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Giardia lamblia Infections of Children Living in Orphanages

By Dr. Jane Aronson

Giardia lamblia is the most common protozoal illness afflicting Americans today. We see it commonly in campers and in daycare. Parents of children in daycare are victims of this common parasite which infects the small intestine. It is clearly associated with individuals living in institutionalized settings and therefore is of interest to parents adopting children from abroad. Children from all over the world living in orphanages are at risk for Giardiasis.

Giardia causes a variety of symptoms including diarrhea, abdominal distension, chronic belly pain, and flatulence. The stools can be watery, but are often very thick and formless, large in volume, and very foul smelling. Some individuals have minimal symptoms, but the parasites are still shed in their stool and are therefore a source of infection of those in the immediate environment, like their household. Asymptomatic cyst passers should be treated!

Children with Giardia can be irritable and have behavioral disturbances. Because of malabsorption of nutrients, they can fail to thrive and suffer growth failure. This is probably a common problem for children in orphanages.

It is easy to detect Giardia lamblia in the stool by collecting stools for ova and parasites with directed attention to testing for the Giardia antigen. It is best to obtain at least three stools for the evaluation for Giardia because cysts are inconsistendy shed.

When a child is adopted from abroad, stools for ova and parasites and Giardia antigen should be obtained. Then if there are Giardia cysts and/or Giardia antigen, the child should be treated with either Furazolidone (Furoxone) or Metronidazole (Flagyl) which are prescribed by your physician. Adults who have traveled to the childs country of origin should also be assessed for Giardia if there are symptoms of abdominal pain and/or a change in bowel habits. The changing of diapers of infants and toddlers should always be accompanied by good hand washing habits. Giardia cysts are easily transmissible.

If a child has one parasite it is not uncommon for there to be other parasites. A follow-up culture should be obtained after treatment of Giardia to confirm eradication of the infection and to also see if other parasites have been uncovered.

Other common parasites commonly found in children living in orphanages are Cryptosporidium parvum, Entamoeba histolytica, Ascaris lumbricoides, Hymenolepis nana, and Enterobius vermicularis (pin worms).

© Copyright Dr. Jane Aronson 2001

Dr. Jane Aronson is a board certified general pediatrician and pediatric infectious diseases specialist and the Clinical Assistant Professor of Pediatric at the Weill Medical College, Cornell University. She is an established international adoption medicine specialist and has treated over 1400 children adopted from abroad. Dr. Aronson reviews pre-adoption medical reports, evaluates videos and photographs, prepares people for travel abroad, and speaks and writes about international adoption for family adoption groups, adoption agencies, and physicians. She can be reached at or visit her website at
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