Ostomy care instructions

When to empty and change your child’s ostomy pouch

Emptying the pouch

You will need to empty your child’s pouch when it is one-third to one-half full.

If you have a drainable pouch with spout, you may want to use a syringe to empty it. Otherwise, you can empty it into a basin, into a diaper or directly into the toilet.

Have a piece of toilet paper or a wipe to help wipe the end of the pouch to prevent soiling when you close the pouch.

Changing the pouch

Plan to change the whole system every three to four days or twice a week or if it leaks. You may extend your child’s wear time if the skin around the stoma remains intact. If there are any signs of redness, skin irritation (e.g., rash, moist skin, ulceration) then increase the frequency of the pouch changes until the skin is healed.

Tips for changing your child’s ostomy pouch

• At first, it might be easier to change the pouch when someone else is nearby to help you.
• If possible, change the pouch when the stoma is less active. This will depend on when your child has eaten. Before eating or drinking or at least two hours after are usually good times.
• Some find it helpful to change the pouch after a shower.
• There is a lot to remember. Keep a record of questions you have, information you have been given, and if you want, photos of your child’s stoma.

Preparing to change your child's ostomy pouch

• Gather all your supplies.
• A soother and/or toy can help to distract your child and keep them occupied.
• If the pouch needs to be changed and your baby is very upset or crying, wait until they are calm.

How to change your child's ostomy pouch

Remove the used pouching system

Note: Full-term infants are born with skin that is similar to that of an adult. Premature infants have skin that is more sensitive. This means that they are more at risk for skin breakdown.

1. Carefully lift an edge off the flange and gently push the skin away from the flange as you peel.
2. Clean the stoma and peri-stomal area (skin around the stoma) with water and a soft cloth. Rinse and dry thoroughly. Avoid use of baby wipes near the stoma as they have moisturizers that can be left on the skin and make it difficult for the pouch to stick well.
3. Do not use oils, baby powder, lotion or lotion-type soaps on the skin as they can leave a residue on the skin.
4. Observe the stoma and the peri-stomal area.
• The skin should always be healthy and free from any signs of redness or irritation. The skin should appear similar to the rest of the skin on the abdomen. Some redness after the device is removed is normal (after removal of the adhesive) and will disappear shortly after removal.
• The stoma should always be red in colour, moist and smooth.
• Right after surgery, the stoma is often swollen. The stoma size will decrease as the swelling subsides. Measure your child's stoma with every pouch change for six weeks after surgery.
• The opening of the flange should be 1/8 inch larger (2 mm) than the base of the stoma.

Prepare the skin barrier and pouch

5. Measure the stoma using the measuring guide.
6. Trace the pattern onto the flange and cut the flange to match the pattern.
7. Apply stoma powder if skin irritation is present.
8. Apply non-sting barrier spray, or wipes, on the peri-stomal area.
9. Apply a barrier ring around the stoma.
10. Remove the backing from the flange and place the flange around the stoma.
11. Attach the new pouch.
12. Close the pouch.
13. Hold your hand over the pouch for two to three minutes. This will help the barrier ring and flange stick to the skin.

For more information about changing your child's ostomy pouch, please see the below videos.

How to change a one-piece system

How to change a two-piece system

Managing gas and odours from an ostomy pouch

Gas is a common concern, especially with colostomies.

It is normal for babies to produce more gas than adults. They swallow large amounts of air during sucking and crying. Assisted ventilation also produces extra air. Too much air in the pouch can break the seal.

Pouch changes to manage gas and odours

If you or your child are concerned about the amount or odour of gas in their ostomy pouch, there are some adjustments you can make to the pouch to help. For example, you can use a pouch with a filter or use a two-piece pouching system.

Pouch filters

• Pouches with charcoal filters allow for a slow release and deodorization of gas from the pouch. There should never be an odour from the pouch, but if there is, you will need to check the seal.
• A pouch with a filter can also decrease the number of times you need to empty the pouch and increase pouch wear time. But once the filter gets wet, it does not let gas pass through.
• So that the filters don’t get wet, they should be covered with a sticker (stickers are enclosed in the box of pouches) when showering, bathing or swimming. Loose or liquid stool can ruin the filter too.

Two-piece pouching system

• Two-piece pouching systems provide the flexibility to use different-sized pouches for day and nighttime. This is especially helpful when gas and/or larger volumes of stool are a problem overnight.

Diet

You can help manage your child's gas by being mindful of the foods they eat.

Be aware of potential gas-producing foods:

• vegetables of the cabbage family
• broccoli
• asparagus
• sweet potatoes
• onions
• milk and milk products
• strong cheeses such as Roquefort, Brie
• melons
• dried beans and peas

Foods that tend to produce odour:

• fish
• chicken
• fried eggs
• onions
• beans
• vegetables of the cabbage family

Foods that may reduce odour:

• yogurt
• buttermilk
• cranberry juice

When to ask for help and who to contact

Please contact your health-care provider and/or Wound, Ostomy, & Continence (WOC) Nurse if you notice:

• changes in appearance of the stoma, and it is affecting drainage
• that the stoma is bleeding more than a small amount or will not stop bleeding
• decreased length (stoma retraction below skin level)
• narrowing of lumen (the hole where stool comes out from in the stoma) that impacts drainage of stool
• changes to the amount or consistency of stool
• difficulties with pouch adherence on the skin (e.g., increase in leakage)
• difficulties with skin, such as rashes, due to leakage from the ostomy pouch

Please return to nearest Emergency if:

• The stoma changes in coloration—e.g., the stoma becomes purple or black or pale.
• Your child is not peeing or has low output of stool in their pouch.
• Your child's belly becomes firm and bloated.
• Your child has a fever of 38.5°C (101°F) or higher.
• Your child is crying non-stop or otherwise seems to be in pain.
• Your child has green vomit, even once.
• Your child is unusually sleepy.

Contact information

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