Parents of children with stomas have to be very cautious about their stoma and peristomal skin health because it is the area that has to support the weight of an ostomy pouch.
Intestinal stoma care is needed for neonates who suffer from congenital bowel conditions and Necrotising Enterocolitis (NEC). These temporary stomas remain there for up to 12 months. Older children and adolescents will also need intestinal stoma care. These children usually suffer from conditions such as Crohn’s disease and ulcerative colitis.
There are two types of intestinal stomas: colostomy and ileostomy.
- A colostomy brings a part of the colon out through a cut in the belly, creating a stoma.
- An ileostomy also creates a stoma but by bringing a part of the small intestine or ileum.
Referral to the stoma therapist
Parents will need to refer to a stoma therapist as soon as the child is admitted or is already an inpatient, waiting for the stoma surgery day. A stoma therapist will:
- Advise and assist the nursing staff in teaching parents, caregivers, or children how to take care of a stoma
- Provide information on how to contact a local community stoma therapist for ongoing stoma care support
Caring for a new stoma
Parents need to meet a stoma care nurse within the first five days of the occurrence of stoma necrosis. They will observe, assess, and document the stoma status in response to the following conditions.
- Perfusion
- Bleeding
- Skin integrity
- Prolapse
- Problem attaching an ostomy pouch
- Stoma retraction
- Signs of infection in the incision wound
Stoma output
During the first couple of days after surgery, the stoma output will be watery. The colostomy output will tend to be semi-formed.
- You will need to report to the medical staff if the ileostomy output is greater than 20-30mls per kg per day.
- Report to the medical staff if the output is greater than 30-49mls per kg per day.
Removing the ostomy pouch
While removing an ostomy pouch,
- Use warm water and a soft cloth
- Peel the skin barrier downwards
- push down the skin and lift the flange up
After removing the skin barrier, pat the peristomal skin dry.
Applying the ostomy appliance
A stoma therapist will recommend the right ostomy pouch for your child. Be sure to follow a few standard steps while applying a new ostomy pouch.
- Clean the skin with warm water. Pat it dry and use the skin barrier cream if needed.
- Use a flange cutter to create a hole in the ostomy barrier. Make sure that the hole is of the exact shape and size of the stoma.
- Smooth rough edges of the skin barrier’s hole by running a finger through it.
- Use your palms to warm the skin barrier. It will ensure a good seal.
- Place the skin barrier on the peristomal skin and smooth down at the edges.
Skincare
Ensuring skin integrity of the area around the stoma is crucial for comfortable stoma management. Skin complications in the peristomal skin area occur due to contact with fecal materials, moisture, and chemical or biological irritants. Ensuring proper adhesion of the ostomy appliance is the best way to prevent any skin complications. You may need to speak to your stoma therapist to get information on what to do to avoid these complications.
