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Medical Issues Common to Ethiopian Adoptees
By Rebecca Dinkins and Dr. Jane Aronson
Edited February 13, 2007

DISCLAIMER: The following information has been compiled from parent experiences and from various websites to provide general descriptions of various medical issues common to children coming to the U.S. from Ethiopia. This is a general summary of possible health issues for kids adopted from Ethiopia. The notes are not a substitute for in-person medical expertise with your healthcare provider. Please see the Resources at the end of this document and consult your health professional for your particular situation.

Note regarding Medical care in Addis:  Children should receive an Intake Medical Exam when the adoption agency takes them into care.  You should receive a copy of the Intake Exam record at some point.  They also have a basic physical exam and HIV test as part of their Visa processing to check for significant health issues.  Children who become ill may receive medical treatment at a local clinic or hospital.  However, lice and parasite treatments may not be given because the likelihood of re-infection is very high.  Medical care your child may receive in Addis is very good but is different from what you are accustomed to in the U.S.  Children in the care of an adoption agency undoubtedly receive better medical care (immunizations, exam, etc.) than many other children.  If you would like to make a difference in the health care all children receive, consider supporting Dr. Aronson’s World Wide Orphan program, (www.wwo.org) World Health Organization, or other programs seeking to enhance medical care in Ethiopia and other countries.  Also, your adoption agency may have a means for you to donate vitamins, analgesics, or other basic medications for the children in their care and for those in orphanages which refer children to the agency.

Questions to ask your agency about pre-placement medical care:
What vaccinations or tests are given to children at the Intake Medical Exam?
When will I receive a copy of the Intake Exam record?
Will I be notified if my child becomes ill while in agency care?
I’m traveling to bring my child home -- what should I do if my child becomes ill while I am in-country
                       -------------------------------------------------
CONTENTS
I. Choosing a doctor.                                     
II. Arrival Medical Exam and Follow-Up
            A. Physical exam
            B. Medical Tests – Blood, skin, gastrointestinal, other
            C. Immunizations
            D. Follow-up exams
            E. Disclosure of medical issues
III. Other Health Exams
            A. Vision
            B. Dental
            C. Hearing
IV. Common Systemic Issues & Treatment – Parasites, TB, lactose intolerance, etc.
 V. Common Skin Issues & Treatment – Ringworm, Molluscum, Dermatitis, etc.
VI.  Allergist-recommended products for sensitive skin
VII. Parent tips for lactose-free diets
VIII. Selected Resources

 

I.  Choosing a doctor.  Many families already have family physicians when they adopt.  Some continue working with their physician, some seek a health professional with more expertise in international health issues.  These are some considerations when choosing a physician for your child. 
            Will the doctor meet with you to review medical issues before your child arrives?
            How long is the wait to get in for a sick child or well child appointment?
            Once you are there, how long are you likely to be in the waiting room?
            Will your doctor converse with you at your level of understanding (“layman’s terms”) or in medical jargon?
            Does he have experience with children adopted internationally and/or an immigrant population?
            Is she willing to learn from and be educated by you?  For example, is she open to you sharing a list of medical tests suggested by international adoption specialists?  Will she respect your request to have a test run based on what you learn from other adoptive parents?  Does her philosophy regarding immunizations match yours?
            If he doesn’t have much experience, is he willing to consult colleagues with greater expertise at your request?  Will she be comfortable if you consult one of the international medicine doctors about your referral and/or meet with the specialist when your child first arrives?
            What is his after-hours contact policy?  (shared “on call” service?  24-hour nurseline?)

Keep in mind that the most important element for most people is to feel good about who you are taking your child to and the medical care provided.  You may really like your doctor, but if you are not comfortable with the care your child is getting, you may choose to get a second opinion or even to change physicians, even if that hurts someone’s feelings.  It is very fair to simply say that you wish to work with someone experienced in international adoption issues.  And, of course, a face-saving position is to say something along the lines of “Our adoption agency strongly recommends we work with a physician experienced in international adoption issues.”  The best doctors are able to look past ego and seek what is best for the patient.
            Pediatricians and family doctors may consult The Redbook of Pediatric Infectious Diseases 2006 when diagnosing issues with your new child.  It has authoritative information on parasites, diseases and conditions listed in this document.  The selected Online Resources below provide links to some international adoption specialists.  Your local homestudy agency may provide additional resources.

II. Arrival Medical Exam and Follow-Up.  It would be great to have an Amharic speaker available (face-to-face or by telephone) to explain the exam to children, but most parents manage with pantomime and “baby” Amharic.  The children should have an Intake Medical exam when they come into agency care, as well as the U.S. Embassy Visa medical, so should have a general idea of what is involved.  Your child may take the experience in stride, perhaps because it is simply one more incomprehensible thing in an overwhelming new life.  However, be prepared for a tantrum:  children may demonstrate fear through appearing to faint, by screaming or by kicking and hitting anyone in the vicinity while trying to escape.
Your agency may recommend that the initial exam take place within the first month.  Parents may  decide to go to the doctor within the first week to minimize the potential for passing illnesses -- particularly parasites -- to others.  Some families have separated the office visit into parts, with an exam one day and “needles” a week or so later.  Others may prefer to squeeze exam, bloodwork, dentist and eye exam into the child’s first 2-3 weeks.  What works best for your family is whatever you decide.
NOTE:  A few traveling parents with urgent medical concerns have chosen to have their children examined during their stay in Addis by Dr. Sophia Mengistu, a well-known Addis pediatrician, or to consult the Hyat Hospital physicians.

            A. Physical Exam.  Your doctor should perform a standard pediatric exam with developmental assessments, as much as language and cultural barriers allow.  This includes height, weight, checking the eyes, ears, nose, and throat, lungs, heart, neck lymph glands and thyroid, abdominal organs, genitalia, and reflexes.  The doctor or nurse should make note of any scarring or dark skin areas (Mongolian spots).  Scars may look fleshy or simply be a darkened area similar to a birth mark.  Summary data from this exam should be included in your agency and family reports.
                        1. Genitalia.  Hopefully, an older child will allow the doctor to make a quick check of the genitalia.  Some boys are circumcised and some are not.  Some girls have been “circumcised,” which is also referred to as Female Genital Mutilation (see under Common Skin Issues & Treatment).  If your older child is not comfortable with a genital check at this time, you can do it after the child has been here for awhile, perhaps at the TB recheck or at an annual exam.
                        2. Vision.  You may be able to prepare your child ahead of time with a sketch of the images used in the standard wall chart for non-verbal children, so they know the words for the shapes in either Amharic or English.  Adoption Medicine specialists recommend that a pediatric ophthalmologist examine all international adoptees due to unusual medical conditions sometimes found in children born in developing nations.  (An ophthalmologist is a medical doctor who specializes in eye problems.)  Some conditions can show symptoms that may be found during a thorough retina examination. 
                        3.  Uvula.  The Uvula is a small finger-shaped piece of tissue hanging down from the back of the throat which some experts believe helps direct food away from the breathing passage when swallowing.  Some Ethiopian children have had this removed – and some had been home for years before this was noted by the doctor, dentist, or parent.  One cultural belief your adopted child may have heard is that he can die if the uvula touches the tongue.  According to Dr. Sophia Mengistu, in information shared with Dr. Jane Aronson:
Cutting the uvula is one of the traditional malpractices like female circumcision.  Any infant with failure to suck and fever is believed to have inflamed obstructing uvula. We always ask if grandma is at home because they are the ones who push the mothers to do this.  They will be taken to the traditional healer where it will be removed with a sharp object.  In the city some of them present to the hospital with bleeding, infection and sometimes with aspiration of the cut piece.”

