Articles on adoption, foster care, & pediatrics

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Melamine and Chinese Adoptions

What We Do and Don't Know About Melamine

As details of the melamine contamination scandal continue to emerge, many of our pre- and post-adoptive parents are wondering how potential exposure to this chemical may affect their child. I wish we knew more. But I'd like to start by offering some general information about melamine, and some tentative guidelines about how to manage this issue.

Melamine is a chemical with a number of industrial uses, and an already scandalous history as one of the major contaminants in the 2007 Chinese pet food debacle. It is suspected that it was added to milk at milk collecting stations in China to disguise the fact that milk was being watered down, since melamine artificially increases the testable protein content. We don't yet know how long this has been a problem. According to Sanlu, a popular budget formula manufacturer implicated in this event, contaminated milk was used in the manufacture of infant formula processed before 8/6/08, as well as in other dairy products like liquid milk, frozen yogurt, and coffee creamer.

There is essentially no reliable toxicology information about melamine and human consumption. The animal data suggests that it is not metabolized in the body, and is excreted in urine. At high doses in animals, it can cause bladder stones, and inflammation of the bladder. Over time, this may be carcinogenic, but we have no human studies to evaluate this risk. 

The high number of serious kidney complications and deaths in pets exposed to contaminated food has been linked to the particularly toxic combination of melamine and cyanuric acid. We have not seen reports of cyanuric acid in human-consumed milk products, but it can be a contaminant in melamine products.

What is additionally confusing is that in animals, melamine alone can cause bladder stones (a mixture of melamine, protein, uric acid and phosphate), but has not caused kidney stones or kidney failure. The preliminary reports from China, however, do indicate that a small fraction of children who received contaminated formula have been diagnosed with kidney stones, reportedly containing uric acid. We are told that 4 infants have died, perhaps from obstruction of their kidneys from such stones, and 150 children have had renal failure. I don't know what to make of the high number of reported hospitalizations (over 14,000), and suspect that some of those may have been for workup and not because of illness.

Symptoms to Watch For

Please keep in mind that recently adopted children have plenty of more common and benign reasons for crying. That said, here are some things to watch for that would deserve prompt evaluation:

  • Unexplained crying episodes or abdominal pain, especially with urination
  • Passing blood, crystals, or particles in urine
  • Dramatic decrease in urine output
  • Swelling of the hands, feet, or around the eyes (edema)
  • Pain when tapped over the kidneys
  • Unexplained lethargy or vomiting

Our Evolving Approach

What remains unclear is which children deserve what workup. I'll cover our clinic's current approach here (which may be updated as consensus evolves and new information becomes available):

  • So far, we are checking a urinalysis with microscopy (to look for blood or crystals), and an electrolytes/BUN/creatinine panel (to look for signs of impaired kidney function) on all new Chinese adoptees. We may also add more routine ultrasound of kidneys, ureters, and bladder to look for stones themselves (see below).
  • Many of our previously adopted children have had some of these tests, but we are asking any symptomatic children (see above) to come in for urine & blood testing, and for an ultrasound, or perhaps CT scan if our suspicion is very high.
  • Children who came home from China in the past 3 or so years (vague because we don't know how long melamine has been a contaminant) who are asymptomatic should probably have at least a non-urgent urinalysis, if they have not previously had one. If they've been growing well and are asymptomatic, and have no other reason to need a blood draw, I'm not convinced that bloodwork is necessary. But we may start ultrasounding more routinely for this group as well.
  • A reasonable diagnostic code to use would be V87.39: contact with and (suspected) exposure to other potentially hazardous substances (for asymptomatic children), or codes based on a child's specific symptoms.
  • As for specific testing for melamine itself in blood or urine, we are not doing that at this time. Such testing is investigational and hard to come by, and given the expected fairly rapid excretion of melamine, may not be of much clinical use. Plus, children may be exposed to insignificant amounts of melamine from other sources, which would complicate interpretation of results.
  • Treatment of children with stones may involve close observation, IV fluids and urine alkalinization, medical management of acute renal failure if present, and various procedures to break up and remove recalcitrant or obstructing stones.

