Ostomy Care
Your child has had surgery that changes the way the intestines (bowels) empty. He/she now has an ostomy. The part of the ostomy you see is called a stoma. Stool will come out of the stoma. At first, the stoma will be bruised and swollen; but with time, good care, and healing it will look red, moist and smooth.
What the stool looks like will depend on the type of ostomy your child has. If he/she has an ileostomy, the stool drains often and is liquid. If your child has a colostomy, the stool still drains often but is thicker. Your child will need to wear a skin barrier and drainable pouch at all times to collect the stool and protect the skin.
In some cases your child will have two stomas. One stoma will drain stool. It is called the functioning stoma. The other stoma is in a resting stage and will drain only mucus. It is called the mucus fistula. If the stomas are close together, both can be put in a pouch. If they are far apart, only the functioning stoma needs a pouch. The mucus fistula can be covered with a small diaper square or gauze pad and changed when soiled.
Your child can still eat, play, and go to school like other children his/her age. All children must stool; most do it from the rectum. Some children do it from a stoma. Your positive feelings and reactions will help your child feel good about himself/herself and the stoma. Teach other family members about your child's ostomy so they can help in his/her care too.
Changing your child's ostomy pouch
During the first weeks after your child's surgery, you will begin to see a pattern on how many days the pouch stays on before leakage occurs. Every child is different. You should work with your child to set up a routine to change the system before it leaks (for example, every third morning). This will help prevent leakage problems at school or play.Since the bowel is less active on an empty stomach, you may want to change the pouch first thing in the morning.
You may notice the pouch fills with air. This is only gas. If using the traditional pouches, release the clamp and expel the air.
Supplies you will need:
- Measuring guide
- Skin barrier
- Drainable pouch with skin barrier
- Closure clip or rubber band
- Scissors
- Soft wet wash cloth and towel
- Mild soap/skin cleanser
- Optional:
- Skin preparation wipe
- Paper tape
There are many types of ostomy pouching systems. By trying different ones, you will learn what works best for your child. The type of system used does not matter as long as your child is comfortable and the ostomy and skin surrounding the stoma stay in good condition. The nurse practitioner or doctor will tell you about the different types of systems and suggest the best system for your child.
The most common pouching systems are the one-piece system, the two-piece system, and the two-piece system with flange.
Preparing to change the one-piece system
- Wash your hands.
- Gather all the supplies you will need to change the pouch.
- Figure 1: Loosen the pouch by placing the fingers of one hand at the top of the pouch and pull while holding the fingers of your other hand against your child's skin. This will make the pouch come off easier. You may need a moist cloth to help remove the backing.
- Remove any stool by cleaning the skin around the stoma with a mild soap and water skin cleanser or just water. Rinse well and dry.
- Figure 2: Cover the stoma with a cloth or gauze to absorb or collect any stool that might drain out while you get the supplies ready.
- Figure 3: Measure the stoma size. Use the stoma size guide inside the one-piece system package or the pattern used in the hospital. After surgery, the size of the stoma may decrease from week to week for about 3-6 months. Check the stoma size weekly to make sure the opening in the one-piece system is the right size for your child's stoma.
- Cut an opening in the skin barrier part of the pouch 1/8" to 1/16" larger than your child's stoma. Be careful not to cut through the plastic pouch or make the opening too large.
- Figure 4: If you are using a special skin wipe, apply it to the skin. Let it dry, then reapply. Center the pouching system over the stoma with the pouch hanging downward. Press it onto your child's skin. Smooth away any wrinkles or bubbles in the system.
- Place your hand gently but firmly over the pouching system for 1-2 minutes. The warmth of your skin helps the pouch mold to your child's skin so that it will stay on better.
- Remove any air from the pouch by placing your hand on the top of the pouch and moving it downward.
After you feel comfortable sizing your child's stoma, you should cut the holes in the pouch before you begin. This will make changing the pouch easier and quicker for you and your child.
- Figure 5: Fold the bottom of the pouch upward several times. Fan-fold it or gather it tightly toward the center and apply a rubber band. If the pouch comes with a closure clip, follow the directions for its use.
