You'll be seeing more about probiotic formulas, now that Nestle has introduced an infant formula with probiotic cultures to the US market. I can't say that the verdict is in on probiotics and infants, particularly when it comes to which strains and doses to use, but there is mounting preliminary evidence that this may be a good thing. I don't think everyone should jump on this bandwagon just yet, but something to think about for adventurous early-adopter "natural" medicine type folk. Our article on probiotics has more, including some brands to consider, if you'd like to add your own.

I do recommend that newly adopted infants and young toddlers stay with formula as their drink of choice for about 2-3 months post adoption, and certainly to at least 1 year of age. It's just much more nutritionally dense than milk, juice, etc. Since many adoptees have micronutrient deficiencies (vitamins, mineral, iron), the formula can help. As for "toddler formulas", it's a trade-off: on the good side, they've got more calcium and phosphorus, on the bad side, the sugars are typically from corn syrup (unless you're convinced your child is lactose intolerant, then it's good). Confused yet?

Many parents choose to continue using the familiar local formula when travelling, which makes sense in terms of minimizing transitions. You can gradually switch to a US formula when you get home. However, I do think it's a good idea to bring some US formula too, in case you run out, or for children who don't seem too picky about such things. For children getting rice cereal in their bottle, I would wean that too when you get home. Rice cereal is for eating, not drinking, and it won't "fill them up for sleep" (sadly).

If you child is refusing formula during your travels, please see our topic on Transitional Feeding Difficulties for some ideas. We also have an article on Nutritional Supplements in Adoption with more advice on vitamins, minerals, and essential fatty acids.

When it comes to specific brands, it's more about your philosophy and pocketbook, and your child's digestion, and less about science. But to reward you for making it this far through the article, I can tell you that I have a wee bit of a slight preference for Similac Organic Infant Formula with Iron, since it comes from a longtime formula company, is organic, and includes DHA/ARA. But other excellent, and considerably less expensive options are available. For a list of formulas with commentary, please see below ...

One last thing: use bottled water to reconstitute formula in developing countries, and consider doing the same in the US, at least for infants. It doesn't need to be designer water from artesian alpine watersheds, those cheaper jugs will do. Not that our water supply isn't the envy of many countries ... it's just that now the ADA has recently stated that using fluoridated water for infant formulas may overdo the fluoride. For toddlers, for whom formula is not the mainstay of their diet, I'm not as fussed about the fluoride issue, so filtered or tap water is probably fine. Brita and Pur-type filters remove a bit of the fluoride, but do leave enough for the water to be considered fluoridated.

One more one last thing: if you have yet to buy your baby bottles, consider buying a brand that is free of Bisphenol-A (BPA). This is a chemical you may have heard of by now that can leach out of certain plastics, especially at high heat or with older bottles. There's not enough data in humans yet to know what it does, but in animals it doesn't seem to be a good thing (it's an "endocrine disrupter"). Thus for young developing infants who get most of their nutrition from bottles, why not pick something that may be safer? Yes, there's currently a price premium, but it's not awful compared to brands like Avent (still using BPA) that have been the thus-far faves of the best-for-my-baby set. See the Z Report for an exhaustive guide to brands that do and don't have BPA, some bottle reviews, and this guide to Smart Plastics (pdf). We've had good luck with the Born Free bottles at our house ...

Updated: 2/08

Bottle-feeding and Formula Links:

Initial delays in speech and language are almost universal in children adopted from institutions, with expressive language (talking) usually more delayed than nonverbal social interaction skills. Those of us who work with a lot of adopted children develop a rough sense of what are "typical" orphanage delays, but fortunately, we're also seeing some useful research data on what actually is "normal" language development in internationally adopted children.

The thing to remember (and remind your pediatrician, school district, mother-in-law, etc ...) is that this is not just an ESL or bilingual issue. Internationally adopted children from backgrounds of neglect or inadequate stimulation are usually delayed in their native language.  When they are adopted, they have "arrested" development of that 1st language (unless you happen to be fluent in Russian, Mandarin, etc). They then rapidly lose what abilities they had in their native language, before their "new first language" (English) has time to develop. This leaves them in the "language lurch" for awhile, without functional abilities in either their 1st or 2nd languages.  Not an easy place to be ... this may be partly responsible for those "the honeymoon is over!" behavioral issues that many families experience several months post-adoption.

