find my family: Naomi

November 24, 2015 by nohandsbutours 0 Comments

Naomi is a precious two year old little girl who is listed with Lifeline. Her special need is cerebral palsy.


Naomi is a beautiful little girl! She responds to others asking for her belongings and waves goodbye to others. She is a good sleeper and likes playing with toys. Naomi’s file reports that she is attached to her caregiver. Please visit our special needs page to learn more about cerebral palsy.


Please contact Lifeline for more information and to review her file.


Nothing Else Mattered: FAQs About Anal Atresia

November 24, 2015 by nohandsbutours 0 Comments

We saw her face. We fell in love. Nothing else mattered.

My husband and I simply wanted to be parents and we knew in our hearts that our children were in China; we just had to go get them. Like most parents to be, we hoped and prayed that our children would be healthy. Our first child’s SN was minor and had resolved by the time we brought him home. Imagine our delight when our agency showed us the file of a beautiful baby girl with a “repaired” imperforate anus. We were ecstatic (and considered ourselves lucky) to be bringing home another healthy child!

We did not have a reason to think anything else. No one we talked to told us any differently, not the multiple pediatricians we talked to and not the international adoption doctor we consulted. We were told she would suffer from chronic constipation and we would need to watch her diet, and possibly give her a laxative.

WOW! Doesn’t that sound easy?

I am thankful everyday that we went through her adoption wearing rose-colored glasses. God was protecting us. With tears in my eyes as I type this, the painful truth is if we had known what we know now, we would have said no. That absolutely breaks my heart. My little girl is exactly where she is supposed to be. She was the missing link in our family and she completes our perfect family of four. I can’t imagine one single minute of one single day without her in my world.


I cannot tell you our journey has been easy. It has been so very hard. Every time we turned around, we were thrown another curve ball with her needs.

It started in China when we opened up her diaper. We were horrified by what we saw. We did not know what was wrong, but we knew that it definitely did not look right. I found myself overwhelmed and unprepared for her needs. Post-adoption depression is real and not talked about nearly enough.

Trauma is real for these kids and it is so difficult at times. I was not prepared for the need to travel for care. I was not prepared for the enormity of the “re-do” surgery and recovery. I was not prepared that my daughter might be the “smelly girl” at school, a thought that brings me to tears. I was not prepared for a lifetime of daily enemas.

Our journey has been long. Our journey has been hard, but it has also been so worth it!


People often ask me if I would do it again and the answer is YES! In a heartbeat I would adopt another ARM child, however my family is complete. So now, my calling is to help others. I want to help other families on this hard, wonderful, and often tearful journey.

I was very alone when we went through all the surgeries and recovery for my daughter. I found myself looking to the internet for support and started finding other moms that were traveling the same road. Two years ago, on a whim, I stated a FB group for moms with children born with an ARM and adopted internationally. The group, which started with four women, has grown to over 200 members and is an amazing support system and community.

In an effort to help my daughter, I have read everything I can get my hands on regarding ARMs. I have talked to every professional I can find that will talk about this defect, and it has been my mission to share what I have learned with others. I am happy to chat with potential parents as I feel that knowledge is power.

I have put together a list of the most commonly asked questions (and answers) that I get and shared it below.

guest post by Heidi


Frequently Asked Questions about Anal Atresia/Imperforate Anus

Q: What is the difference between imperforate anus and anal atresia?

A: When reading a file these terms appear to be interchangeable and essentially mean the same thing. The proper terminology for this defect is Anorectal Malformation (or ARM).

Q: What is an anorectal malformation (aka imperforate anus)?

A: An ARM is a spectrum of abnormalities of the rectum and anus. There are many possible abnormalities such as:

• The absence of an anal opening.
• The anal opening in the wrong place.
• A connection, or fistula, joining the intestine and urinary system.
• A connection joining the intestine and vagina.
• In females, the intestine can join with the urinary system and vagina in a single opening, known as a cloaca.

Q: What is the incidence of ARM?

A: There is no known cause for anorectal malformations and most cases are isolated and do not run in families. This birth defect occurs in one in every 5,000 live births. It is more common among Asians and is somewhat more common in boys than in girls.

Q: Why do some children require a colostomy at birth and some do not with this defect?

A: If there is a fistula (opening) to the skin, urethra or vagina, and the newborn is able to pass stool then often a colostomy is not needed. If there is no anal opening and the newborn is unable to pass stool then a colostomy will be required. Once the anal opening is made, the colostomy can be taken down.

However, in China, often the newborn is given a colostomy regardless of the type of defect. This is done as a life saving maneuver. The anoplasty – or creation of the anus – can be done in China, or more ideally by an expert once home.

Q: What is the name of the surgery to repair this defect?

