Helpful Medical Items to Take for Your Child

Written by Deborah Borchers, M.D

With the assistance of your child’s physician it may be helpful to a course of antibiotics. My personal favorite is Zithromax, as it does not require refrigeration and only needs to be given for five days. Antibiotics 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 child’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 prior to travel you should discuss with your child’s physician at home conditions under which you should start antibiotics. Such symptoms may include a child with a fever for three days or an irritable child who is pulling her ear. A runny nose (including with green drainage) is not usually bacterial and does not require antibiotics. Neither does a constant cough, which parents often attribute to bronchitis. Given that most childhood infectious illnesses are viral in etiology, antibiotics are rarely needed.

Many pediatricians are reluctant to give antibiotics, particularly since they have never examined your child. Sometimes US trained physicians travel with adoption groups, and one may be able to examine your ill child (although the physician will not have access to a pharmacy to prescribe necessary medications). Otherwise, ask for the best way to contact your child’s physician via e-mail or phone (you may need to reimburse if a callback is needed) for appropriate guidance about what medical care is needed, as well as whether or not to start medications. Before starting medications, please consult with a health care provider to insure that your child will not be harmed by taking medication, as well as to make sure the medication is really needed. If your child’s physician is reluctant to prescribe, please ask him/her to provide you with a reference list of where to access appropriate medical care in the country of your child’s birth, as well as where to obtain medications if they are prescribed by a physician where you are traveling.

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 taking liquids.

Nystatin cream (prescription) or Lotrimin cream (over the counter, in the athlete’s foot treatment area of pharmacies) 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, and 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 health care provider 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 rashes, especially on their faces, heads, hands or feet. A doctor should always be the one to diagnose scabies 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, and 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. Good pictures of scabies are often available on the internet (try a Google images search).

Nix cream rinse is the best (and unfortunately the most expensive) treatment for head lice. Lice are little hopping bugs about 1/8 inches 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. Combing every day for several days will help to successfully remove all of the nits. Sometimes they must 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 and 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, then giving a dose of 10 milligrams per kilogram of body weight. 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 should always seek medical care if your child is acting ill or not responding to you (“lifeless”). With any fever your child will require an increase in his/her fluid intake to prevent dehydration.

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 (before feeds and sleeping), as the saline drops will help to restore the nose’s natural moisture and make breathing easier.

Many physicians do not routinely prescribe over the counter cough and cold medicines anymore. Many children have some runny nose and a dry cough after leaving an 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,” and you may be concerned about bronchitis or pneumonia. This is merely the sound of the nasal congestion being transmitted into the chest cavity. You should be concerned about one of 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 rapid breathing is present, especially with fever more than 101 degrees (although children may breathe fast just from the fever itself). If recommended, 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.

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, scabbing, 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 give a trial dose of 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 children 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 inch 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. Most pediatricians do not recommend more than 4 ounces of juice a day once a child’s stools are regulated.

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 salt 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.

Written by Deborah Borchers, M.D
Adoption and foster care medical specialist
Mother of three daughters born in China
Eastgate Pediatric Center, Cincinnati, Ohio
513-753-2820; fax 513-753-2824
daborchers@aap.net

Revised May 29, 2005. Permission is not necessary to reprint this information with parents, health care professionals and social workers involved in international adoption. Please contact me for permission before placing on a website.

This advice is not intended to be a substitute for medical care. All families traveling to another country for the purpose of international adoption should schedule an appointment with their child’s physician or nurse practitioner prior to traveling to review these recommendations, as well as others that their health care provider may have.