Travelling half-way around the world with a shell-shocked child who's rarely been outside of the orphanage, let alone the country, is understandably a source of anxiety for most adoptive parents; it ranks high up on the top 10 list of things to obsess about while waiting. We get a number of requests for "sedatives for travel", and it's not always clear who's going to need them the most ... :)

General Transition Tips:

• Start with the Serenity Prayer ("God grant me the serenity to accept the things I cannot change; courage to change the things I can; and wisdom to know the difference ..."), or the succinct, secular, Frank Costanza version: "SERENITY NOWWW!"
• Routine, routine, routine. The less you can change meal and sleep routines the better. That said, good luck with that while travelling.
• Ditto for familiar clothes, toys, and lovies. As smelly as they may be (that being a good, reassuring thing to your child), wait a day or two before whipping out the brand new (but prewashed) Osh-Kosh's.
• Don't read too much into your child's transitional behaviors - we expressly FORBID you from drawing any conclusions about attachment in the first few days. That magical instantaneous bidirectional bonding moment (cue choir and soft heavenly spotlight) is a rarity - it may take days, weeks, or sometimes months for that feeling to happen.
• Also - if your child doesn't cry, wail, beat their breast, and otherwise bemoan their familiar caregivers for days it does not mean they have attachment disorder. Kids deal with stress, grief, and transition in all different ways - inconsolable crying, withdrawing, poor appetite, listlessness, hyperactivity, or just being a bit more subdued or irritable. You may not realize for weeks that your child actually was grieving at first.
• In the early "velcro" phase of attachment, your child may want to be held ALL THE TIME. That's OK, that's what all those hip holders and slings are for ... but prepare for it. Seriously, kids are heavy - if you're not used to lifting things you may want to do some working out before you travel. Parenting is hard work physically, as well as emotionally.
• Or your child may want to be on their own two feet. If you anticipate an active toddler or preschooler, consider bringing a cute animal backback with 4 ft. tail that serves as a safe connection to you. Yes, it's a leash, but being such a cute accessory it's a bit more palatable, no? Not something to overuse, but invaluable in airports and other travel situations.
• You may want to resist sightseeing in crowded noisy places. Nesting up in your hotel room may be more useful for the overwhelmed new adoptee.
• As long as you're nesting in the hotel, baby/toddler-proof outlets, exposed cords, and drawers with painter's tape (via the eminently practical ParentHacks).
• Frantic cuddling and consoling and jiggling and swaddling and eye-gazing and shushing and bottle-offering can be more overstimulating than helpful for many adoptees. Kids pick up on your cues - the more serene you can be in the face of inconsolable crying and glaring co-travellers, the more you'll help your child settle. Remember to breathe.
• Sometimes there's just nothing you can do - don't take it personally.
• If your child seems overwhelmed by what you're doing, try less: try fewer sensory inputs, be a bit less intrusive, and see if their own self-soothing skills kick in.
• The flipside is also true - if something happens that seems upsetting (head bonk, scary event, etc) but your child is not seeking consolation, give it to them anyway. They may not know to ask yet.
• Make sure you learn some survival phrases and basic parentese in your child's native language before you travel.
• For older children, use pictorial schedules, picture books, hand puppets, street mimes if available, or whatever else it takes to help them anticipate each day's events (see our Make-a-Schedule Software blurb).
• It's hard to bring home too much memorabilia - orphanage and caregiver photos, artifacts, local dress and toys ... go nuts with that. It'll come in handy now and later ...
  
  

Trains, Planes, and Automobiles

• In all likelihood, drugging your child with benadryl will probably not help much. If you're considering this option, make sure you try it out in the hotel first, since 1 in 5 kids have a memorable "paradoxical" reaction to benadryl where they get loopy and agitated.
• Aromatherapy? Sleepytime teas? Some families swear by these, not a lot of evidence either way. In general I don't give a lot of teas to infants - it leaves less room for more nutritious fluids, like formula.
• Feeding onboard - bring lots of fun, tasty snacks ... and dole them out one at a time.
• For older kids, bring a variety of activities and toys aboard, and also bring them out one-by-one. Distraction works, even better than drugs.
• Use a carryon as a footrest for your child, so their legs don't go numb on long flights. That may help with seatback-kicking! Don't be shy about moving around the cabin, as well.
• Ears and pressure changes - this seems more fearsome than it usually is. Here's where the serenity prayer comes in - there's nothing you can do about this. Even sucking/eating on ascent and descent is overrated; crying may help just as much. The only situation where a popped eardrum may happen is with an acute ear infection - but the holes tend to be pinpoint, they relieve the ear pain, and typically heal nicely.
• Kids can get motion sickness too, but it's rare in under 2-year-olds. Benadryl (see above, though), ginger (dosing for adults and children >12yo is 1,000 mg/day, taken one hour before traveling, or 250 mg 4x/day; dose is reduced by half for children 6-12yo, and by three quarters for children 3-6yo), or chamomile may help.
• Bring a change of clothes for YOU aboard as well. Bodily fluids may be involved. Speaking of which, bring lots of alcohol-based hand gel for you and yours. Use it frequently during your travels. You don't need to gown-and-glove for diaper changes, but puhhhlease "wash" your hands carefully after doing so. You'll be very happy you did when your child tests positive for giardia.

And finally - savor this experience, soak up your child's native culture, and take good care of each other. It probably won't be as rough as you think. If it is, have a "tagteam" signal (Serenity Now!) with your travelling partners for the moments when you'll need your own time out. Take those moments, practice good self-care, and sleep when you can - you'll need it.

Happy travels,
Julian and Julie

Additional Resources:

• Transitional Feeding Difficulties
• Sleep and Adoption
• Mandarin for the Adoptive Parent
• Urgent Medical Care While Travelling
• Top Ten Attachment Tips for the First Year of Placement
• How to Ease Your Child's Transition into Your Family
• Adoption Mosiac- "The First Hours"
• Airplane Travel with a Baby - Elizabeth Pantley (detailed and practical)
• Ask Moxie: Air travel with babies and toddlers
• BabyCenter - Planning a Trip
• ComeUnity Adoption Travel Section
• FlyingWithKids.com

Julian Davies, MD is one of three pediatricians specializing in adoption medicine at the Center for Adoption Medicine in Seattle, Washington. He, along with Julia Bledsoe, MD and Cynthia Kertesz, MD, perform pre-adoption consultations by telephone with families adopting from abroad or domestically, provide on-call travel support during the process, and post placement specialty care for foster and adopted children once they are home with their families.