This information was developed with the assistance of Sandy Quigley, CWOCN, CPNP, a paediatric nurse practitioner and clinical specialist in wound, stoma care and continence care at Boston’s Children Hospital.
Unless your child’s physician says otherwise due to specific medical concerns, absolutely! Your child can be held, hugged and may even play with friends and family, just as he or she did prior to surgery. The only restrictions may be contact sports, such as football or wrestling, as the impact from these activities may damage the stoma. Your healthcare professional can provide you with any restrictions.
Look for these characteristics:1
- Red, moist, and soft to the touch, like the inside of your mouth
- Round or oval in shape
- Flat or raised up on the abdominal surface
A stoma is created from tissue that is much like the lining inside your cheek. The stoma has a good blood supply, and it is not uncommon for it to bleed slightly when it is cleaned during pouch changes.
Certain foods may change the color of stool. For example, red gelatin or beets may give stool a bright red color that looks like blood, but is harmless. However, if you are ever uncomfortable with the color of your child's stool, call the doctor.2,1,3
If you see these abnormalities in your child's stoma, contact his or her stoma care nurse immediately:1
- The color of the stoma becomes very dark or very pale
- There is blood in your child's stool, or blood is flowing from the stoma
The stoma has no nerve endings, so your child should not feel pain when you touch the stoma, or when she or he passes stool or urine.1
Right after surgery, your child's belly may be tender, but this should lessen each day as the stoma heals. Once healed, your child can play as desired—and even crawl on his or her tummy—unless nurses and doctors advise against it.
The stoma may change size and shape the first few months after surgery. A stoma can be at skin level, retracted (below skin level) or prolapsed (sticking out) from the belly's surface.4 Your child’s stoma care nurse can give you specific instructions on how to care for each type.
Certain products can improve pouch wear time if stool empties from a stoma at skin level. For children with a prolapsed stoma, you may be instructed to check the color of the stoma on a regular schedule. A change in color may indicate that the stoma is being pinched or cut by a pouch, snug diapers, safety belts or clothing.
As your child grows, the size of the stoma also grows. The size or opening of your child's stoma system may need to change. Your child’s stoma care nurse will be able to assist you with resizing, as needed.4
Typically, the pouch is emptied when it is one-third full.1 This will prevent heaviness, pulling away from the skin and leaks. It is also more difficult to empty the pouch when it is too full.
Wiping the end of the pouch clean helps avoid odors and clothing stains. You can avoid skin irritation by always making sure the tail closure is not pressing into your child’s body.
For many parents, it is easiest to empty the pouch into a nappy every three to four hours, or as needed. Older children who are beginning to be toilet trained should be taught to sit on the toilet, with their bottoms back as far as they can sit, and to empty the pouch directly into the toilet. Placing toilet paper in the toilet before the pouch is emptied may help prevent splashing.
Every child is different, so you should ask your child’s stoma care nurse about his or her unique needs. Pouch wear time often depends upon the child's size, activity level, and for kids living with a colostomy, the thickness of his or her stool. For example, an infant may need a pouch change daily. An older child may only need a pouch change every three to four days.
A regular schedule for pouch changes will help ease the transition to home care. Parents often learn when there are periods of slow stoma activity—such as before feedings or meals—and plan routine pouch changes during those times.
If you notice stool or urine leaking under the baseplate, the pouch should be changed to avoid skin irritation. If you need to change your child’s pouch more than once a day, call your child’s stoma care nurse for suggestions.
Bathing will not hurt the stoma. Many parents choose to bath their children with the pouch on, since there is no way to know when stool or urine will pass from the stoma. They then change the pouch after the bath.
When bathing your child, choose a mild, oil- and moisturiser-free soap that will not interfere with how adhesives will stick to your child's skin.5 Make certain that the skin is rinsed with water and completely dry before applying a new pouching system.
A common cause for irritation is when stool or urine gets under the baseplate and touches the skin. Sometimes, irritation may be caused by the way the stoma system has been applied. This may be due to a variety of reasons. The opening in the baseplate may be too big. The pouching system may not be the right size.4 Or you may need to use additional products such as paste or seals to ensure a better seal between the stoma and the adhesive.
Your paediatric stoma care nurse can help you resolve any skin irritation issues and advise you on solutions to sizing or system questions.
Every child is different. You can start by having your child help you with simple tasks, such as gathering supplies, helping to remove the pouch, and helping to clean the skin. This may help your child's self-confidence—and yours, as you slowly transition your child to self-care.