            B. Medical tests.  Items in the following list are taken with permission from Dr. Aronson’s site, http://www.orphandoctor.com/services/postadopteval/tests_evals.html, with some descriptions added by this author from a variety of sources to provide general background information for adoptive parents.  Please see the resources listed at the end of this document for additional personal research.  It is advisable to print the list directly from Dr. Aronson’s site to share with the pediatrician because it provides test details doctors should see.  You could also print the comparable information from the AdoptiveFamilies “Adoption Medicine” articles for your doctor. 
            The amount of time required to process tests and receive results will vary depending on the test and the lab facilities used by your physician, but generally should be less than two weeks. 

                        1.  Blood tests.  Descriptions are based on common knowledge and information from various authoritative online medical resources.
                                    a. Antibody Titers (children over one year of age) measure the presence and amount of antibodies in the blood to determine immunity developed from previous illness or vaccine.  Your pediatrician uses this information to determine which immunizations your child has already received and which are needed.  Most Adoption Medicine specialists use titers to measure antibodies in order to avoid re-immunization.  Titers are not used for children under 12 months because they are likely to carry antibodies from the birthmother.  Titers are used in concert with the immunization record from the country of birth.  (You should receive a copy of your child’s medical records from the agency.) You should discuss this further with your pediatrician.
Diphtheria            Measles
Tetanus            Mumps
Polio            Rubella
Chicken pox (varicella)
                                    b. Complete Blood Count (CBC) with differentials and platelets counts the number of red and white blood cells, the total amount of hemoglobin, and other data about the red blood cells.   For example, a high number of white blood cells indicates infection, and low hemoglobin indicates anemia, which is common in about 25% of children adopted from abroad.
                                    c. Hemoglobin electrophoresis – tests for different types of hemoglobin (including sickle cell disease); unusual hemoglobin levels may indicate anemia, malnutrition, lead poisoning, heart disease and other issues.
                                    d. Lead levels – determines the amount of lead in the blood.  Exposure to lead-containing gases from gasoline and the burning of coal are the two most common causes of elevated levels; this appears to be a rare medical issue for Ethiopian adoptees.
                                    e. Hepatitis – Hep A, Hep B and Hep C.  Hepatitis is a liver inflammation -- A, B and C are common viruses that cause liver inflammation.  The children are tested for Hep B during the intake physical. 
                                    f. Liver enzymes – checks the composition of liver fluids
                                    g. Rickets screen – Rickets is a disease involving softening and weakening of the bones, primarily caused by lack of vitamin D, calcium, or phosphate.  The Rickets screen tests for these substances.  Rickets may also be associated with premature birth. 
                                    h. Syphilis – Syphilis is a sexually transmitted disease easily treated with antibiotics.  Infants may initially test positive for syphilis if the birth mother was infected.
                                    i. Thyroid screen – Checks the thyroid.  A number of parents have reported a slightly enlarged thyroid at the initial exam, but not necessarily an elevated thyroid function test.  The enlargement could be related to malnutrition and/or iodine deficiency.  This is very common in Ethiopia.  Parents have shared that the thyroid was normal size when rechecked after several months of improved nutrition in the U.S.
                                    j. HIV – In addition to an arrival screen, the HIV test should be repeated about 6 months after arrival.   The test used could be either an ELISA (tests for HIV antibodies) or PCR HIV DNA (tests directly for HIV presence).  The ELISA can be less accurate for children under 24 months because they may test positive for HIV if the birth mother was infected with.  The ELISA looks for antibodies, which babies may receive from an HIV-positive birthmother and carry for 18-24 months.  The PCR DNA test is more accurate for these children, and also for the few people who have HIV but for some unknown reason do not produce antibodies that can be detected by the ELISA assay.  (For more information on these tests, consult your doctor, local Health Department, or one of the online medical resources below.)  
Due to the prevalence of HIV in Africa and its long incubation period, pediatric infectious disease specialist Dr. Jane Aronson recommends the HIV ELISA with confirmatory Western Blot, followed by a PCR DNA test for all children coming to the US from Ethiopia. 
NOTE.   Within her practice, Dr. Aronson orders an HIV ELISA with reflex Western Blot as well as a qualitative PCR HIV DNA at the initial evaluation.  

Note regarding HIV testing in Ethiopia:  As of January 2007, the ICL laboratory in Addis recommends children to be tested with the ELISA, with a follow-up PCR.  Children under about 18 months should be tested a third time, with the ELISA, prior to traveling to the US.  
Dr. Jane Aronson believes that PCR HIV testing is the gold standard for HIV testing in youngsters under 2 years of age, which is the standard in the U.S.  That said, the resources are limited in countries outside of the U.S.  We are indeed fortunate to get any PCR HIV testing outside the U.S.  The only countries with international adoption programs where it is available are Ethiopia and VietNam. With this understanding, Dr. Aronson supports the use of a step approach using the HIV ELISA and the PCR as noted in this section. Finally, however, all parents must recognize that there are scientific circumstances wherein a child may have a negative ELISA and turn out to be infected with HIV.  This is why Dr. Aronson tests every child on arrival in the U.S. no matter what the age with an HIV ELISA and confirmatory Western Blot as well as a PCR HIV DNA qualitative test.

                        2. Skin tests.
                                    a. Culture – if your child has an area of rash or apparent fungus on the scalp or elsewhere, your pediatrician should take a sample for culture to determine which type of rash and the appropriate treatment for it.  A “toothbrush” is rubbed gently over the area, then placed in a tube and sent to the lab.
                                    b. TB – A tuberculin skin test (TST) is also called a Mantoux or a PPD (Purified Protein Derivative).  The test involves injecting a small amount of inactivated – harmless -- TB bacteria under the skin (usually on the forearm), forming a small bubble.  The bubble disappears and the skin must be checked for a reaction 48-72 hours later by the person/agency who administered it.  It is strongly recommended that your child be re-tested 3-6 months after arrival -- false negatives may occur when the patient is affected by malnutrition or an immunodeficiency of some kind, and there is a possibility of exposure shortly before travel to the U.S.  Children may receive a BCG vaccination at the Intake exam if they have not already received one.  Be aware that some doctors will not want to do a PPD on a child with BCG, but adoption medicine practitioners and the RedBook on Pediatric Infectious Diseases say the PPD should be given even when the child has a history of BCG vaccine.  (See the “Tuberculosis” description below under “Common systemic issues and treatment,” or your health professional for more detailed information.)  
            NOTE:  Dr. Aronson recommends that anyone traveling to Ethiopia have a PPD test 2-3 months before travel, and again about 3 months after travel.  Because TB is prevalent in developing countries, travelers could easily be exposed to a contagious individual without being aware of it.
                                    c.  Lice.  Most parents have treated for lice, if needed, before the child is seen by a doctor in the US.  Your pediatrician may check your child’s scalp for lice, particularly if you have post-treatment concerns. 