Sharon Glennen, Ph.D., CCC-SLP, has done a lot of the research on this topic, including a longitudinal study of language development in children adopted as infants and toddlers from Eastern Europe. On her website, she reviews the effects of orphanage care on language development, presents some very useful tables of typical language development in international adoptees, as well as pre-adoption language questions for parents to ask.

Other Resources:

• Our Favorite Books for Speech/Language Delays
• Article from Adoptive Families Magazine on Language in Toddler Adoptees
• Harvard Study of Language Development in Internationally Adopted Children (ongoing)
• Study of Language Development in Children Adopted from China (ongoing)
• RUSH Into English, a CD for Russian children 4-5 years and up to help them learn English

I'm lucky - I've had some fabulous Russian teachers among the kids at Maria's Children, an arts rehabilitation center for orphans in Moscow. They've taught me all the different ways to say "wicked cool" (klass, kroota, preekolna, voa!), "boogers" (kaizafkee), and "butt" (popa), and delight in getting me to say said words in adult company.

Lacking their expert tutelage, what is the preadoptive parent to do? My personal favorite Russian phrasebook is The Rough Guide to Russian Phrasebook and Dictionary , which is a pocket-sized guide to pronunciation, phrases, and culture. I also whipped up a quick Arts Camp Russian Survival Guide for participants in our Maria's Children summer arts camp for Russian orphans. Beware (ostarozhna) - some of the above slang and more is to be found in this document, but then if you're squeamish about these things - hah! - welcome to parenthood ...

Parents have also liked Adopting from Russia, by Teresa Kelleher, an audio CD and handbook by a Russia adoptive parent. She also has RUSH Into English, a CD for Russian children 4-5 years and up to help them learn English.

Travelling half-way around the world with a shell-shocked child who's rarely been outside of the orphanage, let alone the country, is understandably a source of anxiety for most adoptive parents; it ranks high up on the top 10 list of things to obsess about while waiting. We get a number of requests for "sedatives for travel",  and it's not always clear who's going to need them the most ... :)

General Transition Tips:

• Start with the Serenity Prayer ("God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference ..."), or the succinct, secular, Frank Costanza version: "SERENITY NOWWW!"
• Routine, routine, routine. The less you can change meal and sleep routines the better. That said, good luck with that while travelling.
• Ditto for familiar clothes, toys, and lovies. As smelly as they may be (that being a good, reassuring thing to your child), wait a day or two before whipping out the brand new (but prewashed) Osh-Kosh's.
• Don't read too much into your child's transitional behaviors - we expressly FORBID you from drawing any conclusions about attachment in the first few days. That magical instantaneous bidirectional bonding moment (cue choir and soft heavenly spotlight) is a rarity - it may take days, weeks, or sometimes months for that feeling to happen.
• Also - if your child doesn't cry, wail, beat their breast, and otherwise bemoan their familiar caregivers for days it does not mean they have attachment disorder. Kids deal with stress, grief, and transition in all different ways - inconsolable crying, withdrawing, poor appetite, listlessness, hyperactivity, or just being a bit more subdued or irritable. You may not realize for weeks that your child actually was grieving at first.
• In the early "velcro" phase of attachment, your child may want to be held ALL THE TIME. That's OK, that's what all those hip holders and slings are for ... but prepare for it. Seriously, kids are heavy - if you're not used to lifting things you may want to do some working out before you travel. Parenting is hard work physically, as well as emotionally.
• Or your child may want to be on their own two feet. If you anticipate an active toddler or preschooler, consider bringing a cute animal backback with 4 ft. tail that serves as a safe connection to you. Yes, it's a leash, but being such a cute accessory it's a bit more palatable, no? Not something to overuse, but invaluable in airports and other travel situations.
  