A: The PSARP (posterior sagittal anorectoplasty or pull-through procedure) was introduced by Dr. Alberto Pena in 1980. This surgical procedure revolutionized the treatment and outcome for these children. Often, children adopted from China do not receive this surgical procedure and an older technique may be used. A video and more information on this procedure can be viewed here.

Q: If the newborn is able to pass stool through a fistula how many surgeries are needed to repair the defect?

A: Typically, this can be done in one surgery and is done in the neonatal period and a colostomy is not required.

Q: If the newborn is unable to pass stool and there is no anal opening, how many surgeries are needed?

A: The child will require 3 surgeries. In the first 1-2 days of life, the newborn will need to have a stoma made in order to pass stool (colostomy). After a few months (allowing the child to grow) the surgery can be done to create the anal opening. This operation is followed by a series of anal dilations. Once dilations are complete, the child will have an operation to take down the colostomy and connect the colon to the rectum. The child will then be able to pass stool through the new anus.

Q: What are anal dilations?

A: In order to prevent stricture or narrowing of the anal opening, a series of dilations are required postoperatively. If the anal incision contracts or becomes tight, then it will be very difficult to pass bowel movements. This process typically lasts several months.

Often it is found, in our children adopted from China, that the anal dilations were not done correctly. The child’s anal opening may be too small. In this situation, a “re-do” operation may be required. In some situations, the anal dilations will need to be repeated.

Typically, anal dilations will need to be done again after the “re-do” operation. However there is one surgeon in the US that is doing this procedure and dilations may not be needed.

Q: How common is it for a child adopted from China to need a “re-do” operation?

A: Sadly, this is very common. The surgeons do the life saving maneuver to open the anal opening but often do not place the new anus through the muscle complex. In most cases, unless a “re-do” (PSARP) operation is performed, the child will have difficulty achieving social continence. You need a very highly skilled and trained surgeon to perform this type of surgery.

Q: What does a “re-do” operation entail?

A: Most families travel to an expert to have this surgery done. The day before the surgery, an NG tube (a tube from the nose to the stomach) is placed and the child is given golytely to clean the colon. The typical protocol is to have the child remain NPO (nothing by mouth, no food or drink) for an average of 7 days post-operatively. The child is given nutrition from an IV. About a month after the surgery, the child will require anal dilations be performed by the parents for about 4-6 months (but there is one surgeon who is doing a new procedure where anal dilations may not be needed).

Some surgeons will place a colostomy for the “re-do” and the child will require another surgery to take down the colostomy once the anus has healed.

Q: Are there any other birth defects associated with an ARM?

A: Children with ARMs can fall on the VACTERL association spectrum. If a child is diagnosed with VACTERL, they typically have 3 or more of the anomalies listed below. It is important to understand that most children are screened for these anomalies in China. Often parents are “surprised” to learn about these anomalies once home.

V – vertebral anomalies – the most common thing we see in our children is a tethered cord
A – anorectal malformation
C – Cardiac or heart defects
TE – tracheoesophageal atresia/fistula
R – renal or kidney (this is very commonly seen in our ARM kids)
L – limb abnormalities

In addition to the above anomalies, girls born with an ARM often have gynecological concerns/anomalies (including cloaca) and hypospadias is often found in boys.

Q: Will my child be continent?

A: As moderator of a large adoption support group, I get this question asked a lot. It is often difficult to answer, as every defect is so different and there are so many factors to consider when determining continence. It is important to know that the large majority of ARM children will always struggle to some degree with their bowel movements and some struggle more than others. Some children experience stool leakage and soiling more than others. Most ARM children will potty train later than other children. However, almost all of these children can remain clean and in normal underwear at typical potty training age along with their peers with bowel management.

When discussing continence or soiling, there are three factors to consider.

1. The quality of the pelvic muscles. Abnormal muscles may result from poor development as commonly seen in ARM children. Abnormal nerves may be a result of congenital neurologic anomalies such as a tethered cord or spine bifida.
2. The ability to sense stool. The ability to sense the presence of stool in the rectum is either present or absent. This will vary from child to child. If absent, conscious control of the pelvic muscles and the anal sphincters may be learned as the child gets older.
3. Chronic constipation. Chronic constipation will decrease the ability to sense the presence of stool. The relief of constipation can improve this rectal sensation.

It is crucial that constipation is prevented in these children in order to remain continent and free from soiling.

The most important thing to know is that with successful bowel management ARM children can be socially continent and wear normal underwear!

Q: What is bowel management?

A: Children can achieve bowel control with a daily stimulant laxative (senna based product such as ex-lax) or a daily large volume enema. Some children can achieve continence (free from soiling) though diet alone, however, this is the exception and not the norm. The goal of the daily laxative or enema is for the child to completely empty the colon at a predictable time each day. Once the colon is clean then the child should remain clean and in underwear the rest of the day. Often, families will travel to an expert to determine a specialized plan tailored to each child.