                        3. Gastrointestinal – Ova and Parasites and Girardia Antigen.   You will need to collect stool samples from 3 different bowel movements, each at least a day apart, to check for parasites and other gastrointestinal abnormalities.  Three samples are used because there is not always evidence of parasites in every bowel movement – and sometimes parasites are missed even with three samples.  Most children from Ethiopia are treated for parasites.  Your doctor will check the lab results with medical reference books to determine if your child needs treatment and which medication(s) will be most effective.  To avoid spreading parasites to other family members, practice very good hygiene – wash hands well with soap, use antibacterial hand sanitizer when out and about, etc.  Some families use the antibacterial or disinfecting disposable cloths to wipe down “public” surfaces, such as toilet seats and levers, sink levers, doorknobs, remote controls, etc.
Adoption Medicine specialists generally are very aggressive in treating even the slightest abnormality because there is a high prevalence of bacteria and parasites in the water in developing countries.  If a child shows a failure to thrive or lack of growth/weight gain over time, this is an indicator that parasites should still be considered. 
*Although some parasites are sufficiently common in the U.S. that U.S. children are not treated unless the child is symptomatic, this does not apply to children adopted from Ethiopia
*Some parasites are more easily transmitted than others, and some medications cannot be administered concurrently. 
*Some children may be symptomatic even if their stool samples are negative, so your doctor may choose to prescribe treatment based on the symptoms (i.e. empiric therapy).
                                    a.  Older children.  For many children this is a significant source of embarrassment.  Be prepared to give positive reinforcement or a special treat for willing compliance.  Be alert to times they are likely to defecate – after breakfast is typical. 
                                         1. The doctor or lab staff will give you a plastic “bowl” to lay over the toilet for your child to defecate (“kaka” or “arrr”) into and vials with comprehensive instructions.
                                         2.  After your child has used the bowl, you will open a vial and use the scoop inside to collect small amounts from different parts of the sample and place them inside the vial.  Close and shake – the fluid inside preserves the sample and prepares it for examination.  Label accurately.
                                         3.  Collect samples for 2-3 vials on each of 3 days, at least 24 hours apart.
                                         4. Take the vials to the doctor or lab – some facilities prefer that you bring all samples in at one time, some allow you to bring them whenever ready.  Results may be available within a week, depending on the facility.
                                    b.  Babies and toddlers.  If your child is out of diapers, try the procedure above.  For children in diapers, your doctor will probably ask you to use plastic wrap to obtain an “uncontaminated” specimen.  This is easier if you are able to predict somewhat when a bowel movement will occur.  Lay plastic wrap inside the diaper before putting it on your child.  Be prepared for mess --  urine will leak out, and if your child has diarrhea, it may not be contained very well.
                                    c. Test of cure (Re-check).  After the course of treatment is complete, your doctor may ask you to re-test your child.  Also, if your child continues to have symptoms or if any family member begins to show symptoms, your doctor should retest the child and/or family members.  A few children have needed a second treatment or different medication to eliminate symptoms.  If your child is gaining weight, has formed (if stinky) stools, tests negative for parasites, and otherwise appears healthy, she may simply have bacteria in the colon that is indigenous to Ethiopia, which can take years to change. 

            C. Immunizations. Your child likely had vaccines in Ethiopia. The issue is whether they were recorded in the orphanage. Most orphanages are part of the Ministry of Health system of health care in Ethiopia and the vaccines come from the World Health Organization. In the last few years, orphanages have developed standards for medical care with the government and kids are getting better health care. Some large government owned orphanages may still not keep the best records, but if there are records, you should ask for them when you adopt your child. Most adoption agencies are accustomed to keeping excellent records for the kids in their orphanages. The vaccines are administered at local clinics and recorded on a yellow card and this is available to parents at the time of the adoption. The dates will likely be in the Ethiopian calendar and can easily be translated into the Gregorian calendar used by the U.S. There are websites where you or your pediatrician can perform the conversion of the dates. The dates can then be entered in the vaccine grid and if the blood titers obtained from the routine blood work done on arrival in the U.S., are positive for diphtheria, tetanus, polio, hepatitis B, chicken pox, measles, mumps, and rubella, then those vaccines can be accepted. If there is no record, then you can use some of the titers and also give vaccine from scratch to create an individualized schedule acceptable for school entry. A child can legally enter any school while in the process of catching up for vaccines as long as there is a letter from the pediatrician explaining that the child is in the process of being vaccinated.
            The Center for Disease Control and Prevention website has a standard immunization schedules as well as a “catch-up” schedule at http://www.cdc.gov/nip/menus/vaccines.htm#Schedules

            D. Follow-Up exams.  American Academy of Pediatrics recommends annual or biennial exam for children over age 6 with no chronic health issues (asthma, Hep B, ADHD, etc.).  Because your child will experience a tremendous growth and development spurt over the first 12-18 months in the US, your pediatrician may recommend more frequent check-ups for the first year or two.  You can use a pediatric development chart or the “What to Expect” books to mark the progress of children under three.

                        1. Bone-age.  A doctor can request a wrist x-ray to determine bone-age to confirm the child’s chronological age.  This is an inexact science.  Bone estimates are accurate to within an 18-24 month range, but may be less accurate for your child due to the effects of malnutrition.  This is more likely to be investigated after the child has been with the family for some time and the parents (and/or physician) question the assigned age compared to the behavioral and physiological age indicators (including precocious puberty).  Parents should probably wait at least a year to do this due to the growth spurt most children experience with improved nutrition.

            2. Repeat medical tests
a.  TB. If your child tested negative for TB on arrival, you should schedule a repeat TB screen at 3-6 months.  Some families have re-tested again at 9-12 months, with positive results for Latent TB infection. Parents and others who traveled to Ethiopia to visit or bring home a child should have a PPD about three months after returning, due to the possibility of exposure during travel.
                         b.  HIVDr. Aronson recommends repeating the HIV screen about 6 months after arrival if the child had a positive test in Ethiopia. 

            E. Disclosure of medical issues.  Who “needs” to know about any medical issue is a parent decision to be made in consultation with a health professional, who should know specific rules for your school district or state.  Parents may prefer to keep issues private if at all possible.  Your physician may be required to report some issues (such as active TB disease) to your local Health Department, who may, in turn, be required to alert your child’s school that an unnamed child is present with that particular issue.  The following are some general guidelines.
1. HIV, Latent TB, Hepatitis B and Hepatitis C infections are not communicable diseases in a school setting, which has State Health precautions in place.  HIV and Hepatitis can be transmitted by blood-to-blood contact, so it may be appropriate to notify (and educate) a volunteer leader for activities where a skin injury might take place, such as a soccer field. 
                        2. Lice and ringworm are two health issues for which schools may be required to send a child home, if the issue is caught by the school nurse.  Discuss this with your pediatrician.  Children should be treated for lice promptly upon arrival, so this only becomes an issue if reinfestation occurs.  Ringworm lesions should be kept covered with clothing.  Lesions not covered by clothing may need to be kept covered by an adhesive bandage.  Scalp lesions that are dry and healing should not be an issue.
                        3. Molluscum pustules are not contagious.  Broken pustules should be covered with an adhesive bandage.
                        4. Skin issues (impetigo, etc.) with weeping, open sores may be best kept at home until they are healing.  Discuss this with your physician.
5.  Children under treatment for parasites are unlikely to transmit them to others in a school or licensed day care setting.

III. Other Health Exams.  You and your pediatrician may choose to have your child examined by other health care specialists based on the results of the Arrival Medical Exam and observation.  The following are recommended by Adoption Medicine specialists.

  • Comprehensive Vision Screening.   Some parents choose to have vision checked promptly, while others prefer to wait several months or a year, when it is easier to explain procedures to the child and have him/her interact more.  Ophthalmic equipment can measure how light enters the eye to provide a fairly accurate estimate of prescription needs for non-verbal patients, so the ability to interact is not critical for a “baseline” exam.  Adoption Medicine specialists recommend that a pediatric ophthalmologist examine all international adoptees due to unusual medical conditions sometimes found in children born in developing nations.  Some conditions can show symptoms that may be found during a thorough retina examination. 

 A small melanin spot (“freckle”) on the white of the eye is normal, but not common, and easily examined by the doctor.  Dilation of the eye for deep examination may be postponed until the child comprehends enough English to not be scared by the temporary inability to focus.