• You may want to resist sightseeing in crowded noisy places. Nesting up in your hotel room may be more useful for the overwhelmed new adoptee.
• As long as you're nesting in the hotel, baby/toddler-proof outlets, exposed cords, and drawers with painter's tape (via the eminently practical ParentHacks).
  
• Frantic cuddling and consoling and jiggling and swaddling and eye-gazing and shushing and bottle-offering can be more overstimulating than helpful for many adoptees. Kids pick up on your cues - the more serene you can be in the face of inconsolable crying and glaring co-travellers, the more you'll help your child settle. Remember to breathe.  Sometimes there's just nothing you can do - don't take it personally.
• If your child seems overwhelmed by what you're doing, try less: try fewer sensory inputs, be a bit less intrusive, and see if their own self-soothing skills kick in.
• The flipside is also true - if something happens that seems upsetting (head bonk, scary event, etc) but your child is not seeking consolation, give it to them anyway. They may not know to ask yet.
• Make sure you learn some survival phrases and basic parentese in your child's native language before you travel.
• For older children, use pictorial schedules, picture books, hand puppets, street mimes if available, or whatever else it takes to help them anticipate each day's events (see our Make-a-Schedule Software blurb).
• It's hard to bring home too much memorabilia - orphanage and caregiver photos, artifacts, local dress and toys ... go nuts with that. It'll come in handy now and later ...
  

Trains, Planes, and Automobiles

• In all likelihood, drugging your child with benadryl will probably not help much. If you're considering this option, make sure you try it out in the hotel first, since 1 in 5 kids have a memorable "paradoxical" reaction to benadryl where they get loopy and agitated.
• Aromatherapy? Sleepytime teas? Some families swear by these, not a lot of evidence either way. In general I don't give a lot of teas to infants - it leaves less room for more nutritious fluids, like formula.
• Feeding onboard - bring lots of fun, tasty snacks ... and dole them out one at a time.
• For older kids, bring a variety of activities and toys aboard, and also bring them out one-by-one. Distraction works, even better than drugs.
• Use a carryon as a footrest for your child, so their legs don't go numb on long flights. That may help with seatback-kicking! Don't be shy about moving around the cabin, as well.
  
• Ears and pressure changes - this seems more fearsome than it usually is. Here's where the serenity prayer comes in - there's nothing you can do about this. Even sucking/eating on ascent and descent is overrated; crying may help just as much. The only situation where a popped eardrum may happen is with an acute ear infection - but the holes tend to be pinpoint, they relieve the ear pain, and typically heal nicely.
• Kids can get motion sickness too, but it's rare in under 2-year-olds.  Benadryl (see above, though), ginger (dosing for adults and children >12yo is 1,000 mg/day, taken one hour before traveling, or 250 mg 4x/day; dose is reduced by half for children 6-12yo, and by three quarters for children 3-6yo), or chamomile may help.
• Bring a change of clothes for YOU aboard as well. Bodily fluids may be involved. Speaking of which, bring lots of alcohol-based hand gel for you and yours. Use it frequently during your travels. You don't need to gown-and-glove for diaper changes, but puhhhlease "wash" your hands carefully after doing so. You'll be very happy you did when your child tests positive for giardia.

And finally - savor this experience, soak up your child's native culture, and take good care of each other. It probably won't be as rough as you think. If it is, have a "tagteam" signal (Serenity Now!) with your travelling partners for the moments when you'll need your own time out. Take those moments, practice good self-care, and sleep when you can - you'll need it.

Happy travels,
Julian and Julie

Additional Resources:

• Transitional Feeding Difficulties
• Sleep and Adoption
  
• Russian for the Adoptive Parent
• Mandarin for the Adoptive Parent
• Urgent Medical Care While Travelling
• Top Ten Attachment Tips for the First Year of Placement
• How to Ease Your Child's Transition into Your Family
• Adoption Mosiac- "The First Hours"
  

• Airplane Travel with a Baby - Elizabeth Pantley (detailed and practical)
• Ask Moxie: Air travel with babies and toddlers
• BabyCenter - Travel with Infants Index
• BabyCenter - Travel with Toddlers Index
• ComeUnity Adoption Travel Section
• International Adoption Center - Travel Tips
• FlyingWithKids.com

"There's only one way to treat the common cold - with contempt"

    - the esteemed Sir William Osler, MD

Ah, the common cold. Common, indeed - the average preschooler has six to 10 colds per year, with each illness lasting 10 to 14 days. And the sad truth is, Dr. Osler's 1890s-era wisdom is still largely correct. He went on to say, "... toss the pills into the ocean. So much the better for mankind, so much the worse for the fish"!