What is currently controversial is whether ultrasounds should be a routine screening test for asymptomatic Chinese adoptees with normal urinalysis. Thus far, we're not sure, and we have a low threshold to order ultrasounds if we're not sure about the "symptomatic" part, and are happy to order them for concerned parents. There have been several reports of renal stones diagnosed by ultrasound in otherwise asymptomatic children with normal urinalysis and bloodwork. If more of these are confirmed, we probably will start routinely ultrasounding. What remains unanswered is how common are these cases, and what needs to be done if asymptomatic stones are discovered.

We are in discussion with our local kidney and urology specialists, as well as other adoption docs, about the advantages and drawbacks of more universal ultrasound screening for Chinese adoptees. There are other radiographic approaches, such as a CT KUB (non-contrast) or CT urogram (with contrast), which can give better resolution for children in whom we highly suspect stones based on symptoms or labs, but the substantial amount of radiation exposure (and cost) with CT scans makes them unattractive for routine screening.

We've not yet seen any children in our practice with diagnosed kidney stones or other complications. According to informal data from Half the Sky, less than 5% of exposed children in the orphanages they work with have been diagnosed with kidney problems. And without stones and renal complications, we think it unlikely that melamine-exposed children will have significant long-term impacts. But we will keep you posted here as we learn more. And as always, please do involve your child's medical provider. Their opinion on this as-yet-fuzzy issue may not be the same as ours, and they know your child better than the internet does.

Useful Melamine Resources

Recommendations from the Chinese Ministry of Health:

(via the WHO, as of 10/08 - check here for updates):

The World Health Organization has agreed to circulate the information contained herein regarding the treatment plan that is being implemented in China by the Ministry of Health. The information below does not reflect the rules, regulations, policies and guidelines of the World Health Organization.

The following regimen has been issued by the Ministry of Health, China.

Clinical manifestations
  • Unexplained crying, especially when urinating, possible vomiting
  • Macroscopic or microscopic haematuria
  • Acute obstructive renal failure: oliguria or anuria
  • Stones discharged while passing urine. For example, a baby boy with urethral obstruction with stones normally has dysuria
  • High blood pressure, edema, painful when knocked on kidney area
Key diagnostic criteria
  • Been fed with melamine-contaminated infant milk formula
  • Having one or more of the above clinical manifestations
  • Laboratory test results: routine urine tests with macroscopic or microscopic haematuria; blood biochemistry; liver and kidney function tests; urine calcium/creatinine ratio (usually normal); urinary red blood cell morphology shows normal morphology of red blood cells (not glomerular haematuria); parathyroid hormone test (usually normal).
  • Imaging examination: preferably ultrasound B exam of urinary system. If necessary, abdominal CT scan and intravenous urography (not to be used in case of anuria or renal failure). Kidney radionuclide scans can be used where available to evaluate renal function.
  • Ultrasound examination features:
    • General features: bilateral renal enlargement; increased echo on solid tissue; normal parenchyma thickness; slight pyelectasia and calicectasis; blunt renal calyx. If the obstruction locates in the ureter, then the ureter above the obstruction point dilates. Some cases have edema with perinephric fat and soft tissue around the ureter. As the disease develops, the renal pelvis and ureter wall may have secondary edema. A few cases have ascites.
    • Stone features: most stones affect the collecting system and ureters on both sides. Ureteral stones are mostly at pelviureteral junction, the part where the ureter passes across iliac artery, and ureter-bladder junction. Stones stay collectively, covering massive areas. Lighter echo in the background. Most stones are different from the calcium oxalate stones. Urinary tract is mostly completely obstructed by the stones.
Differential diagnosis
  • Haematuria differentiation: need to rule out glomerular haematuria.
  • Stone differentiation: the stones are normally radiolucent and have a negative image on urinary tract x-ray. This feature differentiates the stones from those of radiopaque stones of calcium oxalate and calcium phosphate.
  • Differentiation of acute renal failure: need to rule out pre-renal and renal failure.
Clinical treatment
  • Immediately stop using melamine-contaminated infant formula milk powder.
  • Medical treatment: use infusion and urine alkalinization to dispel the stones. Correct the water, electrolyte and acid-base imbalance. Closely monitor routine urine tests, blood biochemistry, renal functions, ultrasound findings (with particular attention to the renal pelvis, ureter expansion, and the change of the stones in shape and location). If the stones are loose and sand-like, they are very likely to be passed out with urine.
  • Treatment of complicated acute renal failure: priority should be given to the treatment of life-threatening complications such as hyperkalemia. Measures include the administration of sodium bicarbonate and insulin. If possible, blood dialysis and peritoneal dialysis can be used early. Surgical measures can be taken to remove the obstruction if necessary.
  • Surgical treatment: if medical treatment is not effective, and hydrocele and kidney damage present, or blood dialysis and peritoneal dialysis are not available in case of renal failure, surgical methods can be considered to remove the obstruction. Stones can be removed by different methods including cystoscope retrograde intubation into the ureter, percutaneous kidney drainage, surgical removal and percutaneous kidney stone removal. Extracorporeal shock wave lithotripter (ESWL) is greatly limited in its application, because the stones are loose and mainly composed of urate, and the patients are infants.

