SELECTED ARTICLE
Author
Alla Gordina, MD, FAAP 
Article Title
Adoptive parent medicine chest or what medicines to bring with you on your adoption trip, in case your child gets sick. 
Posted Date
12/15/2005 

In my personal opinion, if your child is sick enough to take a prescription medication, your child is sick enough to see a doctor. Your baby did more or less fine with the local type of medicine, so it would only be reasonable to use local help until you will be able to see a Western-trained physician. Children in the former Soviet Union are usually over-treated with different medications. This practice can leave children allergic to many preparations and bacteria – resistant to most antibiotics.

Another good reason to see a doctor is when you no longer feel able to handle the situation well. Don’t be afraid to ask “stupid” or “silly” questions. Number one, usually those questions are the most valid and the most important. Number two, when you are dealing with a sick newly adopted child in a foreign country – there is very little room for second guessing. The probability that un-experienced parents will be able to diagnose the problem and assess the condition of the child sufficiently in order to prescribe a treatment can be pretty low.

GENERAL CARE OF A SICK and/or UNCOMFORTABLE CHILD

The stress of adoption, a lack of structured environment, and exposure to outside world, can all make your baby more susceptible to any new infection or exacerbation of an existing chronic problem. It is very important to ask the orphanage employers how this particular child usually handles stress, colds, teething and so on. Usually (unfortunately, only usually, not always) the caregivers can provide you with the valuable insight on management of those situations. Another good question to ask – how are the medications usually given to your child. Medicines as liquids and chewable tablets are not as common there as here, in the United States. Pills can be crashed, divided, and given in some soft foods. In Russia children as young as 5 years of age can swallow pills. On the other hand, there are some things that you can not travel without.

 1. THERMOMETER

Temperature can be taken orally (in the mouth), rectally (in the rectum), axillary (under the arm) and in the ear. Children in Russia are not used to the ear, oral and especially rectal route of taking the temperature. Taking the temperature rectally is very invasive, uncomfortable both for parents and children, and, in my opinion, humiliating. Ear thermometers usually are not very reliable at any age and they are especially not recommended for infants and small children. Glass thermometers are more accurate and do not need batteries. Digital thermometers are quicker, have a “read” alarm and some can convert from C to F. Oral and rectal thermometers can be used to take axillary temperature – the way they take temperature in Russia and now in the USA too. To take an axillary temperature, raise your arm up and put a thermometer in the deepest part of your armpit parallel to the floor. Make sure, that there is no clothing between your skin and thermometer. The moment you will put your hand down and hold it (arm) tight, the thermometer will be secured and will be hardly even moving between the folds of your skin. When taking axillary temperature on your child, position him on your lap with the thermometer side turned to you, hug him, hold him gently but firmly and wait for 4-5 min with the glass thermometer or till the sound of the “ready” signal of the digital one. Telling how you love him, singing and kissing can make the time go faster, fever – lover and all of you – happier. The quick reference in the Celsius /Fahrenheit system: 36.5C = 97F = normal. 38.5C=101.5F=fever

2. MEDICINE DROPPER/SPOON/CUP

A dropper is more convenient for smaller children and infants, 1-2-teaspoon (5-10cc) capacity would be enough to cover most of the possible uses. Droppers are also better for very sick and/or uncooperative children. Put a dropper between your baby’s gums and a cheek (never on a tongue! – baby will spit all the medicine out) and deliver the medication slowly, literally by drops. If your child will like the taste – you can give him medicine quickly. Medicine spoon will be more appropriate for older children. 1 teaspoon equals 5cc or 5ml. Not all utensils labeled teaspoons are 5 cc in volume – some can be bigger and some can be smaller. So, the best way of measuring the medication is to use the special graduated medicine droppers, spoons or cups. Various medications can come with the special droppers or other measuring devices (see below).