For children less than 5, there just isn't any safe, effective treatment available to treat the common cold. None of the common cold medicines can convincingly outperform sugar water, and the FDA has recently warned of a number of serious adverse reactions when used in children under 2 (our advice: don't risk it). But that doesn't seem to keep cold remedies from being a billion-dollar-a-year industry.

We all know what a cold looks and feels like, although we sometimes seem to forget when it comes to our own kids. Signs of something more serious like pneumonia, bronchiolitis, or asthma could be:

• Prolonged or high fever (more than 2-3 days, or >102 degrees)
• Breathing fast (count breaths over one full minute while quiet or asleep; infants should breathe <50-60 times per minute, toddlers <40x/min, older children <30x/min)
• Working hard to breathe (heaving chest, visible rib movement, nasal flaring, grunting)
• Getting dehydrated (not drinking enough, no tears/drool, less than 3 urinations/day)
• Acting really ill or lethargic

If those are happening, please let us know - if you're travelling, we may want to start the zithromax, and possibly find someone to evaluate in person. We do have a lower threshold to start antibiotics when we can't see kids ourselves.

Other Complications:

If nasal congestion and wet cough last more than 2-3 weeks then it may be bacterial sinusitis, which can be helped by antibiotics as well; the color/consistency of the snot doesn't tell us if this is viral or bacterial, unfortunately. Ear infections can be a complication of colds, often marked by new fever and irritability when a cold seems to be running its course. Ear tugging and fiddling is not a reliable sign of ear infection in preverbal children, unfortunately.

Let's review the common medications and treatments for the common cold:

• Decongestants (pseudephedrine, etc) - Somewhat effective for daytime relief in adults and school-age kids, but they just don't work in young kids. Besides, does putting your ill, sleepless child on over-the-counter speed seem like a good idea?
• Decongestant Nasal Sprays (Afrin, Dristan, etc) - These work for short-term congestion emergencies (less than 2 days at a time) but can be nasally addictive, causing "rebound congestion" when you stop using them. Not routinely recommended, and not for infants/toddlers.
  
• Antihistamines (Benadryl, etc) - A good treatment for allergies, but colds are caused by a viruses; useful only for their sedative effect in desperate sleepless situations. Beware - 1 in 5 kids gets LOOPY on benadryl.
• Cough Suppressants (dextromethorphan, codeine, etc) - It sure is tricky suppressing that cough reflex without putting your child in a coma. Safe doses of codeine and it's synthetic cousin, dextromethorphan, don't seem to be that effective at suppressing this vital reflex. That said, in older children with a lingering, nagging, non-productive cough, you might try some Delsym (long-acting dextromethorphan).
• Expectorants (guaifenesin) - These don't work in young children, who don't need any help making copious secretions. In older kids and adults, they may make phlegm thinner, but so does drinking lots of fluids. Mucinex is a single-ingredient, extended release form of this for older kids and adults.
• Tylenol or Ibuprofen - IF your child is uncomfortable from fever, or in pain, these can help. Otherwise you may be suppressing the body's immune response.
  
• Antibiotics - No. Nyet. Bu.
• Zinc - Yuck. Zinc lozenges and zinc up the nose have not shown to be effective in kids. But zinc deficiency is associated with poor immune function (and many adoptees are zinc deficient). There's lots of zinc in high-protein foods like meats, seafood, milk, and fortified breakfast cereals. A "complete" multivitamin with minerals can also help.
  