Once the urinary obstruction is relieved, and the general condition and renal function and urination are back to normal, the children can be discharged.

Key issues to follow-up

Urine routine tests; ultrasound of urinary system; renal function tests; IVP (intravenous pyelogram) if necessary.

Mandarin for the Adoptive Parent

These key words and phrases for the adoptive parent, with Pinyin pronunciation and audio links, are invaluable for parents traveling to China and in the first weeks home.

Here's a Guide to Pronouncing Mandarin in Romanized Transcription.

Another nice resource is, an in-depth guide to Chinese characters and culture, with spiffy clickable character definitions and language genealogy.

Some of our families have found the Simple Language for Adoptive Families booklets/CDs helpful as well.

Medical Resources in China

This is a handy list of medical resources in China for travelling families, graciously shared by Todd Ochs, MD. Please note that this list originated in the mid-00s, so many items here may be out of date.

Anhui Province

Hefei - Anhui Provincial Hospital
No. 1 Lujiang Road
(VIP section for foreigners)
Hu Yunwen, MD

Anhui Provincial Children’s Hospital
No. 39 East Wang Jiang St.
230051 Hefei
Shan Hua, MD
0551-367103-3035 (off.)
13966681963 (cell)

Beijing - International SOS Clinic
No. 1 North Road, Xing Fu San Cun
Chaoyang District
8610-64629117 (clinic)
8610-64629100 (alarm)

Beijing United Family Hospital
#2 Jiang Tai Lu, Chaoyang District
Beijing 100016
8610-6433 3963
8610-6433 2345 (emergency number)
Theresa Horton, MD (pediatrics, USA)
Yan Feng, MD (pediatrics, USA)
Celine Marchand, MD (pediatrics, Canada)

Beijing United Family Hospital and Clinic - Shunyi
Pinnacle Plaza, Unit #818
Tian Zhu Real Estate Development Zone
Shunyi District, 101312
8610-8046 5432
Family Practice

Chongquing - Professor Chen Yuan
Children’s Hospital of Chong Qing Medical University
82623-63632756, ext, President’s Office

Dennis Valdez Gomez, MD - Chongqing Clinic
Room 701 Business Tower
Hilton Chongqing
No.139ZhongShan San Lu
Chongqing, 400015

Fujian Province

Fuzhou Lakeside Hotel - Fujian Province
Women’s and Children’s Hospital
Zhao Min Jun, MD, a pediatrician, who speaks English, will come to the hotel.

Xiamen - Lifeline Medical Systems
123 Xidi Villa Hubin Bei Road 361012
Mobile 138-5008-2911

Gansu Province

Lanzhou - Jin Yu, MD
Department of Pediatrics
First Affiliated Hospital of Lanzhou Medical University

The Army Hospital, Lanzhou Military Command
International Red Cross Center in Northwest China
Qi Li He

Guangdong Province

Guangzhou - #1 Affiliated Hospital of Guangdong Medical University
1 Yangjiang Road, Guangzhou 510120
8333-7750 X3046
Emergency hotline 8333-6797

Guangzhou Children’s Hospital
318 Remnin Central Road, Guangzhou 510120
Emergency hotline 8188-6332 X5103

Can Am International Medical Center
5F Garden Tower, Garden Hotel
368 Huanshi Dong Lu
Western-trained MD’s

International SOS Clinic
Room 152, Dongshan Plaza, 69 Xian Lie
Zhong Road 510095
Western-trained MD’s

#1 People’s Hospital (Global DoctorClinic)
1 Panfu Lu 51080
Emergency Hotline 8108-0509, 8333-6797
Mobile 135-7003-5254
Email: <>

