Articles on adoption, foster care, & pediatrics

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Russian for the Adoptive Parent

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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.

Travel and Transition in Adoption

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    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:

    Our Post-Placement Evaluations

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    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 (infants only)

    • Complete blood count and ZPPH or ferritin (iron deficiency tests)

    • HIV antibody; Hepatitis B panel; hepatitis C antibody (on arrival and 6 months postplacement)

    • Hepatitis A titers (asymptomatic in young children, but can make their older contacts quite ill)

    • 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, or a stool PCR panel that includes giardia (one fresh specimen)

    • Urinalysis if growth deficient, symptomatic, or any history of issues

    • Calcium, phosphorus, and alkaline phosphatase levels, if child has signs of rickets

    • If height deficiency is profound, further lab evaluation for short stature

    • Tuberculin skin or blood test (on arrival and 6 months postplacement - this is crucial)

    Urgent Medical Care While Travelling

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    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.

    Transitional Feeding Difficulties

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    While many international adoptees have no trouble eating & drinking & growing & gaining, some children from orphanage or neglectful backgrounds have initial trouble with age-appropriate foods. Feeding difficulties are some of the hardest to cope with emotionally, since feeding your likely malnourished child gets at the core of parenting.

    The trouble you may have likely has little to do with you or your feeding skills. If you just received the child, they may be scared, stressed, grieving, and just not that hungry. Also, their past experiences with feeding have a large influence on your early mealtime issues.  Prior feeding practices may have including bottle-propping with wide-open nipples (chug-chug-chug passive feeding with little active sucking involved), uncomfortably hot or cold foods, sweeter formulas thickened with cereal, and limited or no introduction of solid foods. These practices can lead to markedly immature oral-motor-feeding skills, aversions to feeding, fear of novel food experiences, and taste/temperature sensitivities. Some kids have the feeding ability, but just want things the familiar way, so if you get the opportunity, do ask their caregivers what that way is.

    The immediate focus in children with marked feeding difficulties or refusal should be on keeping up hydration; that said, it is VERY unusual for a child to refuse himself into severe dehydration. Solid foods can wait until you get home. Formula is still the drink of choice, as your child will need the calories. If your child is refusing the bottle, you might try some of the following tweaks:

    • try the familiar local stuff, in a local bottle (straight bottle, big open nipple)
    • experiment with various formula brands (see Choosing a Formula)
    • add in 1 tsp of sugar per 6-8oz bottle if the local stuff is sweeter (but wean this over the next 1-2 weeks)
    • try a slightly more dilute formula (not for more than a day or so)
    • mix in some rice cereal to the formula (I don't love this practice but they're often used to it)
    • play with temperature (from cooler to warmer than you'd think, but test it on your wrist first)
    • and definitely try different nipple styles or open up the nipple you do have

    The massive transition you're going through together may also contribute to your child's energy level and interactivity. Keeping as much routine as possible around meals/snacks/sleep, nesting in your hotel room, and avoiding crowded and overwhelming spaces can help.

    The solid foods can happen at their pace ... oral defensiveness is certainly something that we see. What these children need is a gradual, persistent, and consistent approach to introducing textures (simple to more complex) and tastes (bland to more stimulating). The same approach should be used for children with difficulty making transitions from one feeding stage to the next (pureed to junior textures, bottle to cup). If they don't progress in the next few weeks then visiting a feeding/speech/oral-motor therapist on return would be a good idea.

    Things that also may contribute - any painful-looking mouth sores or teeth (emerging or decayed)? Any painful reflux behaviors (sour face, arching back)? Any cough/sputter with eating? Vomiting/diarrhea, or bad constipation? Other concerning signs of illness? If so, let us or your doctor know.