• Vitamin C - Controversial. Large doses may shorten symptoms in adults, but megadoses are not clearly safe in kids, and can cause diarrhea. Like zinc, let's make sure you're getting enough, and some extra at the first signs of a cold may help.
  
• Echinacea - Recent study done here found no clear benefit at reducing symptoms in kids. Bummer.
• Probiotics - Lactobacillus milks, active culture yogurts, and probiotic supplements are emerging as a good thing, although definitive studies are still pending, and it's not at all clear that they treat colds. They may be effective at preventing colds, allergies, and diarrhea, with a host of other potential benefits.
  
• Andrographis (Kan Jang) - Herbal remedy that's all the rage in Scandinavia. Some smaller studies showing benefit in colds and flu. Promising, but larger studies may sink this ship as well.
• Umcka drops - Ancient Zulu Homeopathic Geranium-ness. Germans love this stuff, available here through Nature's Way. Some promise for sinus, throat, and bronchial infections. Who knows, really? If you enjoy taking the latest natural remedies, give it a try.
• The Stuff That Teacher Invented Who Never Ever Got Another Cold (Airborne) - It was on Oprah, so it must work. This contains Lonicera, Forsythia, Schizonepeta, Ginger, Chinese Vitex, Isatis Root, Echinacea, along with vitamins, zinc and magnesium. Phew. Feels a bit faddish to me, with a few too many ingredients.
• Whiskey - Dr. Osler's preferred cold remedy: "hang your hat on the bedpost, get into bed, start drinking whisky. When you see two hats stop!" Not an option for the kids, but what you do with the colds they give us is entirely up to you.
  
• Humidification - Unclear benefit from humidifiers and vaporizers, but they feel good for many, and may keep nasal secretions easier to clear. If you use these, clean them obsessively, as they are effective at aerosolizing molds and bacteria.
  
• Menthol, Eucalyptus, VapoRub - Studies show that people think these are working even if they aren't. You can put them in the vaporizer, plug a gizmo into a wall outlet, or rub them onto your child. That may be the key ... with the massage, you get the healing power of relaxation and parental tender loving care.
  
• Chicken Soup - Yup, studies and grandmothers actually agree on this one.
  
• Nasal Saline Drops/Sprays and Bulb Suction - This really can help infants and toddlers, who can't effectively blow their nose. Infants, in particular, have tiny nasal passages that they depend on for sleeping and eating. You can buy nasal saline or make it with 1/2 tsp salt in 1 cup warm water. Put 1-2 drops in each nostril before suctioning to help clear dry nasal secretions. A bulb syringe is most effective if you squeeze it, put the tip in one nostril, and pinch the nose to get a good seal on the side you're suctioning and close off the side you're not, and SLUUURP. Don't go too crazy with this, as you don't want to overly irritate the nasal mucous membranes.
  
• Plenty of Rest and Plenty of Fluids - Yes. Da. Shi.
• and finally ... Tincture of Time - The ONLY cure for the common cold. Support the immune system in its good work with rest, fluids, love, and attention, and otherwise stay out of the way.
  

Additional Resources:

• Colds - Kidshealth.org
• Colds - DrGreene.com
• The Difference Between Colds and Allergies - DrGreene.com

Updated 8/07

Here's what we hope to accomplish during our hour-long initial appointments with new arrivals, ideally scheduled 1-2 weeks after you get home. We then like to see children roughly every 2 months until they've been home 6 months, to closely follow adjustment, growth, and developmental catchup. Our Welcome Home Guide is a printable summary of what we usually cover at our first visit, but here is a quick overview.