Sunshine (Kai Yi) Dental Clinic
#2 Tianhe Road
3886-2888 X3111

Guangxi Province

Gulin - Li Xinhui, MD
Department of Pediatrics
Gulin District Hospital

Nanning - (English-speaking pediatrician)
Dr. Liaoning
First Hospital of Guangxi Medical University
6 # Shuang Yong Road
Nanning City, Guangxi China 530027
0771-5356703 (0ffice)
13978812808 (mobile telephone)

Guizhou Province

Guiyang - The Affiliated Hospital, Guiyang Medical College
28 Guiyi Street
0851- 6855119

Hai Nan

Haikou - Hainan People’s Hospital
#8 Longhua Road 570001
0898-6864-2660, 6622-3287 (outpatient)
Emergency hotline 0898-6622-5866/6666/2423

Hebei Province

Guo Zhiliang, MD
Affiliated Hospital of Handan Medical School,
Department of Pediatrics
056002 (86310)3092829

Shi Jia Zhuang
Hebei Number One People’s Hospital
348 West Heping Xi Lu

Heilong Jiang

Harbin - Harbin Medical University #1 Hospital
#5 Youzheng Street, Nangnang District 150086
0451-3641918, 3607924, 3641563

Harbin #1 Hospital
English-speaking contacts: Dr. Sun Wei Fu
468-3733 X5012, Dr. Chen Mi Bin
(Ultrasound Room)
151 Diduan Street, Daoli District 150010
0451-4683864, 4614606, 4614636

Henan Province

Sheng Guangyao, MD
First Hospital of Henan Medical Hospital,
Department of Pediatrics
40053, Henan (86371)6913382

Zhengzhou - Professor Sheng Guanyao
President, First Hospital of Henan Medical University
Henan Provincial People’s Hospital
No. 7 Wei Wu Road, Jin Shui District 450003
0351-595-1056/2183, 588-0011

Hong Kong- International SOS Clinic
16/F World Trade Center
280 Gloucester Road
Causeway Bay
852-25289900 (alarm)

Hong Kong Adventist Hospital
40 Stubbs Road

Hubei Province

Wuhan - #1 Affiliated Hospital to Hubei Medical University
238 Jie Fang Lu, Wu Chang District, Wuhan 430060
027-8804-1919, 8806-6234

Xie He Hospital Affiliated to Tong Ji Medical University
1095 Jie Fang Da Dao, Wuhan 430030
027-364-6230, 363-459

Hunan Province

Hunan Children’s Hospital
BP. 127-5259097 Tel. 0731-5600965
Liu Zhiqun, born in the year of 1972, has gained Bachelor of Medicine after a five-year study in the Clinical Medicine Department of Hunan Medical University since 1990. Upon graduation he starts to work with the Emergency Center of Hunan Children’s Hospital, concentrating on emergency cases in the Department of Pediatrics. Now he has been the physician-in-charge in the Emergency Center.

Changsha - Hunan Province People’s Hospital
28 Dong Mao Jie, Jie Fang Xi Lu 410002
0731-222-4611 X3333/2210

Inner Mongolia

Hohhor - Inner Mongolia Autonomous Hospital
N0. 20 Zhao Wu Da Road

The Affiliated Hospital to Inner Mongolian Medical College
1 Tong Dao Bei Jie, Hui Min District 010050
0471-696-5931/ 3300 x6804

Baotou - Zhiang Jianmei, MD
Department of Pediatrics
General Hospital of Baotou Gantie Company

Jiangsu Province

Nanjing City - Jiangsu Provincial People’s Hospital
#300 Guangzhou Road, Nanjing City

AEA Nanjing Clinic
Nanjing Hilton Hotel
Zhong Shan Dong Lu
319 Hao Ground Floor

Jiangxi Province

Nanchang - Zhao Jian, MD (speaks English)
No.1 Municipal Hospital, Nanchang, Jiangxi, PRC
Appointed Head of Dept of Cardiology. Promoted as Chief Doctor and Professor of Medicine.

