Parent & Baby Series- Q&A with Nurse Michelle

Hi everyone,

My name is Michelle, I look after babies and children who have had or are due to have a stoma formed. I wanted to share the answers to the top 6 questions I've received from parents and carers through my years of nursing:

Why does my baby’s stoma bag leak?

When a baby has a stoma formed there can be issues with the pouches leaking. This can be due to various reasons, one of the main reasons is the scars from surgery which make the tummy uneven, causing loose stools to leak along these tracks created by the scars. If you’re concerned about the amount your baby’s stoma is leaking, check in with your stoma care nurse.

How can we avoid our baby getting sore skin around their stoma?

Skin around the stoma can often become sore and there could be a few different reasons why. Sore skin may be the result of the pouch is not fitting correctly around the stoma spout. I find it really important to teach parents how to cut the template to the correct size as well as recognise the signs of when the skin is starting to become irritated.

Another factor of sore skin may be that the pouch is left on for too many days. As nurses, we use a special powder for sore skin, and we teach parents how to apply this to help protect and health the area. It’s important address the sore skin before applying a new pouch, as sore skin can affect how to pouch adheres to the skin.

Just as we do with parents, we also educate these important issues to teenagers, young people and adults to help them be pro-active in their stoma care.

Can my child still attend school/nursery?

There is no reason why a child cannot attend school or nursery. It’s important to speak to your child’s education provider to make them aware of your child’s health care needs. Teaching at the child’s school/ nursery can be carried out to ensure staff involved with the child are trained to be able to change the pouches and observe for possible concerns.

Can my child take part in physical activity?

Physical activity is a large part of children's education and childhood and many parents fear that their child cannot participate in physical activity once they’ve had a stoma formed. This is not the case, there are items such as support waistbands/ shields or support belts which enable children to continue with physical activity. Parents may also worry about their child taking part in swimming, or school trips. To help ease their mind, I recommend creating a travel bag of spare stoma supplies as well as any comfort items such as a support belt.

What is a parastomal hernia?

Parastomal hernias occur when there is a defect allowing loops of the bowel to protrude in an area of weakness in the torso. With babies, hernias may appear as they use a lot of accessory muscles during development, such as while they’re crying. I advise observing the colour of the stoma to check for signs of strain as well as keeping an eye on the baby’s output as it can also be affected by the presence of a hernia. My suggestion of a small waistband or support belt may try to prevent a hernia increasing in size.

Hernias may cause an issue with adhering a pouch. If parents are struggling to adhere a pouch due to a hernia, I recommend looking into a washer or a convex pouch to aid the smooth application and help to avoid the pouch leaking due to an uneven surface.

Will my child have lots of dietary requirements?

This is one of the biggest questions I get asked, especially when parents start weaning babies. It’s always important to check with your surgeon as some may be happy to let babies with a stoma explore foods such as baby rice as early as 4 months but their dietary requirements may be different depending on what type of stoma they have.

As children get older, their dietary requirements will change and it’s important to speak with your stoma care nurse or doctor to ensure you’re aware of foods that may change their output or that may cause an obstruction.