History and Physical Examination:

• Review any newly acquired medical, educational, or institutional records
  
• Interview older children, with interpreter
• Discuss family concerns and adjustment issues including sleep, feeding, and attachment
• Assess growth
  
• Thorough physical examination
  
• Developmental screening
• Screen hearing and vision - hard to accomplish accurately <4 years old, so ...
• Likely referral for audiology, opthalmology, and/or dental examinations
• If delays are greater than expected, Early Intervention referral
  

Immunizations:

• Immunizations from Korea (and sometimes Guatemala and Taiwan) are generally trusted
• From other institutional settings, we usually combine checking titers (blood tests of immunity, not reliable <1yo) and repeating immunizations based on the individual child's age and shot record
  

Lab Workup:

• Newborn screening panel (young infants only)
  
• Complete blood count and ZPPH (iron deficiency test)
  
• HIV antibody; Hepatitis B panel; hepatitis C antibody (on arrival and 6 months postplacement)
  
• Serologic test for syphilis
  
• Thyroid function tests
  
• Lead level
  
• Stool examination for ova and parasites (three preserved specimens - you'll get vials at the visit to collect and drop off)
  
• Stool examination for Giardia antigen (one fresh specimen)
• Urinalysis if growth deficient, symptomatic, or any history of issues
  
• Calcium, phosphorus, and alkaline phosphatase levels, if child has stigmata of rickets
  
• If height deficiency is profound, further lab evaluation for short stature
  
• Tuberculin skin test (on arrival and 6 months postplacement - this is crucial)

 

It's a sad day when poop just isn't funny anymore ... at least for someone like me who does enjoy poop humor and things scatological (it's an occupational hazard). That sad day is a lot more likely to happen when travelling to adopt a child. In fact, constipation is so common a concern for travelling adoptive parents that I've taken to inventing medical terminology with a reassuring cachet such as "transitional slowed bowels", just to take the edge off of the hour-and-minute countdown since last passed stool. It's also a problem for many other children in my practice ... our modern processed diet may be to blame, as a diet low in fiber, low in fluids, and high in sugars predisposes kids to constipation.

In general, constipation is defined more by what your child is passing rather than how often. Normal stool frequency in infants varies from several times a day to 1-2 times per week. But if your child is passing painful, hard "rocks", "golf balls", or "boulders" (egad), especially if there is intermittent leakage of more liquid stool (encopresis), then indeed we've got a problem. If your child is vomiting, or has a full, tight, and tender belly, then we've really got a problem needing urgent medical attention.

In the recently adopted child, constipation is often blamed on iron, when in fact it's more likely to be from the stress of travel and transition, dietary changes, and perhaps dehydration. The association between iron and constipation is overrated, and since most adoptees are iron-deficient, it's not wise to try and limit their iron intake.

Soy formula can cause harder stools, so you may not want to switch your child to this if constipation is an issue. Luckily, cow milk intolerance is another overrated issue - most infants and young toddlers tolerate cow milk products just fine (rarely, cow milk protein allergy can be associated with intractable constipation).

To assist you in your quest for smooth bowel movements, or Smoovements^TM, if you will ... I will now share with you ancient secrets of "FPBM - For Proper Bowel Movements". Let's start with F - FLUIDS, FRUITS, and FIBER are your Friends when it comes to constipation.

Infants:

• several ounces of 100% fruit juice 1-2x/day, especially prune, pear, or apple juice
• Fewer white foods like bananas, rice, soy, cheese, white flour products, and ...
• more "P" fruits and veggies like pears, peaches, prunes, plums and peas
• in hot climates where dehydration is a concern, a few extra ounces of water can help, but since our kids usually need the calories, I'd stick with juice or watered-down juice
• if you've gone more than 3-4 days with no stool, and your child seems to be in pain or straining a lot, try a glycerin suppository and a warm bath; you can also gently lubricate around the anus with vaseline or diaper cream
• if your child is straining, you might try bicycling their legs or holding them upright in squatting position (their back against your chest, holding their knees up towards their chest)
  

Toddlers and Older Children:

• fruit juice, and fewer white foods/more "P" fruits and veggies as above can help ...
  