3. ELECTRIC TEAPOT and THERMOS

These will provide you with the constant supply of the safe warm water for your child. At the time of illness appetite is usually going down and in this situation drinking becomes important than eating. Malnourished children can easily become dehydrated and not be able to fight the infection efficiently. Children with ear infections and severe nasal congestion can refuse to drink from a bottle because of the pain – be ready to literally spoon feed them in order to provide the necessary fluids. You can also use the small cup without a sippy-top, if your child is not familiar with drinking from a straw or sippy-cup. The trick is to frequently offer your baby very small amounts of fluid at a time.

4. SKIN CARE

Skin care products have to be mild and simple. Many every day products, like antibacterial soaps, sunscreen lotions and mosquito repellants can cause allergic reactions and irritations. You can use mild soaps like Dove or Aveeno, provide sun protection with the clothing and umbrellas and apply the mosquito repellants on the clothing rather then on the skin. If your baby is afraid of the bathtub (as many PI children do) calmly wash the areas gently with a face cloth. Band-aids, alcohol swabs, cotton balls, and antibiotic ointments would certainly make any medicine cabinet complete.

MANAGEMENT OF SOME SPECIFIC CONDITIONS

1. FEVER and PAIN.

Fever most of the time is how our body fights infection. Like many other defense mechanisms, it is not dangerous by itself. Different people can react to infection differently and some can easily mount the 104 fever while still being very active. Others can be “sick as a dog” without any apparent fever at all. It is usually not recommended to “chase” a fever in a relatively comfortable child until it reaches 101.5 F or 38.5C. If your child is in pain – that warrants the prompt full dose of pain reliever. The only exception from that rule is the abdominal pain – do not give any pain relievers in this situation and see the doctor ASAP. I usually recommend for parents to calculate the dosage of medications as soon as they know a recent weight of the child. One full dose of the medication will provide better and longer relief than several small dosages.

Most of the time placing your burning with fever child in a cold/tepid bath will scare the child and will “reset the thermostat” – the condition, when body will realize, that it is cold and will raise the temperature, rather than lower it down. Frequently wiping your burning baby with towel, dipped in 70-80 F temperature water will produce a gentle evaporation and cooling effect and therefore could bring the fever down more efficiently and comfortably for everybody. Do not overdress your sick child! Overdressing the child or overheating the room can significantly increase your baby’s temperature.

Dehydrated child will have a higher temperature, than a child who is drinking well. ACETAMINOPHEN (Tylenol, Tempra, Non-aspirin pain reliever) is given every 4-6 hours. Usually it comes as concentrated drops 80 mg/0.8cc or as a liquid 160 mg/5cc. IBUPROFEN (Motrin, PediaCare Fever, Ibuprofen) recommended to use every 6-8 hors. Ibuprofen usually works better and longer on teething pain and fever. Beware of the different dropper sizes (1.25 cc for ibuprofen compared with .8 cc of acetaminophen) Ibuprofen can come in concentrated drops 50 mg/1.25cc or as a liquid in 100 mg/5cc concentration. Make sure to contact your pediatrician for the appropriate dose of those medications. Please be very careful with TEETHING GELS (Oragel and others) while you are on the road, because they can cause some rare, but serious complications.

2. COLDS and CONGESTION.

Colds and congestion are very common and most of the times do not require any specific treatment. If your child can drink from a bottle well, sleeps quietly and is active and happy – the probability that any medical treatment will be necessary is very low. “Cold medications” can have paradoxical effects. They can affect sleep and behavior and usually produce very limited results. In some situations (asthma, "obstructive bronchitis" and others) "cold medications can actually make your child's condition worse. Don’t forget that it is very important to wash your hands and to use disposable tissues for everything.

NORMAL SALINE (Ayr, Ocean, Little Noses, and non-medicated saline). Spray/mist is better than just drops. Saline loosens nasal secretions and often helps with congestion better than the over the counter “cold medications”. You can easily make the saline solution yourself by diluting 1/3 teaspoon of table salt in 8oz (240 ml) of water.

