Unfortunately, intestinal parasites, particularly parasitic infection, is the most common medical condition that I diagnose in many of the internationally adopted children that I examine shortly after they arrive in the United States. The principal reason why these children are so prone to this condition is because of crowded living conditions in the orphanage, and because of the poor hygiene of both the children and the staff that cares for them. Intestinal parasites are widespread in orphanages across the world. Clinical findings encountered in infested children can range from anemia, chronic diarrhea, and failure to gain weight. In Eastern European orphanages, Giardia Lamblia infestation is the most common, but in other parts of the developing world, multiple infestations often coexist. Reinfection rates in developing countries can be so great that medical professionals do not even bother to treat for them.

Clinical signs that suggest the presence of a parasitic infection in an Internationally adopted child:

  • Bloating
  • Diarrhea
  • Vomiting
  • Trouble digesting foods
  • Rectal itching
  • Recurrent abdominal pain
  • Large volume in stools
  • Blood or mucous in stool
  • Abdominal distention

Unfortunately, these vague abdominal signs and symptoms can also be associated with many other problems encountered in adopted children, such as introduction of new foods to the diet, food allergies, and lactose intolerance.

In order to determine if a child is infected with parasites, universal screening should be performed at the post-arrival visit regardless of whether or not there are signs or symptoms. It is imperative to diagnose and treat the infected child before the problem becomes a public health hazard in the home and school system.

Three screening stool samples for intestinal parasites need to be carefully investigated 2-3 days apart. Multiple specimens are required to increase the detection rate. A special collection kit supplied by the reference lab needs to be used in order to collect the stool specimen. Stools that have been collected in the early morning and then left to sit for a couple hours are not adequate for evaluation.

My personal approach is to provide the collection medium and tongue depressors for the parents at the post-adoption examination. They can catch to stool in the diaper and immediately transfer the specimen to the appropriate collection medium. In the toilet-trained child, I suggest that they apply saran wrap around the toilet bowel and allow the child to stool right on the wrap. The parent can the use the tongue depressors to transfer the specimen into the transport medium. In both cases, the parents are instructed to immediately deliver the specimen to the laboratory for processing. Along with the routine screening for Ova and Parasites, I concomitantly check for Giardia Antigen and Cryptosporidium Antigen.

A negative initial evaluation of the stool testing doesn’t mean that sometimes a late-onset presentation of intestinal parasite will not occur moths later.  Children that have persistent signs or symptoms of intestinal pathology should be retested regardless of prior studies results. Therapy may need to be implemented if stool evaluations are determined to be positive.


The information and advice provided is intended to be general information, NOT advice on how to deal with a particular child’s situation or problem. If your child has a specific problem, you need to ask your pediatrician about it. Only after a careful history and physical exam can a medical diagnosis and treatment plan be made. This website does not constitute a physician-patient relationship.