China Travel Groups: An interview with Dr. Stephen J. Lerman

WHFC China families always travel to meet their children with a professional, and often it is someone from the healthcare field. We talked with Dr. Stephen J. Lerman, a retired pediatrician who has traveled over the past six years with 15 of our 113 China travel groups. During that time, Dr. Lerman has been a valued participant in bringing home 152 children from China.

Generally, what are a family's concerns about their child's health before traveling?

Naturally they are concerned about whether or not their child will be healthy, smart, happy, and outgoing. They also want some confirmation about "Will the child relate to me?" and "Will I be able to relate to them?"

Some families may have anxiety about small head circumference measurements as a possible indicator of neurologic problems. Time and time again, we find that the measurement was either inaccurate or incorrectly recorded and that the head circumference is in fact normal.

There are also concerns about development. Most of the children are developmentally delayed, due to poor diet, lack of stimulation and insufficient individual attention. As a rule of thumb, there is a one month developmental delay for every three months in an orphanage. However, as soon as the children are with their parents, get lots of love and nutritious food and receive individual attention and stimulation, they advance quickly. Even during the two week travel period, we see amazing progress.

What are the typical child medical issues families might expect to deal with while in China?

Poor nutrition is a common issue in children from orphanages. However, over the years I have seen the nutritional status of the little girls from Chinese orphanages become progressively better.

Colds are very common as the orphanages are crowded. Bronchiolitis (wheezing) is also common. There is a very high frequency of ear infections. Children may have had multiple ear infections, as it is often undiagnosed or inappropriately treated.

Often babies spend a lot of time on their backs in the orphanages, so that their skulls may be flattened and the hair rubbed off on the back of their heads.

Other ailments include dry skin, eczema, scabies, diaper rashes, and diarrhea.

Additionally, because these babies go through a profound separation, they can be very sad for a day or two or even the whole trip. It is not unusual for children to wake up at night crying, perhaps from nightmares. One child cried the entire two weeks of the trip. The parents felt desperate; however, as soon as they got home the child blossomed and made a wonderful adjustment.

When a doctor travels with the group, she or he brings a well-equipped medical kit that is stocked as a donation by CVS. Even fairly serious illnesses, such as pneumonia and dysentery, can usually be treated by our traveling physician. Local hospitals are available if a more sever problem arises.

Also, to better prepare families, WHFC distributes recommendations on travel immunizations and good hygiene that I have prepared and suggestions about medicines to bring, both for the parents and the baby.

What about medical issues after the trip?

Toward the end of the trip, I discuss with parents the latest recommendations on immunizations and screening tests for children adopted in China and give them a handout that they can share with their pediatrician.

What kinds of care and activity have you seen in the orphanages? How do these relationships impact the children?

In my visits to the orphanages, I am always struck by how loving and involved the orphanage workers and the administrative staff are. They are very close to each of the children and know their individual personalities. The orphanage workers often experience a profound sense of loss and sometimes help is needed from the guide to facilitate the child's separation.

Because of resource limitations, orphanage care cannot be as individualized as might be desirable, so children spend a lot of time bundled up in their cribs. Babies are never placed on the ground, so they often don't go through a crawling stage. However, they do go outside in walkers, which are very popular in the orphanages. You will often see a big group of children scooting around in walkers. The freedom of this movement allows their true selves to emerge.

Babies can serve as great supports for each other, both in the orphanage and also during the time when they are transitioning to their families. Those who have lived in the same orphanage, and often the same room, have a special bond. In Chinese culture, your sisters are a very important group. They learn at an early age that an older child should look out for the younger child. So, when they get to the US, they will most certainly miss their orphanage "sisters."

In addition to relationships between the children and the staff, children are conscious of being separated from the kinds of faces, smells and sounds (noise levels) with which they are familiar. The absence of this can be upsetting. Also, during this transition, they encounter many new experiences that might include mirrors, elevators, air-conditioning and bathtubs.

How would you describe the families' experiences and interactions during their time in China?

During the first few days, parent may be concerned about issues, such as "Am I an adequate parent?"; "Am I up to being a parent?"; "Will I love this baby the way I'm supposed to?" It always amazes me how quickly they fall into the parenting role and within a day or two usually feel entirely comfortable with their child.

Also, parents have pre-travel concerns about communicating with and understanding the needs of their child. They soon learn how much you can pick up non-verbally. This is the way babies educate their parents.

Sometimes the baby will bond with one parent or the other. Most orphanage workers are women and the babies may not be accustomed to men. It takes a great deal of patience, flexibility and skill to overcome this. Sometimes the children from foster homes easily bond with men because of contact with fathers or grandfathers in the foster family. Also, parents who bring their older children on the trip often find that the new baby attaches very quickly to her older sister or brother.

During travel and far beyond the trip, the group experience is a very important support system. More likely than not, the group becomes very cohesive: sharing diapers, clothes, taking care of each others' babies, helping while others are eating. It is an interesting dynamic, because at the travel meeting the group is a room full of strangers, with different backgrounds and interests. By the end of the trip, there is a very different dynamic to the group and they often become connected for life.

After living so closely with the parents and babies during the trip, I, too, have a period of separation and loss when the trip is over.

How do you see the children progress after coming into family care?

One interesting and surprising issue is that Chinese babies are toilet trained by 9 months of age. They are taught to urinate and defecate when held over the toilet with a signal - a whistle. Sometimes babies awake crying in the middle of the night with a full bladder and parents don't know what to do. It might take a night or so for the parents (who have been told about this training) to catch on. Most parents, however, aren't comfortable with the whistling, and in a week's time, the child usually forgets the initial training.

On average, it seems that the child's development progresses every week by approximately two months during the initial period. For example, parents report a few weeks after they get home that the child is cruising and then walking, while in China the child was barely sitting up.

Language development is usually the last area to normalize because the children are confused about the new language. Most babies, however, so effectively communicate their needs non-verbally so that parents sometimes don't even notice that they are slow to talk.

Inevitably, with love and good care, these children blossom.

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