- Figure 6: You can place paper tape around the edges of the pouch to add to the system. The tape will look like a picture frame.
- The pouch may be tucked into your child's underclothes or left outside. Now TLC (tender loving care) is in order - you've both done a great job!
Cleaning:
You will need to empty your child's pouch once it gets 1/3 full. If too much stool collects in the pouch, it may cause a strain on the seal so that leakage occurs. Rinsing the pouch out when you empty it will decrease odor.- Fill a cup or syringe with warm water.
- Figure 7: Open and unfold the bottom of the pouch. Pour a small amount (about 1/2 to 1 ounce) of water into the pouch.
- Figure 8: From the outside of the pouch, use your fingers to loosen stool from the stoma. Allow the water to swish around in the pouch.
- Figure 9: Place the end of the pouch in the cup and allow the stool and water to empty out. Empty stool into cup or into toilet.
- Remove any air from the pouch. Dry the inner edge of the bottom of the pouch with a tissue or a cloth and close.
Daily Living
Your child can wear normal clothes. The pouches are small and cannot be seen. Tight belts or elastic should not be placed over the stoma.Play
Normal play should be encouraged. Check with your child's doctor before letting your child take part in physical or rough sports such as soccer or football.Bathing
Your child may bathe with the pouch on or off. The water will not hurt the stoma. Avoid bubble bath or bath oil. They may be irritating to the stoma. They also leave a film on your child's skin, making it harder for the skin barrier to stick.Diet
Your child will not have to follow a special diet, but an ostomy works best when your child eats regularly. Constipation could result from not eating healthy meals or not drinking enough.
Diarrhea may result from highly spiced foods and raw foods. There are also other reasons why constipation or diarrhea can occur, such as viruses or illnesses. If the constipation or diarrhea lasts longer than 1-2 days, call your child's doctor. Do not give your child medicine for this unless your child's doctor has told you to do so.
| Some Diarrhea-Causing Foods | Some Gas-Causing Foods | Some Odor-Forming Foods |
| Broccoli Raw fruits Spinach | Cabbage Corn Peas Broccoli Mushrooms Dairy products | Fish Eggs Peas Beans Broccoli Asparagus |
Each child is different. Let them try the foods. If odor or gas is a problem, the foods can be eaten in small amounts.
Skin
When changing the pouching system, check to make sure:
- The stoma(s) are pink/red and moist.
- The skin is without redness or a rash.
If the skin is irritated, clean with a mild soap, skin cleanser, or just plain water. Rinse well, and dry. Next, apply ostomy powder in a light dusting, then apply the normal pouching system.
The stoma may bleed a small amount when you clean it. This is normal. There are no nerve endings in the stoma itself, so your child will not feel any discomfort when it is cleaned.
Avoid creams and lotions on the skin around the stoma because many have an oil base which will interfere with the skin barrier sticking to the skin.
Ostomy paste can be used to make the skin barrier stick better. Apply a thin layer on the sticky side of the skin barrier directly around the stoma opening. Let the paste dry for a minute. Then apply pouching system to the skin.
NOTE: When working with the paste, wet your finger or apply paste with a moist cotton applicator.
Store supplies in a cool, dry place to prevent melting of the skin barriers. In warm weather, or if your child has a fever, the skin barrier may break down or melt more quickly. Ask your child's nurse about a pouch cover for your child to wear which will help prevent this.
Getting your child involved:
Your child should be encouraged to take care of the ostomy. Although each child is different, here are some basic age guidelines:- A toddler may be able to help gather the supplies.
- A preschooler can help empty the pouch.
- A school age child can help change the pouch and care for the ostomy.
- By 10-12 years, a child should be doing most of the care for the ostomy.
Call your child's nurse practitioner or doctor if:
- There is a change in the size, color, or length of the stoma.
- There is skin irritation that does not heal after 48 hours.
- Diarrhea or constipation lasts longer than 24-48 hours.
Ordering Supplies
You should choose a company before leaving the hospital. Your child’s discharge planner will help you find a supply company.Full article here.
