Your baby and their stoma

What is a stoma?

A stoma is an opening on the tummy where the bowel is brought to the skin surface and allows poo to come out. Your baby will need a general anaesthetic and an operation to have a stoma formed. The nurses and the doctors will explain this all to you in more detail. Some stomas are formed using the small bowel allowing the poo to drain out of the stoma instead of going through the large bowel and rectum. These can either be a:

• jejunostomy (where the jejunum part of the small bowel is used to form the stoma)
• ileostomy (where the small bowel called the ileum is used to form the stoma)

Stomas formed using the large bowel are called a colostomy.

Babies will often have 2 stomas of bowel brought to skin surface. 1 stoma will be where the poo comes out through. This is known as the ‘proximal’ stoma. The other stoma is the distal stoma which is where the bowel goes to the rectum from the stoma. This is also known as the ‘mucous fistula’.

What is stoma care?

After your baby’s stomas have been formed, they will need to be monitored. A paraffin gauze dressing (Jelonet©) will be applied over the stoma to keep it moist until it starts to work and produce poo.

When the stoma begins to produce poo, a stoma bag will be put on the stoma to collect the poo. The nurses and doctors will monitor, measure and record the amount of poo that drains from the stoma. We call these stoma losses.

How do I put on a stoma bag?

The nurses will show you how to put a stoma bag on, and then help you to do this until you are confident to do it on your own.

To put on a stoma bag you will need:

• warm tap water in a bowl (not soapy)
• dry wipes for cleaning the skin around the stoma and for drying the skin
• special adhesive remover wipes or spray which helps to lift the stoma bag off the skin gently
• special adhesive cream or spray that helps the stoma bags to stay on the skin
• stoma bag (you can warm up the base of the stoma bag between warm hands, to help it to become more pliable and flexible to stick on the your baby’s skin)
• scissors

How to put on the stoma bag:

1. Wash your hands.
2. You may need to empty your baby’s stoma bag before you remove it, if they already have one on. You can use a 20ml syringe and a special tube called a ‘quill’ to remove the poo from the stoma bag or just squeeze the poo out of the bag into your baby’s nappy.
3. Gently remove the bag using the adhesive remove wipes or spray. The skin may look slightly red underneath the stoma bag.
4. Prepare the new stoma bag by measuring the base of the bag up to the proximal stoma. Cut a hole using the scissors. The stoma should be able to fit snuggly into the hole you have cut but not be too tight. There should be no more than a 2mm gap around the stoma. If the mucous fistula is very close to the proximal stoma you can cut a hole big enough to fit both stomas in.
5. Clean the stomas and around the skin with water, checking the skin condition. The stomas should be red in colour and the skin around the stomas should look healthy . The skin should not look sore or broken. When the skin around the stoma is clean and dry, apply the adhesive cream or spray on to the skin around the stoma where the bag will be put on, and allow to dry.
6. Remove the protective covering off the stoma bag base and apply the bag over the stomas on to the skin by gently pressing the base from the centre to the edges. When applying the bag, aim to have the end of the bag in a downwards position which will help the poo to drain out into the bag, and it will make it easier to empty the bag.
7. You will need to fold over the end of the stoma bag or apply a special fastening to the end, depending on the type of stoma bag you baby needs, to stop the poo coming out.
8. You can save the protective covering to use as a template to help you cut the base for other stoma bags that your baby will need.

Why is it important to monitor my baby’s stoma losses?

We will measure and monitor your baby’s stoma losses because this will help us to assess how your baby is progressing, help to prevent problems developing and understand what are normal stoma losses for your baby. We will look at the amount of poo your baby produces, the colour and the consistency as this helps us with monitoring your baby.

What medicines will my baby need?

Sometimes your baby may need medicines because they have a stoma. These can be loperamide and sodium supplements.

Loperamide

Loperamide medicine will help to slow down the amount of poo.

Sodium supplements

If your baby’s has a lot of stoma losses, they can loose a lot of fluid and minerals like sodium and potassium which are also known as electrolytes. We will check your baby’s wee every week to check their sodium levels. If the sodium levels are low in the wee, we may need to give your baby sodium as a medicine to help replace the sodium that is lost through the stoma losses.

What problems might my baby have with a stoma?

Prolapse

A prolapse of the stoma happens when the bowel pushes through the opening in the skin more than it should do. A small prolapse is okay if the stoma remains red in colour and continues to work.

Bleeding

A small amount of bleeding from the stoma is normal.

Sore skin around stoma sites

Sometimes the skin around the stoma may become very red, sore or broken down.

Dehydration and diarrhoea

If your baby gets diarrhoea, they can become poorly and dehydrated very quickly. They may need to given extra fluids and electrolytes to help replace fluid and minerals that have been lost.

What creams can I use on the skin around the stoma?

Sometimes your baby may not be able to have a stoma bag put on a stoma. This may be because the skin is sore or the stoma bags will not stick.

If your baby can not have a stoma bag on, they can have creams put on the skin around the stomas to keep the skin healthy, or to help heal the sore or broken skin. There are many types of creams we may use including the following;

Metanium©

This is a thick yellow paste which you can put on the skin around the stoma to protect the skin from the poo and to soothe red and sore skin.

Orabase paste and orahesive powder

This can be used on very sore, wet and broken skin. It helps to heal and protect the skin as it works like a barrier preventing the skin becoming more damaged.

Ilex paste

We can use this paste on broken or non broken skin. It prevents and treats sore, irritated skin. We use soft paraffin with Ilex.

Medi Honey

This can be a wound gel or a honey infused antibacterial dressing. It can used on broken down or sore skin. It helps with healing by protecting the skin. The antibacterial dressing helps by absorbing any fluid coming from the sore skin which helps with healing