Melamine

We have received many calls about the melamine contaminated milk in Chinese orphanages. We are collecting the data as it is coming in. Currently most of the information is coming from our listserve group of international adoption doctors that includes some doctors living in China. As well, the Joint Council for International Adoption has put out some facts. The American Academy of Pediatrics and Center for Disease Control is working towards a consensus on the examination of these children. Below is the current consensus, but we will let you know of any updates as they become available.

Why is this formula causing problems?
Infants have been sickened by Melamine, a toxic chemical that was added to milk to help boost the appearance of protein. Melamine is used in plastics, fertilizers and flame retardants. It has no nutritional value but is high in nitrogen, which makes the products appear to have higher protein content than they actually do. Suppliers to the dairy companies that produced the tainted baby formula have been accused of adding the chemical to watered-down milk. It has also been found in other milk products such as dry milk and eggs from chickens feed with products contaminated with Melamine.

How many children are affected?
We don't know, yet. China is being a bit closed lipped about this, but could be partially due to the fact that they are trying to work as quickly as possible to sort it out in light of the 80 million children under the age of 4 years old living in China who may have been affected. According to a survey conducted by the Half the Sky Foundation in 41 Chinese institutions, a number of children are affected, although the number is probably less than 5% of those who received the tainted formula.

What are the symptoms of Melamine poisoning?

• Unexplained crying episodes, 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

What is China doing about the problem?
The Chinese Ministry of Civil Affairs has been working to provide guidance to all the institutions that house infants in China. According to the Ministry, a letter was sent out to all orphanages as soon as the crisis was recognized. Orders were to have all children examined at local hospitals, and the government will cover all costs, including any necessary treatment. All orphanages using identified tainted brands have changed to either fresh milk or to a brand that has been identified as safe.

Which Chinese orphanages were affected that we know of?

• Tianjin CWI was using Sanlu, among other brands. Forty children were drinking Sanlu and of those, 2 were diagnosed to have kidney stones.
• Xinyang CWI was using Sanlu exclusively. 43 children were taken to hospital and 2 have been diagnosed to have kidney stones.
• Yiyang SWC was using Sanlu exclusively. All children were taken to hospital and 5 were diagnosed to have kidney stones.
• Maoming CWI was using Sanlu among other brands. All children were examined and 2 were diagnosed to have kidney stones.

• Nanjing, Chongqing, Shenzhen, Guiyang, Guangzhou, Luoyang, Nanchang and Qingyuan were using affected brands but the children were examined and are all right.

**None of the children with kidney stones are seriously ill. All are being treated. Most of the other institutions were using non-affected brands.

What can parents do when visiting their child in China?
Those parents who see bloody urine should be concerned. In China, children can have kidney ultrasounds to see if kidney stones are present, as an x-ray would not visualize these.

What can parents do to have their child evaluated?

On newly adopted children:
All parents should consult with an adoption medical specialist. In our clinic, we will collect blood work and urine on the children to look at electrolytes/BUN/creatinine (to assess renal function) and a urinalysis looking for blood in the urine.

If the child is potty trained, a urine analysis is easy to do since they can urinate in a cup. If they are not potty trained, we can put a bag in the diaper at the beginning of the visit and encourage the child to urinate during the visit by giving them a lot of fluids to drink.

In the future, we may begin also doing routine ultrasound of kidneys, ureters, and bladder to look for stones themselves.

On previously adopted children:
If a child's been home since 2005 with no sypmptoms, we recommend that you make a non-urgent appointment at our clinic for urinalysis and possibly bloodwork (BUN/CREAT) if this has not already been done.

Any child who was adopted in the last 3 years who is experiencing the symptoms mentioned above needs to evaluated in our clinic or by another adoption medical professional as soon as possible. In those children, we are collecting a urinalysis, bloodwork to assess renal function and doing a renal ultrasound or perhaps CT scan if needed.

Last edited: 10/27/08