There are procedures that can be done which allow children to receive an antegrade enema as opposed to a rectal enema. These children receive an enema via a catheter inserted in a small hole their abdomen (usually in the bellybutton) instead of the rectum. These procedures are commonly known as the Malone or appendicostomy, as well as cecostomy.

Q: What is everyday life like with a child born with an ARM?

A: This answer will vary from family to family as every child born with an ARM is different, but the one thing we all have in common is poop! Yep, our lives revolve around our child’s pooping schedule.

The few that are able to manage with diet watch their child’s diet very closely and make adjustments according to the child’s stool output. Preventing constipation is key in these children, so parents intervene as necessary with things such as enemas, suppositories, and laxatives. Often ARM children need a bowel management program, especially in their early pre-school and school age years.

Those that manage with laxatives also tend to keep an eye on diet. These children typically sit on the potty everyday for 30 – 40 minutes. They need to completely evacuate the colon in order to remain clean the rest of the day.

Those that manage with enemas (rectal or antegrade) spend, on average, one hour a day with the routine. Most of these kids have more leeway in their diet, although some foods may cause issues.

Managing the child’s bowel needs is and will be a lifelong reality. As the child grows and changes, so will bowel management. If the child experiences soiling, then tweaking of the regimen will be needed. It’s important for the family to find an expert that understands this and that will be there for them throughout the child’s life.

Q: Do the children in China receive bowel management?

A: In my experience, the majority of the children in China do not receive bowel management. However, if they were fortunate enough to reside in a medical foster care home/program, it is possible that they did receive some bowel management.

Most of the children represented in our support group come home to us very backed up (constipated) which can present itself in one of two ways. The child may appear to be incontinent and stool non-stop. Or the child may not stool at all. Regardless, once home, parents should have the stool tested for parasites to rule out an infection and should obtain an abdominal x-ray to determine if the child is constipated. The large majority of the time, the child is found to be very constipated and a bowel clean-out is needed.


Recommended Resources:

Nationwide Children’s Pelvic Reconstruction Center
Cincinnati Children’s Colorectal Center
UCSF – overview of Imperforate Anus

Embracing Their Story: Going Back

November 23, 2015 by nohandsbutours 0 Comments

Their story with us didn’t start at the beginning. I think we jumped in around chapter 3 or 4. Much like opening a book midstream and trying to piece together a plot, our adoptions began with many unanswered questions and many holes that I knew we could never fill.

Yet at some point, I knew my girls would yearn for more. Questions like “Where did I live?”, “Who cared for me?”, “Where was I abandoned?”, were all things they wondered about. Even if they couldn’t share a lot of the details about their earlier life, I knew those memories were imprinted on their hearts. So my goal in taking them back to China was to help fill in pieces of those missing chapters.

A few years ago, I was able to make that trip with my 3 biological kids, our 4 adopted girls and a couple of extra friends.

We had three weeks.


We began in Beijing with a few days of adjusting our time clocks and just being tourists. We walked through The Forbidden City and Tiananmen Square, rickshawed our way through the historic HuTong and stood on the Great Wall soaking up the vastness of beautiful China. What a fabulous way to begin our journey.

Within a few days though, we were headed off to Hefei, where my daughter Jadyn was born. She was nine on our trip and wanted to see her orphanage, where she spent the first two years of her life, find her place of abandonment, and walk through the city. So we did.


She was stoic. There was no emotion that day, absolutely none. No tears and no smiles, just a quiet little girl taking it all in and asking lots of questions. She’s my cerebral one, processing life internally all the time, and holding her emotions close. We never met her nanny who cared for her, and no one seemed to really remember her. It was a stark reminder how difficult it is to stand out among the vast number of kids who have traveled this same journey. But by the end of the day, she was back to smiling again and said, “I’m glad I saw it all but I’m happy I live in the US”. And that was it. She had seen enough and was happily ready to move on.

Our next hometown stop was to Changshu, my daughter Malea’s hometown. A very excited director, met us at the gates and proceeded to shower us with gifts and then more gifts. Malea was thrilled with all the attention, and I wondered how much she remembered of her. The director shared stories of our little girl with clubfeet, about her failed foot surgery and 3 month hospital stay, showed us her crib and told us how much she had loved her. As the day progressed, the bond these two had shared became apparent.

But, when it came time to say goodbye the floodgates opened and out came the tears. We watched the director and Malea struggle to say goodbye to each other yet once again. It was hard to watch her grieve so deeply and try to process what she had heard and what she was feeling. So, for the next 6 hours, as we made our way to Shanghai, all I could do was hold her, allow her to feel it all and wipe her tears.


After a very long emotional day, and a longer travel day we landed in Guilin, where my oldest daughter Allie was from. Allie had met her foster family and visited her orphanage on a prior trip to China, so for our time in her hometown we planned it to be a bit different. We wanted to spend one full day at my non-profit An Orphan’s Wish “giving back”.