B.  Dental.  A pediatric dentist may be better able to evaluate your child’s dental development than a family dentist with a limited pediatric clientele.  Due to malnutrition, lack of prenatal care, possibility of rickets, and poor dental hygiene, some children may arrive with stained, damaged, or “weak” teeth.  Children may not have experienced a dental exam in Ethiopia.  A conversation with an Amharic speaker (in person or by telephone) can help reduce the child’s anxiety.  Bitewing x-rays are good to get at this baseline exam, if the child will cooperate.
Keep in mind that malnutrition can alter dental development.  The dentist can give you a general
age estimate based on the teeth that are in, have been lost or are forming below the gums.  Some children have experienced a dental “growth spurt” the first year or so after arrival.  A website with a “movie” graphic showing dental development for children can be found at http://www.straightteeth.com/ortho.asp
            Consider whether your water has fluoride or not -- the children need it to improve the health in their teeth.  There are fluoride-containing vitamins or fluoride rinses that can be used.

C.  Hearing.  A thorough audiologic evaluation should be performed because children can have underlying hearing deficits that can otherwise be easily undetected.  A hearing deficit can impact language acquisition and learning.

 

IV. Common Systemic Issues & Treatment.  The following health issues have been reported by parents who have adopted from Ethiopia.   The general information provided has been taken from a variety of resources for EDUCATIONAL PURPOSES and IS NOT MEDICAL ADVICE.  Please refer to your local health professional or department of health, the Selected Online Resources below and other medical websites for more information.  
NOTE:  Families may be contacted by the local Health Department if the child tests positive for active TB (generally no contact for latent/inactive TB) and possibly if the child has tested positive for parasites.  Contact is generally by telephone, and a checklist of questions is asked.  Remember that they are acting in the best interest of public health, they may be completely unfamiliar with international adoption health issues, and be patient with them.

            Name:  Bad breath (halitosis)
            What it is:  Unpleasant mouth odor.
            How they get it:  Could be from infection in the mouth, decayed teeth, gum disease, parasites or gastrointestinal flora.
            Likely treatment:  Dental exam to identify and treat mouth issues, screen for and treat parasites as needed.  Acidopholus or yogurt may alter gastrointestinal flora.
            How long it lasts:  Odor usually improves with treatment.

            Name:  Diarrhea,Malodorous Flatulence
            What it is:  Unformed, watery, fecal material. Unusually strong and malodorous intestinal gases.
            How they get it:  Often associated with parasites and/or lactose intolerance, also relates to stress, food eaten and gastrointestinal flora.  May be a side effect of treatment with antibiotics.
            Likely treatment:  Screen for and treat parasites as needed.  Test for lactose intolerance (see below) – with infants, perhaps a change in formula.  Keeping a diet/food journal with descriptions of gastric problems can help you and your pediatrician identify potential issues.  Giving the child acidopholus or yogurt may help alter gastrointestinal flora and improve the foul odor. 
            How long it lasts:  Odor often improves with treatment and change in diet.  If your child is gaining weight, has formed (if stinky) stools, tests negative for parasites, and otherwise appears healthy, she may simply have bacteria in the colon that is indigenous to Ethiopia, which can take years to change. 

Name:  H. pylori bacteria    
What it is:  Helicobacter pylori can cause digestive complaints such as stomach pains, indigestion, abdominal distension, nausea, vomiting, diarrhea, and chest pain from reflux.  It may cause reflux or be related to reflux.  If left untreated, ulcers can develop, although this is not common in children. Children more commonly have reflux, esophagitis and other non-specific GI complaints, especially chronic diarrhea. The diarrhea comes from malabsorption of nutrients in the intestinal tract due to chronic esophagitis and chronic inflammation of the intestines.
                        H. pylori is commonly missed as a cause of irritability and general malaise in a young child.
How they get it:  H. pylori bacteria is commonly found in developing countries and is transmitted from person to person; people get colonized with it and can have no ill effects from it for decades and decades
Diagnosis/treatment:  An H. pylori infection is most easily diagnosed with an H. pylori antigen stool test, which is separate from other stool tests. Antibody blood tests may also be used to make the diagnosis, but the stool antigen test should be included as well for the definitive diagnosis. A blood test, breath test or endoscopy (small tube inserted through mouth, down esophagus to stomach/duodenum) are diagnostic tools more likely to be used for adults. 
Typical treatment involves antibiotics.  Dr. Aronson prescribes three antibiotics -- Metronidazole benzoate, Biaxin, and Amoxicillin -- for two weeks, plus Zantac for 8-12 weeks, in some cases with Prevacid as well.  A test of cure at the end of the antibiotic regimen is recommended.
How long it lasts:  H. pylori is often eliminated with a single course of treatment. 

            Name:  Lactose Intolerance
            What it is:  Body’s inability to break down lactose.  (Some people have a milk protein sensitivity or allergy, which is different from lactose intolerance, and not commonly found in Ethiopians.)
            How they get it:  Lactose intolerance is not unusual in persons of African, Asian or Native American heritage.  Malnourished children may be lactose intolerant, which often resolves after several months of improved diet.  See also links under “Selected Online Resources,” below.
            Likely treatment:  Avoid milk products or cow’s milk-based formula.  Alternate products include: calcium-fortified orange juice, soy milk/yogurt/cheese, rice “milk,” nut-based cheese, lactose-free milk (Lact-Aid), and soy or specialty formula for infants.  See “Parent Tips for Lactose-free diets,” below.  Lactase enzyme drops or tablets can be given to help process lactose when they choose to consume dairy products.
The easiest method to check for lactose intolerance is to remove ALL dairy products from the child’s diet for at least a week.  Read labels -- lactose and various milk products are ingredients in many commercial food mixes.  Re-introduce products one at a time, and watch for symptoms – stomachache or diarrhea.  Some people who do not tolerate fresh milk do fine with yogurt and/or cheese.  Some who eat aged cheese (cheddar, etc.) without incident cannot tolerate process cheese (American, squeeze cheese, etc.)
            How long it lasts:  Some young children who appear to be lactose intolerant may be able to tolerate some milk products by the time they reach school-age.  Malnourished children may be able to tolerate milk products better 3-6 months after improving their diet, eliminating parasites, and addressing other health issues.  For some people, it is a lifelong consideration.

Name:  Parasites Giardia   (See also additional information under Parasites)  
What it is:  A protozoal illness of the lower intestine, commonly found in institutional settings such as day care and orphanages.  Symptoms include diarrhea, stomachaches, abdominal distension, and foul-smelling odor of flatulence/feces.
How they get it:  Giardia is very commonly found in the water in Ethiopia. 
Likely treatment:  Flagyl (Metronidazole benzoate) is the medication parents most frequently report being prescribed.  Parents have reported using Alinia and Furozolidone, but Dr. Aronson reports studies have shown their efficacy is lower.  The Girardia Antigen test recommended by Dr. Aronson is more likely to identify a patient who is a girardia carrier than the regular Ova and Parasite test.  NOTE: If your child does not test positive for giardia, but has malodorous feces or ongoing diarrhea that does not resolve with change of diet, your doctor may choose to treat anyway based on the symptoms to see if they resolve with treatment.
Dr. Aronson strongly recommends 30-50 mg per kg (conversion factor of 1.6), divided into three doses per day for 14-21 days, with a test of cure at 10 days.  If the test is negative, medication ends at 14 days; if positive, complete 21 days, followed by a second “test of cure.”  She notes that some doctors do not want to use metronidazole benzoate and/or do not want to use it at the higher dose with the increased duration.  There is experience now with kids from abroad -- especially Africa -- that if Giardia is not treated aggressively, resistance may occur, making treatment very difficult.  In fact, metronidazole sometimes must be replaced by Albendazole or Tinidazole which are difficult for kids to tolerate.
How long it lasts:  Giardia is often eliminated with a single course of treatment.  Your physician may recommend re-testing after treatment is completed.

