After School Programs
Many children receive most of their recreational experiences through these programs. Coaches can be wonderful mentors and for some families after school programs eliminate some daycare needs.

Audiologist
An audiologist provides intervention strategies and services for individuals with deafness or hearing impairments.

Classroom Teacher
Your child’s classroom teacher is the person who will spend the most time with your child and will know her best. A classroom teacher is a valuable resource for helping identify any educational, emotional or social issues the child may be having in school.

Early Intervention Services
Every state offers an early intervention program to help identify infants and toddlers (up to age three) who may have developmental delays or disabilities. An evaluation is completed to determine the child’s cognitive, physical/motor, speech, language, social, emotional and adaptive development. A physician or the local school district can direct families to those services.

Educational Advocate
An Educational Advisor or Advocate helps parents work with the child’s school. As an additional member of an Individual Education Plan (IEP) team, an Educational Advocate provides additional experience and expertise to get the best outcome for the child.

Occupational Therapist
An occupational therapist is a licensed health professional who provides strategies and services to assist individuals with motor or sensorimotor functions, including fine motor manipulation, self-help, adaptive work skills, and play or leisure skills.

Physical Therapist
A physical therapist is a licensed health professional who works with individuals with motor or sensorimotor functioning in such areas as mobility and positioning.

School Counselor
A school counselor may assist in the identification of a child’s needs and may help to determine appropriate responses.

School Nurse
A school nurse provides medical care during the school day, monitors allergic reactions and may administer medication needed during school hours.

School Psychologist
A school psychologist assists in the identification of a child’s behavioral, social, emotional, educational and vocational needs and helps to determine appropriate responses.

School Social Worker
A school social worker is trained to assess a child’s educational needs including social, emotional, behavioral and adaptive needs. She provides intervention services including individual, group, parent and family counseling and serves as liaison between home, school and community.

Special Education Instructional Specialist
The special education instructional specialist provides ongoing support to special and general education instructional personnel. The specialist helps to identify and plan for the least restrictive environment appropriate for the child.

Speech-Language Pathologist
A speech-language pathologist provides intervention strategies and services related to speech and language development as well as disorders of language, voice, articulation and fluency.

Transportation Specialist
A transportation specialist works with the school district to provide special transportation and equipment for students with disabilities.

Tutoring Services
Many children can benefit from short or long-term use of a tutor. Families receiving federal (and some state) subsidies should look to the schools for help rather than Children and Family Services.

Scabies is an itchy rash-like skin condition caused by a mite that burrows under the skin. It is spread by skin-to-skin contact and is common in orphanages. About 10% of children adopted internationally have scabies. Symptoms are swollen itchy red bumps which tend to be concentrated on hands, feet and skin crevices. Frequent scratching may irritate the area and lead to misdiagnosis as dermatitis or eczema.

The incubation period for scabies is 6-8 weeks, so newly adopted children may not show symptoms until after they have been home for some time.

Treatment is a prescription cream (5% permethrin) applied to the entire body at night and washed off the next morning. All exposed individuals will also need to be treated, regardless of whether they exhibit any symptoms. Itching may continue for several weeks after treatment, but antihistamines may provide relief. Clothing and bedding should be washed in the hottest water possible, and carpets and upholstery should be vacuumed.

Because it is not uncommon, parents may want to travel with scabies cream so that they can both treat a child and prevent themselves from being infected.

Lice are tiny parasitic insects that attach themselves to the skin or hair. They can transmit diseases, although the most common symptom is itching. Lice can be spread by skin contact, and by the sharing of clothing, bedding, hats and combs or brushes. If one member of a family contracts lice, they may quickly spread to other members. Lice are often identified by the eggs (nits) that attach themselves to the hair shaft.

Lice can be treated by using pesticide shampoos with a special comb to remove nits from the hair. Some alternative treatments, like tea tree oil may also be effective. Children should be checked every day for the next 2-3 weeks to see that no nits remain.

Lice can continue to live in bedding, clothing and pillows for a short period of time, so it is important to wash and dry these items in high heat. Combs and brushes should also be washed in hot water and dried.

Malaria causes approximately a million deaths per year around the world. It is endemic in most parts of Africa, Asia, the Middle East, and in large parts of Central and South America. The risk is higher in rural areas. Malaria is caused by a group of four parasites and is transmitted by mosquitoes. Some strains of malaria have become drug-resistant.