ConvaTec stoma pouching systems are designed to lie flat on the body so they cannot be seen under most clothing; however, here are a few tips that can further ensure your child’s comfort:
- Be sure that belts and waistbands do not press firmly against the stoma, especially if it is located at or near the child's waistline.
- Many parents of infants and toddlers find it helpful to use one-piece undershirts, outfits and overalls to help keep curious little hands from pulling off stoma pouches.
- Older girls and teenagers may wish to choose one-piece bathing suits that have a pattern design to help conceal the stoma.
- Boys may feel more comfortable wearing boxer-type swimming trunks.
If you have other questions or concerns, it is always best to call your child’s stoma care nurse, doctor, or other healthcare professional.
Dehydration can happen any time your child loses too much urine or stool and is unable to replace the fluid.6 For example, when a child has the flu with diarrhea and/or vomiting, she or he is at risk of becoming dehydrated.
Call your doctor or stoma care nurse if your child has diarrhea or early signs of dehydration, such as:7
- Decreased urine output
- Less active or unusually sleepy
- Dry mouth
This depends upon your child's medical condition. Unless your doctor recommends a special formula or gives you specific dietary guidelines, your child will most likely be able to eat a variety of foods with few restrictions.
Generally, it is important for your child to eat a balanced diet, chew foods very well, and drink plenty of fluids (as instructed by your nurse or doctor) to prevent dehydration.4 For the first few weeks after surgery, your child may feel more comfortable eating small, frequent meals and snacks.
Your doctor may also recommend introducing foods your child was not able to eat before surgery—or new foods—one at a time, to see how his/her body reacts. You can read more about gas- and odor-causing foods you may want to reintroduce slowly on this page.
A food blockage may develop in a child with a stoma (especially if a child has an ileostomy, because it is narrower than the large bowel). Hard-to-digest food can build up and block the flow of stool through the bowel. That is why it is important for a child with a stomato chew foods very well and drink plenty of fluids.
Some foods that can cause a blockage include popcorn, celery, dried fruits, seeds and nuts, peas and salad greens.3 Signs and symptoms of food blockage can include:2
- Belly pain or cramping
- Swelling of the belly or stoma
- More watery stool, eventually leading to little or no stool output
- Nausea or vomiting
- Irritability or not acting as usual
Ask your child’s stoma specialist about signs and symptoms of food blockage, as this can be a serious condition.
Swallowing air—such as when a child cries, sucks on a pacifier, or drinks with a straw—may cause gas. Certain foods like beans, carbonated beverages and vegetables such as cauliflower, cabbage, cress, broccoli and brussels sprouts can also cause gas3.
If your child’s pouch gets too full of gas, it may lift away from the skin and leak. Pouches are available with a filter system that can help release gas and minimise odor.
You will most likely learn your child's usual pattern and type of stool output before leaving the hospital. This will help you know when to be concerned about diarrhea.
However, if you suspect diarrhea, call your child's doctor. The doctor may ask you questions to help diagnose diarrhea, such as:
- Are you emptying the pouch more or less than usual?
- Is the stool more watery?
- Is your child showing any other signs of illness or dehydration?
Your child’s stoma care nurse can help you resolve any diarrhea issues, make sure your child remains properly hydrated, and get him or her back to feeling fine as quickly as possible.
- Caring for a child with an ostomy. SUNY Upstate Medical University, University Hospital Web site.http://www.upstate.edu. Accessed November 29, 2007.
- Borkowski S. Pediatric stomas, tubes, and appliances. Pediatr Clin North Am. 1998;45(6):1419-1435.
- Ostomy nutrition guide. University of Pittsburgh Medical Center website. http://www.upmc.com/patients-visitors/education/nutrition/Pages/ostomy-nutrition-guide.aspx
- Garvin G. Caring for children with ostomies. Pediatr Surg Nurs. 1994;29(4):645-654.
- Gray EH, Blackinton J, White GM. Stoma care in the school setting. J Sch Nurs. 2006;22(2):74-80.
- Information about specific surgical procedures: ileostomy. The Children's Hospital of Philadelphia Web site.http://www.chop.edu. Accessed November 29, 2007.
- Clark J, reviewer. Ileostomy Guide. United Ostomy Association. 2004.
- Ostomy: adapting to life after colostomy, ileostomy or urostomy. Mayo Clinic website. http://www.mayoclinic.org/diseases-conditions/colon-cancer/in-depth/ostomy/art-20045825