            Name:  Parasites commonly found in the water and food in orphanages include Giardia, tapeworm, roundworm, pinworm (Enterobius vermicularis),  Cryptosporidium parvum, Entamoeba histolytica, Ascaris lumbricoides, Hymenolepis nana, and Dientamoeba fragilis.  Eosinophilia (increased numbers of Eosinophils in the blood count) can be related to parasitic infection, but it is related to many other medical conditions i.e. asthma, allergy.   If issues persist despite negative tests or after treatment, the doctor should look for some of the  parasites that don't easily show up in stool, esp. Strongyloides, Schistosomiasis, and Filariasis. 
            What it is:    Parasites prevent food and nutrients from being absorbed effectively, and are a common cause for failure to thrive.
How they get it:  Some parasites are very easily spread through casual contact and shared surfaces (toilets, sink handles, keyboards, doorknobs, etc.).  Some do not spread as easily.    It is important to practice extremely careful handwashing after diaper-changing, especially in the first days and weeks home.  Carry waterless hand-washing solution with you to use after every diaper change.   Several families have reported that siblings of children with giardia have also contracted giardia.  All family members should be given a refresher course on good handwashing. 
Likely treatment:  Treatment varies according to the type of parasite discovered.  Some require daily treatment for weeks, some require an oral medication taken 2 or 3 times over a 2-3 week period.  Some are sufficiently common in the U.S. that treatment is not required unless the child is symptomatic (stomachaches, diarrhea, etc.)  Your doctor may treat for one parasite at a time and may postpone treatment for inactive TB until parasites have been eliminated to avoid overwhelming your child’s system.  To avoid transmitting the illness to others, keep shared surfaces (door knobs, faucets, toilets, bathtubs, etc.) cleaned regularly with bleach water or other disinfectant and enforce strict hand-washing, especially after toileting/diaper changing.
NOTE:  Antiparasitic medication is not generally tasty, and some parents have had difficulty getting it taken.  Parents have reported suggestions of mixing the powder form with Welch’s white grape juice, applesauce, or pudding.  If your doctor is not able to get a palatable compound, Dr. Aronson (www.orphandoctor.com) has contacts with pharmacies in New Jersey and Connecticut which can make it and ship to you.
            How long it lasts:  Most parasites are eliminated with a single course of treatment.  Your physician may recommend a test of cure (re-testing) after treatment is completed.  Dr. Aronson notes that if a child with stinky feces tests negative for parasites AND is not lactose intolerant AND is gaining weight and looking healthy may simply have bacteria in the colon indigenous to Ethiopia, which may take years to change.   If a child is NOT gaining weight and looking healthy, parasites may still need to be considered.

Name:  Precocious puberty
            What it is:  Early hormonal development.
            It looks like:  Body and facial hair (including pubic hair), breast development, menses.
            How they get it:    Persons of African descent have a tendency to mature a little earlier than persons of Caucasian, Hispanic, or Asian heritage, and the change in diet to a fat-rich and hormonally-enriched meat-rich diet can spur early development, particularly with girls. 
            Likely treatment:  A pediatric endocrinologist may be consulted as soon as breast buds or pubic/underarm hair appears.  Medical intervention with a hormone-suppressing drug (such as Lupron) is possible at any age.  Conservative treatment would be to let “nature take its course” if the girl is within the average age range for puberty.  Aggressive treatment would inhibit the hormones at the first sign of puberty.  The determination that treatment is needed is complicated and based on individual medical and social considerations, in consultation with the pediatric endocrinologist.  Some of these considerations include age at onset, growth (to adult height), cultural and emotional adjustment to their new life, and ability to handle sexuality.
            How long it lasts:  It is normal for hormonal changes to begin about age 10-11 for boys, with increase in body hair and a darkening of hair in the moustache area.  Hormonal changes begin about 9-10 for girls, with breast buds and body hair followed by emergence of pubic hair, then menses.  This development normally takes from 2-4 years, but may be accelerated in our Ethiopian daughters.

            Name:  Shigella/Shigellosis
            What it is:  An infectious disease that causes diarrhea.
            It looks like:  Diarrhea. 
            How they get it:    Bacteria is passed in the feces, so may be contracted by drinking or washing in contaminated water, and when soiled fingers spread bacteria to food or put in the mouth (typical of young children).  Severely malnourished children can be carriers (asymptomatic, but can pass to others).
            Likely treatment:  General antibiotic such as Cipro.  Thorough handwashing is strongly recommended to prevent transmittal.  (See also procedures under Parasites)  One parent reported that her pediatrician treated her child empirically, despite negative stool samples, and his diarrhea finally cleared.
            How long it lasts:  Bacteria is carried in the system for 7-14 days after treatment and symptoms have stopped.

            Name:  Tuberculosis (TB) – Latent TB Infection or Active TB Disease  (See FAQ:  TB, your health professional, or your local Health Department for more information.)  
            What it is:  An infectious disease caused by the bacterium Mycobacterium tuberculosis, M. bovis or M. africanum
            It looks like:  TB commonly affects the lungs of an infected person, but it can infect almost any part of the body. It is prevalent in developing countries – including Ethiopia -- and exists here in the US.
            How they get it:  TB is commonly spread through the air, when a person with TB disease coughs or sneezes and releases the bacteria into the air. When a person breathes in the bacteria, it can settle in the lungs and begin to grow, then spread to other parts of the body.
            Diagnosis:  Your child should be given a tuberculin skin test (PPD) upon arrival.  (See section II.B.2.b above, for test details.) If negative, the test should be repeated 3-6 months after arrival -- false negatives may occur when the patient is affected by malnutrition or an immunodeficiency of some kind.  If the test is positive (reaction site of at least 10mm) then the test is considered positive for possible exposure to Tuberculosis.  Your doctor will order a chest x-ray -- if the x-ray is negative, the child is considered to be exposed to TB (not to have TB disease), and will be diagnosed with and treated for Latent TB Infection (LTBI).  If the x-ray is abnormal, your child will be evaluated and treated for Active TB disease.  Only a few Ethiopian children adopted through AAI have been diagnosed with Active TB disease.
              Ttreatment:  The treatment for Latent TB Infection is Isoniazid (INH) daily for 9 months.  Active TB disease is treated with multiple anti-tuberculosis medications – specific treatment and follow-up care for Active TB disease is outside the scope of this FAQ.   Your physician may notify the local Health Department if your child has Latent TB Infection, and is required to notify the Health Department if your child tests positive for Active TB disease.  In some states, the Health Department may provide medication free of charge.
There are some studies which suggest that taking Isoniazid can decrease the body’s ability to absorb Vitamin B6, resulting in irritable behaviors.  Dr. Aronson reports that children should receive adequate amounts of Vitamin B6 by simply taking a daily multivitamin, and not just high doses of vitamin B6.  Any parent believing the child should take additional B6 supplements should work with the pediatrician because high amounts of Vitamin B6 can have other side effects.
            How long it lasts:  After treatment for Latent TB Infection or Active TB disease, your child will be considered free of disease, and have significant protection against re-infection for the rest of his/her life.  Your child will test positive on any future PPD test, so should have a letter from the physician stating that a course of treatment was completed and that no more TB skin tests should be givenThe Interferon (IFN)-gamma blood test is an FDA-approved alternative to the PPD for adults. 