I don’t recommend using NASAL ASPIRATORS unless you are accustomed to this procedure. Soft rubber bulb type aspirators with the detachable hard plastic tip, which you can not put inside baby’s nose, are the best.

3. VOMITING

Vomiting can be a big problem with any child. The most important thing is not to stop it, but to help your child to get through it. Most often vomiting is caused by viruses and bacteria affecting the gastro-intestinal tract (so called “stomach bugs”). Gastro-esophageal reflux (“heartburn”) can cause frequent vomiting and spitting up in infants and small children. Infections (ear infections, strep throat, urinary tract infections and so on) can present with vomiting as their first sign. Overeating, food allergy and emotional distress can cause your child to vomit too. Until you will be able to see a doctor to determine the cause of the disease and the degree of dehydration, you can use ORAL REHYDRATING SOLUTIONS (Kaolectrolyte and others). Older children usually tolerate flavored oral re-hydration drinks better than the plain ones. Fever and dehydration can make vomiting worse. Warm fluids, carbonated beverages and large amounts of fluids will make the vomiting worse. Frequent small amounts of very cold fluids can help your child to get better soon.

4. DIARRHEA

Diarrhea is extremely common in newly adopted children. As with vomiting, it is very important not to stop it, but to help your child to get through it. Causes for diarrhea can range from overeating, change of nutrition and food allergies to infections due to Giardia, Salmonella and other pathogens to such genetic conditions as celiac disease. Maintaining proper hydration is vital in the case of diarrhea (see above). You can not rule out the possibility of infection until the results of all three sets of properly tested stool specimens will come back negative. Therefore be sure to wash your hands all the time and wear gloves while changing your child, if she is not potty trained yet. If you have another child at home, it is not recommended to bath him together with your newly adopted children until the results of the stool testing will come back negative.

5. RASHES

Rashes can be very confusing in newly adopted children. You can see several skin conditions on a same child at a same time. Skin infections (scabies, impetigo, ringworm), chronic conditions (eczema, allergic dermatitis), and extremely sensitive skin due to malnutrition with vitamin deficiencies are very common. Steroid creams some times can make an infection worse and resistant to treatment. My general rule of thumb – parents should try to dry the “juicy rashes” (like oozing eczema, diaper rash, irritation in the large folds from drooling and poor care) with the diaper rash ointments, such as Balmex and Triple paste. Diaper rash ointments can be used on any part of the body. You can moisturize the “dry rashes” (dry eczema) with Vaseline, Aquaphore, Aveeno and A&D ointment. The simpler the composition of the cream – the better. Many “fragrance free” and “hypoallergenic” preparations can still burn and irritate the delicate skin of your newly adopted child. If a cream is burning and stinging your child’s skin – don’t use it! Any ointment, not containing water (petroleum jelly, Vaseline, Aquaphore) can protect any skin (your baby’s and yours) from the harsh winter freeze-burn.

Don’t forget to put family size packages of common sense, sense of humor and a lot of patience in the bottom drawer of your travel medicine cabinet. Be ready to use these three powerful remedies as frequently and freely as you deem necessary at any time and at any place - on the road, at home and anywhere else. Have a safe trip!

The information appearing here is intended for educational purposes only. It should not be used as a substitute for professional medical advice tailored to your child's individual needs. If you have questions or concerns regarding your child's physical or mental health, please seek assistance from a qualified healthcare provider.

References
GLOBAL PEDIATRICS is an international adoption medical support service that has specialized in assisting families adopting from the Former Soviet Union through every step of the adoption process for the past ten years. Dr. Gordina's unique professional background and attention to detail ensure the highest possible level of service. She is recognized by her patients and peers as a leader and pioneer in the field and has presented her adoption-related research at sessions of the AAP, JCICS, NACAS and other meetings. Dr. Gordina has both participated in and organized several humanitarian missions to pediatric clinics and orphanages in the Former Soviet Union. For all questions regarding our services please check www.globalpediatrics.net 
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