Look for these characteristics1:   Red, moist, and soft to the touch 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 and beets may give stool a bright red color that looks like blood. 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 your healthcare provider immediately¹:

• 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 passing stool or urine or when you touch the stoma¹. Once healed, your child can crawl on his or her tummy unless nurses and doctors advise against it. Right after surgery, however, your child’s belly may be tender, but this should lessen each day as it heals.

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 surface⁴.Your nurse, stoma care specialist, or other healthcare professional can give you specific instructions on how to care for each type. Products such as paste or pectin rings 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 can indicate that the stoma is being pinched or cut by a pouch or snug diapers, safety belts, or clothing.

As your child grows, the size of the stoma grows slowly. The size or opening of your child’s ostomy appliance may need to change. Your stoma care specialist will be able to assist you with this⁴.

Typically, the pouch is emptied whenever it is one-third full¹. This will prevent it from becoming heavy and pulling away from the skin, which can make it leak. If the pouch is fuller than this, it will not harm the stoma, but it may begin to lift the adhesive away from the skin. It is often more difficult to empty the pouch when it is too full. Wiping the end of the pouch clean helps avoid odors and clothing stains. Avoid irritation by always making sure the tail closure is not pressing into the skin.

For many parents, it is easiest to empty the pouch into a diaper 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 stool or urine is emptied helps to prevent splashing.

Every child is different, so you should ask your pediatric nurse, stoma care specialist, or other healthcare provider about your child’s unique needs. Pouch wear time often depends upon the child’s size and activity level, and the thickness of his or her stool. Making a regular schedule for pouch changes will help ease the transition to home care. An infant may need a pouch change daily. An older child may only need a pouch change every three to four days.

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.

Any time you notice stool or urine leaking under the skin barrier/wafer, the pouch should be changed to avoid skin irritation. If you need to change it more than once a day, call your child’s nurse, stoma care specialist, or other healthcare provider for suggestions.

Bathing will not hurt the stoma. Many parents choose to bathe their children with the pouch on since there is no way to know when stool or urine will pass from the stoma. They then will change the pouch after the bath. When bathing your child, choose a mild soap that will not interfere with how well the adhesive will stick to your child’s skin⁵. Make certain that the skin is rinsed with water and dried before applying the new pouching system.

A common cause for irritation is when stool/urine sits under the skin barrier/wafer and touches the skin. Sometimes irritation may be caused by the way the ostomy system has been applied. This may be due to a variety of reasons. The opening in the skin barrier/wafer may be too big. The pouching system may not be the right size⁴. Or you may need to use additional products such as Stomahesive^® Paste or pectin rings to ensure a better seal between the stoma and the adhesive. If you have any questions or concerns, or if your child’s skin irritation continues, talk to your pediatric nurse, stoma care specialist, or healthcare provider.

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.

ConvaTec ostomy pouching systems are designed to lie flat on the body so they cannot be seen under most clothing. Little Ones^® pouches can be worn outside or inside diapers or underwear.

• 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 ostomy pouches.
• Be sure that a belt or a waistband does not press firmly against the stoma, especially if it is located at or near the child’s waistline.
• Older girls and teenagers are encouraged to choose one-piece bathing suits that have a pattern design to help conceal the stoma.
• Boys are encouraged to wear boxer-type bathing trunks.

If you have any questions or concerns, it is always best to call your nurse, doctor, or other healthcare provider.

Yes. It can happen any time your child loses too much urine or stool and is unable to replace the fluid⁶.For example, when a child has the flu with diarrhea and/or vomiting, she or he is at risk of becoming dehydrated. Ask your healthcare provider about signs of dehydration. Call your doctor or other healthcare provider if your child has diarrhea or early signs of dehydration, such as when a child⁷

• Has decreased urine output
• Is less active or unusually sleepy
• Has a 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. At first, 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 — slowly and one at a time. 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 dehydration⁴.

Yes. Some foods like cheese, potatoes, breads, bananas, and creamy peanut butter can thicken stools. Other foods can thin stools, such as fruit juices like apple juice and grape juice, and very seasoned foods. Foods like red gelatin and beets can cause stool to change color^3,8.

A food blockage may develop in a child with an ostomy (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 an ostomy to 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 greens³. Ask your healthcare provider about signs and symptoms of food blockage, as this can be a serious condition. Signs and symptoms of food blockage can include²

• 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

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 cabbage-family vegetables can also cause gas³. If the pouch gets too full of gas, it may lift away from the skin and leak. ConvaTec offers pouches with a filter system that can help release gas and minimize odor.

You will most likely learn your child’s usual pattern and type of stool output before your child leaves the hospital. This will help you know when to be concerned about diarrhea. 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?