V. Common Skin and Scalp Issues & Treatment.  Lice, ringworm on the scalp and Molluscum are very commonly found on children adopted from Ethiopia.  As you research, keep in mind that it is difficult to diagnose skin problems without a visual exam by a health professional. The following are issues other parents have experienced with their children.  Descriptions and treatment options below have been taken from a variety of resources for EDUCATIONAL PURPOSES and IS NOT MEDICAL ADVICE.  Please refer to your local health professional or department of health, the Selected Online Resources below and other medical websites for more information.  
            NOTE:  Tea tree oil has been recommended by some parents for various skin conditions, including molluscum, ringworm, abrasions and acne.  It is a natural topical antiseptic that seems to work well for viral and fungal infections.  However, use it cautiously, because some people may have adverse reactions to the tea tree oil if used frequently.

            Name:  BCG scar peels/erupts
            What it is:  The BCG is a vaccine given in many countries as a TB preventative, and may be given to your child in Ethiopia.  The BCG vaccine scar may be blistery or itchy or swollen when the child arrived home. 
            It looks like:  The scar is round, slightly raised flesh on the upper arm.  Eruption may be flaky (like dry skin), itchy, pink, swollen, or cracked & bleeding.
            How they get it:  Immune reaction to the vaccine.
            Likely treatment:  Hot or cold compress to soothe, antibiotic cream or oral antibiotic, cover with an adhesive bandage if the wound is open.  There can be unusual responses in the skin, muscle, bone, or even the armpit lymph node, so this condition should be monitored by your pediatrician.
            How long it lasts:  Weeks, even months in some cases.

            Name:  Boils
            What it is:  An abscess
            It looks like:  A large, pimple-like abscess, often on the thigh near the bottom.
            How they get it:  Poor hygiene.  A few parents have reported finding boils a few weeks after returning home.
            Likely treatment:  Hot compress as needed, antibiotic, abscess can be ruptured when it comes to a head.  (Icthyol is an ointment used in some areas of Ethiopia, but it damages the skin and antibiotics are strongly preferred.)
            How long it lasts:  Several days up to several weeks.

            Name:  Contact dermatitis vs Hives
            What it is:  Contact dermatitis is a local dermatological response to a contact – usually a product or a plant, whereas hives are a systemic response.      
            It looks like:  Contact dermatitis may present as pink or red splotches, but often resembles goose bumps or small pimples.  The area is generally itchy, so may be scratched into sores, and can appear anywhere on the body that is in contact with the irritant.
                        Hives are a systemic response to something eaten, and are usually round or oval flattened bumps on the torso.  They can be difficult to detect on dark skin.
            How they get it:  Sensitivity to a product or plant or food.  For example, if child is sensitive to a laundry detergent, he might break out where clothes rub, such as underarms and waistbands.  If he is sensitive to nuts, he may break out in hives.  Hives which appear with no apparent trigger could be caused by a virus.
            Likely treatment:  For contact dermatitis, identify and eliminate irritants (retry in a few months).  When your child first arrives, you may want to use fragrance-free products to reduce some of the potential irritants, and let your child gradually adjust to the multitude of scents in your household, especially if your child has any open sores.  See list of allergist-recommended products below.
                        Hives should be promptly reported to your physician because they are a significant systemic reaction and may indicate a life-threatening sensitivity.  Diphenhydramine (Benadryl) liquid is the immediate treatment step.  If the hives do not go away quickly, your pediatrician may suggest taking Famotidine (Pepcid) tablets.  A cold compress can also help reduce the itchy feeling.
                        An oatmeal bath may help with itchiness.  Pour about one cup of oatmeal into a sock and tie it closed.  Soak it in lukewarm bath water, then squeeze out the “oatmeal liquid” and dab gently on the skin or mix into the bath water.  Turn sock inside out and dump remaining flakes into the trash. (oats stick less to nylon sock than cotton)
            How long it lasts:  The hives or contact dermatitis may clear up quickly or may last a day or more. 

            Name:  Eczema
            What it is:  A skin condition consisting of rash, dryness, itchiness.  Sometimes described as “the itch that rashes,” it can appear anywhere on the body, most frequently in areas prone to dryness or where clothing rubs.  It can cause skin color loss.
            It looks like:  Flaky skin or rash or an area of small bumps resembling headless pimples. 
            How they get it:  There is no single cause, although it may be related to allergies in some people.
            Likely treatment:  Avoidance of triggers.  Anti-itch medication (such as hydrocortisone cream), use of non-drying and/or hypoallergenic products (see list of allergist-recommended products, below), possibly allergy testing to identify or eliminate triggers.  One allergist recommended applying lotion over hydrocortisone cream to help the medication be absorbed deeper into the skin. 
            How long it lasts:  There is no “cure,” although symptoms can be controlled.

            Name:  Female Circumcision (FGM or Female Genital Mutilation)
Some of the girls adopted from Ethiopia have been reported to be “circumcised.”  Of those that have, those whose parents have shared with other parents have mostly reported Type I.  This is generally not of immediate concern, but should be noted in the medical file.  The more extensive "cut" may be an issue, due to the potential for urinary and hygiene issues.  See the list of Resources for some websites with information on FGM.
            What it is:  FGM is a term referring to procedures involving partial or total removal of the external female genitalia or other injury to the female genital organs for cultural or non-therapeutic reasons.
            It looks likeThe World Health Organization (WHO) has classified four types of FGM:
Type I- Excision of the prepuce with or without excision of part or all of the clitoris;
Type II-
Excision of the clitoris with partial or total excision of the labia minora.
Type III-
Excision of part or all of the external genitalia and stitching/narrowing of the vaginal opening (also known as infibulation).
Type IV-
Unclassified: this includes pricking, piercing or incising of the clitoris and/or labia; stretching of the clitoris and/or labia, cauterization by burning of the clitoris and surrounding tissue.
            How they get it:  FGM is often part of a rite of passage from childhood into adulthood, though it may also be performed on infants.
            Likely treatment:  Girls with Type I probably do not need immediate treatment, although your pediatrician should note the excision in her records.  US doctors are seldom knowledgeable in these areas, so if your daughter has Type II, III, or IV, your physician may refer you to a specialist to determine if corrective surgery would be advisable.  When your daughter matures, it may be advisable to meet with a knowledgeable gynecologist to cover intimacy issues.

            Name:  Impetigo
            What it is:  A skin infection that usually appears on the face, especially around the nose and mouth.
            It looks like:  Small red sores that rupture, oozes for a few days, then forms a yellowish “crust” or soft scab.
            How they get it:  Usually, bacteria enter the skin through cuts or insect bites, but it can also develop in healthy skin.  Because it is highly contagious, scratching or touching the sores is likely to spread the infection to other parts of the body and to other people.
            Likely treatment:   Antibiotic ointment and/or oral antibiotics.  If itching is under control, children should be able to return to day care or school after 24 hours on the antibiotics.
            How long it lasts:  Usually 2-3 weeks.

            Name:  Itchy scalp
            What it is:  dry scalp, may be fungus (See also Ringworm/Tinnea capitis, below)
It looks like:  pink scalp, maybe flaky, often itchy
            How they get it:  The itch can be caused by dry scalp as a result of shampooing overmuch, irritants in hair care products, eczema, ringworm treatments or simple dandruff. 
            Likely treatment:  Some parents have reported successful elimination following use of a dandruff shampoo, such as Neutrogena T-Gel, Selsun Blue, Tea tree oil shampoo, or Head & Shoulders; moisturizing scalp and/or oiling hair regularly; reducing frequency of shampooing; use of hypoallergenic hair products; evaluation for scalp fungus which may need treatment.  Hydrocortisone cream may be used for small patches, but because it can mask underlying symptoms, do not use for more than three days unless recommended by your physician.
            How long it lasts:  Varies, depending on cause, length of time it takes to determine the cause and treatment.

