Topic: Diseases & Conditions
This handout was written to answer some of the questions most often asked about ostomies in children. Please feel free to ask your child’s doctor or nurse to go over any information you do not understand. An ostomy is an opening made in the belly. The gut (intestine) is brought outside the body and attached to the skin. The child’s bowel movements (stool) come through the opening into a collection pouch or bag. Your child may or may not have bowel movements (BMs) or stool from his or her bottom. A small amount of clear discharge from his or her bottom is normal. The intestines may be put together again later.
WHAT IS A COLOSTOMY?
A colostomy is when part of the large intestine (gut) is brought outside of the body through an opening in the belly. Bowel movements are watery or thicker depending on where the opening was made.
WHAT IS AN ILEOSTOMY?
An ileostomy is when part of the small intestine is brought outside of the body through an opening in the belly. The BM is liquid or like paste, and is irritating to the skin.
WHAT IS A STOMA?
A stoma is the part of the intestine brought to the outside of the belly. The stoma is shiny, red and wet. It looks like the inside of your mouth. The stoma does not have nerves to feel pain. However, it might bleed slightly when rubbed or irritated. The stoma may shrink in size during the first few months after surgery. You will be taught how to measure it and to make sure that the pouch fits well.
HOW DO I CARE FOR THE STOMA?
A pouch is placed over the stoma so bowel movement (stool) does not get on your child’s skin or clothes. Change the pouch at least every three days or when it leaks or starts to come off. The skin barrier may only need to be changed every five to seven days. Clean and dry the skin each time a new skin barrier is put on. Empty and rinse the pouch with a squirt bottle when the pouch is 1/3 full. Letting the pouch fill with stool might make it fall off and need to be changed more often. Try to empty or change the pouch before your child eats because there will be less stool coming from the stoma at that time. When cleaning the stoma, a small amount of bleeding is normal. If bleeding does not stop in a few minutes, apply a cold cloth to the stoma and call the doctor.
HOW DO I CHANGE THE SKIN BARRIER AND POUCH?
• Wash cloths
• Dial® soap
• Skin barrier (wafer)
• Pouch clamp
1. Gather supplies.
2. Wash your hands.
3. Measure the stoma size and trace the opening size on the paper backing of the skin barrier or use pre-measured pattern.
4. Cut the hole in the skin barrier.
5. Remove the old pouch and skin barrier.
6. Wash skin with a mild soap. Rinse thoroughly with water. Pat dry. Be sure skin is dry.
7. Check skin for redness, blisters or sores ( if present, see next page for care).
8. Remove the paper backing from the skin barrier.
9. Center the hole over the stoma and gently press onto skin. Make sure that the skin barrier sticks well around the stomas with only 1/8 inch of skin not covered.
10. Open the pouch to let some air inside.
11. Center the pouch opening over the skin barrier and stoma and apply the pouch in a way that will make it easy to empty.
12. Close the bottom of the pouch with the clamp.
13. Wash your hands.
HOW DO I EMPTY THE POUCH?
One piece pouch: Open the bottom of the pouch over a disposable diaper or container. Let the stool drain out. Use a squeeze bottle filled with cool water to rinse the stool out of the pouch. Dry the end of the pouch and close it with a pouch clamp or a rubberband. Wash your hands. If gas builds up in the pouch, open the bottom to let the gas out. Do not make a pinhole in the pouch.
Two piece pouch: Remove pouch and replace with another pouch. Clean and then store used pouch.
HOW DO I CARE FOR WEEPY OR BLISTERED SKIN AROUND THE STOMA?
Weepy or blistered skin is usually caused by leakage of stool onto the skin. Wash the skin with soap and water. Rinse well and pat dry. Sprinkle Fordustin®, Karaya® or Stomachesive® powder on weepy skin. Dust off extra powder. Apply the pouch over the powder. Change the pouch as soon as leaking is seen, or at least every three days. Call the doctor if the area is not better in one week.
WHAT IF MY BABY/CHILD HAS A RASH AROUND THE STOMA?
Reddened skin with a pin-pointed (prickly heat) rash may be a sign of a yeast infection. Your doctor can prescribe something (like mycostatin powder) to help it clear up. Do not leave your child’s pouch off to “air” the skin. Stool will irritate the skin more. Do not use a heat lamp to “dry” a rash. This can burn the stoma.