Malaria symptoms are similar to those of flu: fever, chills, headache, vomiting, diarrhea, muscle aches and weakness. Severe reactions can cause seizures, kidney failure, coma and death. Symptoms develop as early as seven days after initial exposure, but may not appear for several months. Children who exhibit any symptoms of malaria should see a physician. Parents traveling to any country with mosquitos should carry mosquito repellant with DEET and use it routinely. Routine screening for malaria is not recommended for internationally adopted children.

Giardia Lamblia is a waterborne parasite that infects the intestines and is passed in the stool. It is the most common intestinal parasite in internationally adopted children. It is also common in American children, and is often found in day care or camp settings. There are a variety of symptoms of giardia, including diarrhea, abdominal distention, chronic stomach pain, and flatulence. Not everyone experiences symptoms of giardia, but the parasite is still a source of infection and should be treated. Children with giardia may have growth failures and fail to thrive because they do not absorb sufficient nutrients.

Giardia is sometimes missed by physicians unfamiliar with parasitic diseases. Stools samples should be collected and examined over a period of at least three days. A child with giardia will usually be prescribed Furazolidone or Metronidazole.

Adults traveling to the child’s country of origin should take precautions with what they eat and drink, avoiding uncooked food and using only boiled or bottled water. They should be tested for giardia if they experience symptoms. Careful hygiene is important when changing and disposing of diapers.

Worms affect a small percentage of children but they are troubling.

Ascaris lumbricoides (roundworm): Ascaris infection is caused by ingestion of food or drink contaminated with fecal matter that contains roundworm eggs. Symptoms include gas or diarrhea, stunted growth, mild anemia, or bronchial problems, but the infection may go undetected until a worm is passed. Blood tests, stool samples and x-rays can be used to detect the roundworms, and an antiparasitic medication can be used to treat it.

Enterobius vermicularis (pinworm): Pinworms are common abroad and in the United States. Pinworms, like roundworms, are spread by contaminated fecal matter. Pinworm eggs hatch in the small intestine and the worms spread into the large intestine, and the female lays new eggs around the anus. Scratching around the anal area may be an indication of pinworm infection. Antiparasitic medications are effective for pinworms.

Hymenolepis nana (dwarf tapeworm): Endemic in most countries of the world, h. nana is found in institutional settings and where hygiene and sanitation is inadequate. It is spread by the ingestion of tapeworm eggs in food, water, contaminated soil, or from an infected individual. Most of those infected have no symptoms, but young children may have headaches, itchy bottoms or difficulty sleeping. There may also be nausea, loss of appetite, diarrhea and abdominal pain. Stool samples are used to identify tapeworm eggs. A prescription drug called praziquantel dissolves the tapeworm.

Amebiasis is a disease caused by the parasite Entamoeba histolytica. It is transmitted by fecal matter containing the parasite or its eggs, like contaminated food or water or the stool of a person with the disease.

Approximately one in 10 people who become infected will show symptoms of the disease. The symptoms may be mild, and can include loose stools, stomach pain and cramps. Amebic dysentery is a severe form of amebiasis, and can cause stomach pain, bloody stools and fever.

Several stool samples may be needed to diagnose amebiasis. If the physician suspects that the infection has invaded the wall of the intestine or some other organ, a blood test may be ordered. Amebiasis can be treated with antibiotics.

If your child has been diagnosed with amebiasis, it is important that all family members practice good hygiene to avoid spreading the infection.

See the section on Traveling To Meet Your Child in this course for suggestions on precautions to take to prevent infection while traveling.

Cryptosporidiosis is a waterborne parasite that lives in the intestine. It can survive outside the body for long periods of time, and is resistant to chlorine-based disinfectants. It is commonly found in drinking water and recreational water around the world. The infection is spread by ingesting the parasite, either in food, water, soil or from touching a contaminated surface.

The most common symptom of cryptosporidiosis is watery diarrhea. Other symptoms include dehydration, weight loss, stomach pain, fever, nausea, and vomiting. Symptoms appear two to ten days after the infection, and last for one to two weeks.

Several stool samples may be needed to diagnose cryptosporidiosis. Many people recover without treatment, but a physician may prescribe medication for the diarrhea. Rapid loss of fluids from diarrhea can be dangerous for infants and small children, so consult your physician about fluid replacement therapy.

TIP: People in poor health and with weakened immune systems are at risk for more severe or prolonged illness.