• ... but in this age group, we should focus more on fiber and fluids: goal is at least their age in years plus 5-10 grams of dietary fiber per day, with lots of fluids
  
• whole grain cereals (read the label - lots of fake "whole grain" stuff out there) - remember "Colon Blow Cereal" from Saturday Night Live? That's the ticket - bran cereals, whole grain cereals, muesli, mini-wheats, etc ...
• bran muffins, cookies, crackers, and pancakes with whole grains. Metamucil makes some psyllium fiber cookie-type wafers as well ...
• Benefiber is a nongritty, flavorless fiber supplement that dissolves more completely than Metamucil, for when you can't meet the fiber goal through diet alone
• You can also get your 100% juice plus 10g fiber premixed in one convenient but pricey juice box (they also carry fiber cookies)
• dried fruits (prunes, apricots, figs, raisins, etc)
• beans, peas, and lentils
• fresh fruits and veggies with fiber - carrots, cabbage, celery, rhubarb, prunes, pears, peaches, plums, apricots
  
• the constipation chapter below has nice recipes for "Right and Regular" jam and fruit/fiber smoothies
  
• you can try 1/2 tsp unprocessed bran or flax seed mixed with food 1-2x/day but only if your child is drinking adequate fluids
• for kids 4yo and up, popcorn is a great, tasty source of fiber, as are seeds and nuts

"B"-havior: 

• in older children with constipation, suggesting regular sitting sessions 2x/day can help - after meals is the best time
• reward successes, lay off the failures (it's bad enough as it is)
  
• regular exercise keeps you regular
• for kids who are fearful of pooping from passing painful large-caliber stools, sitting backwards on the toilet leaning onto the tank can help
• 3-5yo "magical thinkers" often feel that if they withhold stools after they've had a painful experience the poop will disappear. It won't. It'll just add to their "boulder collection". Reinforce that the poop needs to come out every day, and help it do so with diet, regular sitting, and Miralax.
• counseling may be necessary (and very helpful) for older children with encopresis
  

Medications that start with M:

• if diet isn't working, if symptoms are severe, if your child is withholding stool, or if there's leakage (encopresis) you need to talk to your doc
• my hands-down favorite prescription laxative is Miralax, a tasteless powder mixed into your choice of fluids that is very safe, well-tolerated, and effective
• if you've been dealing with long-standing constipation or encopresis, you need to continue interventions like Miralax for 2-3 months at least, to help the rectum and colon recover to a normal caliber
  
• Maltsupex or Milk of Magnesia are also frequently used
• Mineral oil is another old favorite but it's yucky (try it in ice cream) and can pose an aspiration risk in younger children
• bowel stimulant products like senna can be used occasionally but are not for chronic use
• DON'T enemize your child without consulting a physician, and avoid frequent rectal interventions in general (unnecessary and traumatizing)
• DON'T give honey or karo syrup to infants - there have been cases of botulism from this

Remember, it's all about FPBM - "For Proper, Pleasing, Painless, and Punctual Bowel Movements"

• Fluids, Fruits, Fiber are your Friends
  
• Prunes, Pears, Peaches, Plums, Peas, Psyllium, Peanuts and Popcorn
• Bran, Beans, Benefiber, and Behavioral interventions
  
• Miralax (and/or Maltsupex, Milk of Magnesia, Mineral Oil)
  

Other Resources:

• Constipation book chapter from "The Holistic Pediatrician"
• Constipation Advice from DrGreene.com
• KidsHealth Soiling (Encopresis) Article
  
• Parent guide: Stool holding: When your child holds back bowel movements and is not toilet trained
• eMedicine Constipation Guide
  

 

If you're a client of ours and dealing with an urgent medical concern abroad, please email or page us using the instructions in your travel packet. We'll do our best to diagnose your issue and recommend treatment.

However, for some conditions, there's no substitute for direct evaluation ... here are some good resources on this issue.

• Urgent Medical Care Abroad, by Jane Aronson, MD
• Medical Resources in China, by Todd Ochs, MD

These key words and phrases for the adoptive parent, with Pinyin pronunciation and audio links, are invaluable for parents traveling to China and in the first weeks home.

Here's a Guide to Pronouncing Mandarin in Romanized Transcription.

Another nice resource is Zhongwen.com, an in-depth guide to Chinese characters and culture, with spiffy clickable character definitions and language genealogy.

For local parents, Mandarin for Parents offers 6-week classes in Seattle and the Kitsap Peninsula. They also publish study books and CDs.

Some of our families have found the Simple Language for Adoptive Families booklets/CDs invaluable as well.