WHEN DO I CALL THE DOCTOR?
1. Severe belly pain
2. A cut in the stoma
3. Large amounts of bleeding from the stoma opening
4. Bleeding that does not stop from the area between the stoma and skin
5. Severe red skin or deep sores
6. Unusual change in stoma size or how it looks
7. Large amount of watery liquid from stoma lasting more than five or six hours
8. Stoma sticks out of the belly one inch more than usual
9. The bowel movement is different than usual – bloody, smells bad, different amount or color change
10. Child acts different than usual; will not eat or play
11. Child’s belly feels full or hurts when it is touched
12. Anything else unusual about the ostomy
Type of ostomy: ___________________________________________________
Ostomy appliances and products Order Number Vendor
_________________________ ____________ ________
_________________________ ____________ ________
Bathing and Swimming:
Water does not harm the ostomy. Your child can bathe or shower with or without his or her pouch on. Water will not get into the stoma. When bathing, do not use soap that contain perfume, cold cream, oils or lanolin. Dial® is one example of soap that can be used.
No special clothing is required because the ostomy skin barrier and pouch are flat. The pouch will not be noticed under your child’s clothing.
1. Sleepers or overalls that snap at the neck and between the legs stop your baby from pulling on the pouch.
2. Tuck the pouch into the diaper and pin the undershirt to the diaper to prevent your baby form pulling on the pouch.
3. Make sure that an elastic band does not ride across the stoma.
It is not necessary to stay at home as long as your are prepared. Take extra supplies in a small cosmetic bag or diaper bag for infant in case of any emergency. Your emergency kit should include a skin barrier, pouch and a small pair of scissors. When you travel by car, fasten the lap-type belt below or well above your child’s stoma. (When possible, use over-the-shoulder belts.) Do not leave supplies in the car or places where heat can damage them. Note: Always bring emergency kit with you to doctor’s appointments.
Eating a balanced diet is the best way to maintain good nutrition and to keep bowel activity normal. Foods act differently with different people. Encourage your child to chew well. Observe what effects specific foods have on the way your child’s ostomy functions. You will soon learn which foods produce gas or odor, cause diarrhea or constipation.
Once your child has recovered from the surgery, he or she may pursue a normal day’s routine. Ostomy care will take only a short time. Your child can lay on his or her tummy and on the pouch.
Whether you and your child tell others about the ostomy or not is a choice you make. Not everyone needs to know. Others will know only if you tell them.
Exercise, Play and Sports:
You do not need to limit your baby’s play. A two piece pouch system is often easier to manage when your baby gets more active. An ostomy presents no barriers to any types of exercise and sports. If you wish, your child can wear a supportive garment. Weight lifting might be limited to not exceed ___lbs. (consult your surgeon).
Note: It is a lot of work to care for a child with special problems. Ask several family members, friends or babysitters to learn the care so that you can go out or just get some rest.
Derechos de autor(c) de The Children's Medical Center, ano 1999. Este material unicamente tiene fines educativos. No puede ser reproducido, distribuido ni modificado sin previa autorizacion de The Children's Medical Center of Dayton, One Children's Plaza, Dayton, Ohio, 45404-1815. Llame al 937-641-3666 para solicitar autorizacion o para obtener un juego maestro para copias. Para obtener mas informacion puede visitar www.childrensdayton.org (consulte la seccion de informacion legal).
La informacion contenida en este material es unicamente informacion de tipo general. No debe considerarse como completa. Para obtener mas informacion acerca de los complementos para leche materna, por favor pidala a su doctor.
Corregido: 1995, 2000
The information contained in this handout is for general information only and should not be considered complete. For specific information about bathing your baby, please ask your doctor or nurse practitioner.
Additional information may be located in the Family Resource Center, 2nd floor, near the Outpatient Surgery Center. Hours of the center vary; please contact the Family Resource Center at 937-641-3700.
Copyright(c) The Children's Medical Center of Dayton. This material is for educational purposes only. It cannot be reproduced or distributed without permission from Dayton Children's.
Revised: 1995, 2000
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