            Name:  Lice
            What it is:  Small parasite that can be found on the scalp.
            It looks like:   About the size and shape of a sesame seed, nits (eggs) are small and attach near the scalp.
            How they get it:  Contact with an infected person.
            Likely treatment:  Nit-picking and/or nit-combing, often in combination with chemical treatment (pediculicides) to kill live lice.  A daily vinegar rinse of the hair for one week will help remove most nits gently and comfortably.  Visit the National Pediculosis  Association website at www.headlice.org for authoritative information.
            How long it lasts:  Recheck daily for several weeks to make sure all lice and nits were removed.

            Name:  Molluscum contagiosum
            What it is:  Small, harmless growths caused by a skin virus.
            It looks like:  Small round blister-like growths that are generally found on the trunk, arms, legs, and face.  They can be as small as a millimeter or larger than diameter of a pencil eraser.  They can have a whitish top similar to a blister, appear as a flesh-colored pustule, or look more like a small pink wart. There may be one or two at a time, or many.
            How they get it:  Skin-to-skin contact with an affected child or sharing equipment (like in a gym).  They spread more extensively in skin already affected by eczema and in individuals with a weakened immune system.  Molluscum is common in the U.S.
            Likely treatment:  The usual treatment is to leave them alone until the body’s immune system kicks in to naturally eliminate the lesions.  This is often indicated by a reddened, itchy area around the growth.  Several parents have reported that using tea tree oil once or twice daily seemed to help them stay small, dry out and go away more quickly than simply ignoring them.  If one breaks open, it should be covered with an adhesive bandage until it dries up to avoid spreading.  Pinching/squeezing them (like a pimple) or poking with a pin/needle and squeezing the “pus” out may help them dry out quicker, but will increase the likelihood of scarring. 
In some cases, a doctor might prescribe removal using an acid/irritant cream like those used for warts, such as Aldara, or scraping with a curette or “freezing” with liquid nitrogen, but scarring is common with these methods. 
            How long it lasts:  a lesion may take weeks or months to dry up and go away, but because new lesions emerge over time, the outbreak can last 18 months or longer before no new spots appear.  Once all the molluscum finally clears, the body generally has built enough immunity to not get them again.

            Name:  Mongolian spots
            What it is:  A flat, darkened patch of skin, similar to a birthmark. 
            It looks like:  Usually a round or oval spot, with a purple-black or blue-gray tinge that resembles a bruise.  Generally, spots occur on the lower back and buttocks, but may occur anywhere.
            How they get it:  Natural skin coloration.  Mongolian spots occur more commonly in children of Asian, Southern European, or African heritage.
            Likely treatment:   None.  However, because Mongolian spots can be mistaken as bruises by unknowledgeable people, it is recommended that they be documented by your pediatrician.  If your little one still has Mongolian spots when starting daycare or preschool, you may want to alert the program director to them.
            How long it lasts:  Usually fades by the age of 5 or 6.

            Name:  Ringworm on the skin / Tinea corporis
            What it is:  NOT a parasite or worm, but a fungal skin infection.  A daycare or school may consider ringworm a contagious disease, and deny attendance until treatment is underway and you have physician’s approval to return to school.
It looks like:  Round lesions, red and often oozing and itchy, starts about the diameter of a pea, and increases in diameter, in rings.  Slightly raised tiny blisters or pimples may appear around the rim.  Generally scabs over after treatment is started.  May start as a circular, flaky area before becoming a lesion.
            How they get it:  Direct contact with an infected person.  Children may scratch one area and carry germs to other parts of the body.  Parents may develop lesions on the chin or cheek after snuggling with an infected child.
            Likely treatment:  Antifungal cream, applied 2-4 times per day, on the lesion and out to about 1/4 inch outside the visibly affected area, until 7 days after the lesion has cleared.  Parents have reported using Micatin, Lotrimin, Tinactin, Clotrimazole and Lamicil.
            How long it lasts:  6-8 weeks (sometimes longer) from the time treatment begins until lesions are cleared.

            Name:  Ringworm on the Scalp / Tinea capitis
            What it is:  Ringworm can infect the skin and hair follicles on the scalp, presenting a different form of the condition than you generally see on the skin.
It looks like:  May present as a scaly rash OR as round, itchy lesions resembling large pimples, the size of a dime or larger, often pink or red, with a small central oozing lesion, which may have a greenish, soft scab/fungal covering.  Generally itchy.  Hair often breaks off at the scalp, leaving circular “bald spots.”
            How they get it:  Direct contact with an infected person, shared hair utensils.  Children may scratch an infected area and carry germs to the scalp.
            Likely treatment:  Some parents have reported using Selsun Blue, Nizoral or Nutragena T-Gel successfully. Because infected hair follicles are difficult to treat, your pediatrician may prescribe an oral antifungal, such as Grifulvin (Griseofulvin) or Loprox.  Antifungal cream may be applied as above concurrently with other treatment, as indicated by your pediatrician.  Dr. Aronson suggests consultation with a dermatologist if your child has an ongoing itchy scalp that is not diagnosed as ringworm by your primary physician because scalp/head ringworm can be easy to miss on African persons.
            How long it lasts:  6-8 weeks (sometimes longer) from the time treatment begins until lesions are cleared.  Long-term ringworm may leave “bald” spots that can take months to clear – this is a consideration for boys with short hair cuts.  In some cases, the “bald” spot may be permanent.

            Name:  Scabies
            What it is:  A very itchy skin condition -- actually an immune reaction -- caused by tiny mites which burrow into the skin.
            It looks like:  Small oozing lesions, very itchy, found anywhere from the neck down.
            How they get it:  Generally, through contact with an infected person or their personal belongings (towels, clothes, etc.) It can take several weeks after exposure for symptoms to occur.
            Likely treatment:  Elimite cream, spread thinly over the entire body, left overnight, then washed off.  Although there have been very few reports by parents of contracting scabies from their child or other children in the orphanages, a few traveling parents have taken Elimite with them to Addis and used it the night before departure as a preventative measure.  Dr. Aronson suggests treating with Elimite cream 5% as a preventative measure because it can take weeks before the infection is discovered and scabies is easily passed to an uninfected person.
            How long it lasts:  Generally eliminates the mites in one treatment, but the skin may take months to heal because the multiple layers of skin have to be rejuvenated.  Depending on the situation, your doctor may prescribe a second treatment a week later, either with cream or oral medication, Ivermectin.

            Name:  Tinea versicolor
            What it is:  A fungal skin infection.
            It looks like:  Small spots or patches showing a loss of pigment, typically on oily parts of the body, particularly the chest and back, but may appear elsewhere.  Spots may be itchy, flaky or scaly spots
            How they get it:  Caused by a common yeast which is generally removed by daily washing.  However, in areas where temperatures or humidity are high, and/or with persons who are more susceptible, the fungi can grow, changing the natural balance on the skin and changing the normal pigmentation.  Not considered contagious.
            Likely treatment:  Topical antifungal cream, applied two or more times daily until a week or so after the spots clear.
            How long it lasts:  Weeks, depending on severity.  May return a year or two after treatment

 

VI.  Allergist-recommended products for sensitive skin.  The following items have been recommended for use by patients who suffer from eczema, chronic dry skin, sensitivity or allergy to product fragrances, or other skin conditions.  Patients should avoid all products with fragrance and color, aerosol products, perfumes, solvents, wool, and lanolin. 
Because internationally aodpted children have so much to adjust to, you might consider reducing the number of fragrances and other potential irritants during their initial weeks here, allowing their systems some time to adjust.