Jianxi Province People’s Hospital
152Al GuoLu, 330006
(0791) 681-3352/3124 x 358

Jilin Province

Changchun - Norman Bethune Medical University #2 Hospital
#18 Zhiqang Street, Nanguan District 130041
Emergency hotline 0431-897-4612 X621

Liaoning Province

Shenyanag - Liaoning Province People’s Hospital
#33 Wenyi Road, Shenhe District 110015
Emergency hotline 024-24810136, 24147900
English-speaking contact:
Dr. Zheng Zhong Xin at X8479, or mobile 13002490807.
Hospital designed for foreigners, with English-speaking MD’s.

#2 Hospital of China Medical University
26 Wenhua Road, Heping District, 110003
Dr. Xie Hui Fang speaks English, ext. 6640
Mon & Fri., 6540/6549 Tues- Thurs.
024-2389-1476 (home)
Mobile 13609827551

American Medical Cernter (Global Doctor)
54Pangjiang Road, Dadong District
024-2433-06778/ 2342-6409
Emergency 024-2432-6409

Ningxia Autonomous Region

Yinchuan - Yinchuan No. 1 Renmin Hospital
No. 2 Li Qun West Street
0591-6192067, 6192235

Ningxia Hui Autonomous Region People’s Hospital
Huai Yuan Lu, Xin Shi District 750021
0951-202-1154/1491 X335/361


Xining - Qinghai Province People’s Hospital
2 Gong He Lu 810007
097-817-7911 X215


Taiyuan - Shanxi Medical University #1 Hospital
85 Jie Fang Nan Lu 030001
0351—404-4648, 404-4111 X25463/26706

Shaanxi Province

Xi’an - Xi Jing Hospital,
affiliated with People’s Liberation Army Number Four Medical University
No. 17 West Changle Road
029-3375548 (foreigner service section)
029-3374114 (operator)

Shaanxi Provincial People’s Hospital
You Li Lu
029-525-1331 X2079 (pediatrics)
Jiao Fu Yong, MD (head of pediatrics dept.)

Shangdong Province

Jinan - Shangdong Province Qianfoshan Hospital
66 Jing Shi Lu, 250014
0531-296-8900/ 3647 x2224/2082

Jinan - Wang Yi, MD
Depatment of Pediatric Cardiology
Shangdong Provincial Qianfoshan Hospital
66Jing Shi Lu, Jinan 250014
0531-296-8900/3647 X2224/2082

Wang Yali, MD,
The Affiliated Hospital of the Weifang Medical College,
Department of Pediatrics

Shanghai - Shen Xiaoming, MD
Shanghai Children’s Medical Centre
1678 Dongfang Road, Pudong District 200092

Shanghai United Family Hospital and Clinics
#1139 Xian Xia Lu,
Changing District, 200336
021-6291 0917

Sichuan Province

Chengdu - Jinka Hospital
affiliated with Huaxi Medical University
No. 37 Guo Xue Xiang

Sichuan International Medical Center & Foreigners Clinic
028-524-2408 (M-F 0830- 1730), 542-2777
(M-F nights and weekends)

Chengdu Children’s Hospital
137 Taishengnai Road
Emergency hotline 028-662-4791

Tianjin - General Hospital of Tianjin Medical University
154 An Shan Da, He Ping District, Tianjin 300450

Xi Zang

Lhasa - Tibet Autonomous Region #1 People’s Hospital
Emergency Medical Facility
#18 North Lin Kuo Road 85000
Emergancy hotline 0891-120
English-speaking contact: 0891-632-2200

Xin Jiang

Urumqi - Xinjiang Uigur Autonomous Region
People’s Hospital
91 Tian Chi Lu 830001
0991-282-2927 X3120/2209

Yunnan Province

Kunming - First attached Hospital of Kunming Medical University
153 Xichang Road, Kunming
Emergency hotline 0871-532-4590

Yunnan Provincial Maternal and Child Hospital
#20 Gu Lou Road, Kunming 650051

Zhejiang Province

Hangzhou - Sir, Run Run Show Hospital
#3 Qing Chun Dong Road, Hangzhou City

Du Lizhong, MD
Children’s Hospital of Zhejiang Medical University,
310003, Hangzhou

List compiled with help of:

Jian Chen, Holt International
Du Junbao, MD, Beijing
Aina Ling, MAPS
Snow Wu, Great Wall Adoptions
U.S. Embassy, Beijing (hospital listing)
Adoptive parents

For additions or subtractions, contact Todd J. Ochs, MD in Chicago, and please let us know as well.