In the extreme heat and humidity, that southern China is known for, we spent that day cleaning, unpacking, assembling, rearranging, and organizing. And then we got to play with some very special kids. Seeing them smile and hearing their laughter was music to our ears. We gave what we had that day, in hopes of making things just a little brighter for the kids still waiting for families.


Guilin is one of the most picturesque places in the world, so we decided to spend a few days sightseeing. It was spectacular! One day, in a very spontaneous moment, we changed our plans, jumped on scooters and toured the Chinese countryside. What a blast! Eight hours later, we’d shared one of the best days as a family, which we all still talk about today.


With only a week left, we still had one more orphanage to visit. Wanting to travel like the locals do, we booked ourselves on the 15-hour overnight train to Jiangxi, where my youngest daughter was born. Averi‘s biggest wish was to see her foster grandma again. And to our surprise when we walked into her orphanage there she was… waiting for us.

What a priceless moment! There were tears from a foster mama who thought she would never see this child again, laughter and joy at how much Averi had grown and just quiet moments where the only thing they could do was hold each other. “I told you she was old,” Averi beamed, “I’m so glad I got to see her again.” When it was time to say goodbye her foster grandma pressed a tiny note with her address into my hand with a plea in her eyes to keep in touch.


We left through the cold metal gates of the orphanage and came across one of the caretakers. After a brief exchange, we realized on a cold February morning three years earlier, she was the one who had found Averi. Wrapped in layers, nestled in a cardboard box, left with a tiny, penciled note, she was that same little dark-haired girl with only one eye. Only God could have arranged that meeting.

Our trip was coming to a close, and like all our adoption trips, we ended it with a few days in Guangzhou and a stay at the White Swan.


We shared so many incredible experiences in those three weeks and saw so much of China. To say it was spectacular, is an understatement. As a family, we laughed together and we cried together. Visiting their abandonment places, meeting the people who cared for them, and seeing the reality of orphanage life, my girls came face to face with the harsh reality of their first few years of life.

But through it all, there is now a new sense of peace and lightness for them. They have a deeper understanding of how their story began and a renewed love for the country they first called home.

– guest post by LeeAnn

Embracing Her Story: Gracie

November 22, 2015 by nohandsbutours 0 Comments


We know that God is the only one who can heal hearts and redeem stories. But what of our role as shepherds of their hearts? One powerful, guiding gift we can dig into is the experience of others, young and old, who are willing to share their stories. As part of our Embracing Their Story …Read More

Appointed One

November 22, 2015 by nohandsbutours 0 Comments


“I will give you treasures hidden in the darkness – secret riches. I will do this so you may know that I am the Lord, the God of Israel, the one who calls you by name.” Isaiah 45:3 In a crib, in an orphanage, halfway around the world, sits a boy. He’s easy to miss, …Read More

Tears In Your Bottle

November 21, 2015 by nohandsbutours 0 Comments


I caught myself staring at my little Chinese boy tonight as he fell asleep in my arms. So much has changed in our three plus years together. He is a whopping five years old now, has gained 15 pounds and grown 10 inches among other things. Our life together is so normal now, it’s almost …Read More

Embracing Her Story: Sarah

November 20, 2015 by nohandsbutours 0 Comments


We know that God is the only one who can heal hearts and redeem stories. But what of our role as shepherds of their hearts? One powerful, guiding gift we can dig into is the experience of others, young and old, who are willing to share their stories. As part of our Embracing Their Story …Read More

She is our JOY: Adopting a Child with CAH

November 20, 2015 by nohandsbutours 0 Comments

When we began our adoption journey we had no idea where it would eventually lead. We were entirely new to the international adoption process yet seasoned parents of four children. Our placing agency encouraged us to begin our home study and fill out some essential paperwork. One form had us place a checkmark beside the …Read More

When Tragic Pasts Meet Hopeful Futures

November 19, 2015 by nohandsbutours 1 Comments

Our children have stories that are a paradox of tragedy and beauty, of despair and hope. There is no easy answer to their stories. It’s complicated and so the way we handle it is complicated, and ever evolving. Children are beautiful. They are full of hope and they believe in miracles. They believe in unicorns, …Read More

It Is What It Is, Not What it Should Be

November 18, 2015 by nohandsbutours 3 Comments


Be joyful in hope, patient in affliction, faithful in prayer. Romans 12:12 That’s been my view on most things in life: it is what it is, not what it should be. Our daughter came to us on September 1, 2013, at 8.5 years old. She’d been adopted from China at age 4.5 by another family, …Read More

© 2015 No Hands But Ours

The content found on the No Hands But Ours website is not approved, endorsed, curated or edited by medical professionals. Consult a doctor with expertise in the special needs of interest to you.