            A. Cleansers
Aveeno Balancing Bar
Aveeno Moisturizing Bar
Basis for Sensitive/Dry skin
Cetaphil Cleanser/Soap
Dove for Sensitive Skin bar (not liquid)
Lubrex
Neutrogena
Purpose Soap/Cleanser
B.  Emollients/Moisturizers
            Cetaphil Cream
Elta Cream
Lubrex
U-Lactin (do NOT use over open wounds)
Vani-cream
Vaseline, Creamy
Vaseline Petroleum jelly (unscented) – however, this can cause more problems in some patients with severe excema

  • Lip Balm.

Neutrogena
Vaseline

  • Shampoo.

Allercreme
Almay
Free and Clear
Head and Shoulders
Johnson & Johnson Baby Shampoo (original formula)
Pantene Clarifying
E.  Sunscreen.  (any not listed should be at least PABA-free)
Elta Block Sunblock
Neutrogena
Shade UA/UB Sunblock
            Vani Cream
F. Laundry products.
All Free
Cheer Free
Dreft
Ivory Snow
Planet
7th Generation
Tide Free
NO Fabric Softener – if necessary, use Downy Free and Sensitive, about ¼ rec. amount
White vinegar may be used as a fabric softerner
Clorox II is okay -- NO Chlorine Bleach
Double rinse laundry to make sure all products are rinsed out.

  • Insect repellent

Off! Skintastic for Kids Unscented
H.  Cosmetics
Allercreme
Almay
Clinique
Physicians Formula

 

VII. Parent Tips for Lactose-Free Diets.  For someone who really can't tolerate milk, these adaptations do not constitute suffering. The best motivator is to let the child have some milk product and then experience the consequence of how lousy it makes him feel. 
1. People DO become accustomed to soy flavor and/or “rice milk” flavor.
2. There are lactose-free soy, and vegetable-oil based margarines.
3. Soy cheese melts well for grilled cheese, pizza, etc. 
4. Ethnic foods:
Chinese, Thai and other Asian food is often dairy-free and easy to make at home.
Mexican is easy to make dairy-free at home, may be difficult at a restaurant – ask.
Italian may use milk products in pasta, and in any creamy sauces.  You can substitute tofu in alfredo sauce made at home.
Pizza is easily made at home. For quick-fix, buy readymade crust and top with about 2 oz of canned pasta sauce (it freezes well, so one can/jar goes a long ways). 
5. Many bakery products have milk in them. Read the label to find dairy-free ones.
6. Health food stores are great for treats because they have stuff with "Lactose free" written right on it.... but they are often more expensive.  Warehouse clubs and “big box” stores sometimes carry them in bulk.
7. Desserts:
Make instant pudding from the box using half silken tofu and half unsweetened Silk soy milk.  For the cooked pudding mixes, you just use soymilk, and can add a little extra cornstarch to help thicken it a little more.
Cool Whip is milk free, and can help if someone feels deprived at a party... they can have their cool whip instead of whipped cream or ice cream.
Soy ice cream tastes great but is expensive and may be higher in fat.
Mix aseptic pack of tofu with about half as much melted dark chocolate (check the label) and add a bit of vanilla or coffee syrup or other flavoring for a “pudding” variation.
8. “Vegetarian” does not mean “dairy free.”  Read the label.
9. Lactase enzyme drops or tablets can be taken to help process lactose when a lactose intolerant person chooses to consume dairy products.


VIII. SELECTED ONLINE RESOURCES

A. Internet.
     1. Adoption medicine (for more clinics, search on “international adoption medicine”)
Adoptive Families – articles by doctors with a practice emphasis in adoption medicine
http://www.adoptivefamilies.com/medical

Center for Adoption Medicine, University of Washington (Dr. Julia Bledsoe)
www.adoptmed.org

International adoption medicine clinics and links to “Adoption Health” sites
http://www.comeunity.com/adoption/health/clinics.html

International adoption medical evaluation and treatment clinics
 http://www.adopting.org/adoptions/adoption-evaluations-and-treatment-clinics
-for-international-adoptees.html

International Adoption Clinic at University of Minnesota (Dr. Dana Johnson)
 http://www.med.umn.edu/peds/iac/

The Orphan Doctor – Jane Aronson
 http://www.orphandoctor.com/  -- click on “Medical Resources”

     2. Dental Development
http://www.straightteeth.com/ortho.asp

     3. Female Genital Mutilation (FGM)
American Medical Women’s Association –search on “circumcision” for related articles
http://www.amwa-doc.org/

Female Genital Cutting Education and Networking Project
http://www.fgmnetwork.org/index.php

National Women’s Health Center –search on “Female Genital Cutting” for related articles
http://www.4woman.gov/index.htm

World Health Organization – Factsheet on FGM
http://www.who.int/mediacentre/factsheets/fs241/en/

    4.  Medical Information – test definitions, descriptions of conditions and diseases, etc.
Centers for Disease Control and Prevention
http://www.cdc.gov 
Immunization schedules http://www.cdc.gov/nip/menus/vaccines.htm#Schedules

Hepatitis Foundation International -- Living with hepatitis
http://www.hepfi.org/living/liv_living.html#live_with_hep_b

Medline Plus Online Medical Encyclopedia
http://medlineplus.gov/

            National Institute of Allergy & Infectious Diseases – HIV vaccine glossary
http://www.niaid.nih.gov/factsheets/glossary.htm

            National Center for Infectious Disease
http://www.cdc.gov/ncidod/

    5. Lactose intolerance
Cornell University article on lactose intolerance
http://www.news.cornell.edu/stories/June05/lactase.herding.ssl.html
 
Science in Africa article on Milk allergy and lactose intolerance 
http://www.scienceinafrica.co.za/2002/may/milk.htm

    6.  Skin conditions – the following websites contain information and photos  

            Skin conditions on dark skin
            http://ethnomed.org/ethnomed/clin_topics/dermatology/pigmented_main.html
 

Impetigo
http://kidshealth.org/parent/infections/bacterial_viral/impetigo.html
http://www.mayoclinic.com/invoke.cfm?id=DS00464
http://www.netdoctor.co.uk/diseases/facts/impetigo.htm 
http://www.emedicine.com/emerg/topic283.htm
http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=16  (images are large and may be slow to download)

Molluscum
http://dermatology.cdlib.org/92/reviews/molluscum/diven.html
http://dermatlas.med.jhmi.edu/derm/IndexDisplay.cfm?ImageID=-1458152046   (images are large and may be slow to download)
http://www.mayoclinic.com/health/molluscum-contagiosum/DS00672
http://www.aad.org/pamphlets/molluscum.html  -- search on “molluscum”
http://my.webmd.com/hw/skin_and_beauty/aa18146.asp

Parasites
http://www.answers.com/topic/ascariasis
Info on natural remedies for  roundworms, Univ. of Maryland Medical Center--
http://www.umm.edu/altmed/ConsConditions/Roundwormscc.html

Ringworm
http://www.1-ringworm.com/

Scabies
http://www.headlice.org/faq/scabies.htm
http://www.medicinenet.com/scabies/article.htm
http://www.mamashealth.com/skin/scabies.asp
http://www.cdc.gov/ncidod/dpd/parasites/scabies/factsht_scabies.htm
http://www.comeunity.com/adoption/health/scabies/index.html

 

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  This page last updated January 24, 2008 9:36 AM EST