In this section
There are a range of conditions that may require stoma formation including anorectal malformations, Hirschsprung disease, intestinal atresia, necrotizing enterocolitis, inflammatory bowel disease, cancer, bowel obstruction and spontaneous ileal perforation. The stoma
formation may be in response to a single congenital malformation or in the context of a more complex condition or injury. In some situations, the stoma may be closed prior to discharge from hospital, alternatively the patient may be discharged home with the stoma in-situ.
Post-operative management of the child depends on their age, underlying condition and the procedure performed and may include monitoring of fluids and electrolytes, as well as management of nutrition and pain relief. Another focus of care is the successful re introduction
of enteral feeding. The success of enteral feeding is dependent on multiple factors, including the pre-operative condition and age. Post-operative complications may be related to wound healing ability, length and type of gut retained, further deterioration of surviving gut, stricture formation and
sepsis, as well as individual characteristics. Each of these may impact on the child’s hospital journey.
To guide practice for all children returning post-operatively with a stoma including:
Colostomy: a part of the large bowel is diverted out through the abdomen.
Ileostomy: a part of the small intestine is diverted out through the abdomen (usually on the right side of the abdomen. Output is liquid and may look undigested.
Jejunostomy: more proximal small intestine section brought through the abdomen. Output may be very watery and corrosive.
Mucous fistula: the other end of the non-functioning bowel brought through the abdomen – the distal bowel end.
Stoma: comes from the Greek word meaning mouth or opening. Often on the abdomen, may be connected to the intestine or urinary system.
Mucocutaneous Junction (where the stoma meets the skin)
Periostomal skin (the skin around the stoma)
If you are concerned about the appearance of the stoma, please notify the medical team.
Stomal Therapy consultants should receive an EMR referral from the surgical team when a stoma is newly formed. Nursing staff caring for an infant with a stoma should ensure this has occurred so the infant may be followed-up and reviewed as required.
Stomal Therapy are involved in education for parents and children with stomas and provide the education they require for discharge home safely and organise their linking in with Ostomy associations.
Stomal therapy should be notified if complications arise and when needing advice regarding dressings or product modifications are required. Stomal therapists do not attend routine dressing or bag changes.
Nursing staff should check all patients with a stoma have a referral to stomal therapy in place.
There are 2 Stomal Therapy Departments within RCH
For patients admitted under CPRS – Hirschsprung's and Anorectal Malformation.
Contact stomal therapy: Colorectal and Pelvic Reconstruction Service:
For all other patients.
Contact NDD stomal therapy on:
Phone 3945 5338
Neonates/infants on Butterfly
If the wafer and bag are secure with no evidence of leakage, the bag can be opened from the bottom and emptied every 4 hours. Document output on the fluid balance flowsheet.
For neonates a syringe with white tipped aspirator may be used to remove contents.
Inpatient wards should have some ostomy appliances and supplies, but you may need to contact the Stomal Consultant for further products.
Neonatal and Pediatric appliances in Australia are available from 5 companies. There are Hollister Premmie Bags™ available to be used in the premature neonatal population.
Please note this is a guide only, often application of a bag/appliance requires an individual approach. Follow all documented plans by stomal therapy. Peristomal skin issues, such as excoriation, should be reported to stomal therapy as these patients this may
require additional input/support.
Inform patient/parent and prepare the patient. See
procedure management guideline.
Perform hand hygiene, and onto a clean trolley or work surface
A stoma dressing may be insitu if a stoma is inactive or if an appliance is unable to be used for example in cases of extreme excoriation of peri-stomal skin due to bag leakage or inverted or flush stomas.
The aim of the dressing is to keep the stoma clean and moist and to measure fluid losses while assessing integrity, healing and identifying emerging complications.
Complications that may occur can involve the stoma itself, the surgical wound or the peri-stomal skin. For ongoing assessment and handover purposes, the Rover/Spectralink device can be used to photograph the stoma and be uploaded to the Media section of the
medical record with linkage to LDAs.
As enteral feeds are introduced, other complications may emerge, such as pre-stomal obstruction, strictures and feed intolerance for a variety of reasons that will need medical and/or surgical management. Report to medical staff/ANUM/stomal consultant episodes of vomiting and changes in output volumes or
appearance. Blood in the effluent is never normal and must be investigated urgently.
Signs and symptoms of feeding intolerance include increasing gastric residuals, emesis, abdominal distension, visible loops of bowel, altered stool characteristics
High loss stoma
Neonates with stomal losses require frequent and regular evaluation of their fluid and electrolyte status to prevent complications. Refer to 'Replacement of neonatal gastrointestinal losses' NICU department guide for further information.
Patients outside the NICU who experience high stomal losses may also need fluid replacement, this should be administered as per the medical team and should include regular monitoring of fluid and electrolyte monitoring.
It is appropriate that parents/carers are educated on the basic care requirements and identification of stoma complications as often parents are willing and able to attend to the stoma care needs of their child while they are inpatients.
Adolescents are encouraged to learn how to care for the stoma and change the appliance independently.
Infants and children may benefit from medical play and distraction provided by child life therapy and/or comfort kids, refer as appropriate.
Stoma education may begin as soon as the child/adolescent and parents/carers are willing to begin. However, it is important to note that not all adolescents or parents/carers are willing to participate immediately and will require support to build confidence.
Adolescents and parents/carers of child who are being discharged with a stoma will be required to learn to care for the stoma before discharge. Care co-ordination and stoma support services are available for any child going home with a stoma.
Occasionally a child may be ordered a stoma refeeding regime, this should always be medically/surgically initiated please see this link for further information.
Please click here for further information regarding Stoma refeeding.
New Stoma bags are required to be applied to all in-patients prior to going to surgery.
Cardiac Theatre stoma care
The patient’s stoma area will be included in a pre-op wash using 2% Chlorhexidine Gluconate wash cloth, taking care not to touch the stoma site. A Raytec® gauze (with the radio-opaque thread visible) and large Tegaderm ™ are then placed on the stoma and bag to seal the area prior to
prepping. The Raytec® will be on the surgical count. The patient will then be prepped and draped as routine for Cardiac Surgery.
Images courtesy of Butterfly Unit.
surgery stoma care
If the patient’s stoma is not being closed, but the stoma will be within the surgically draped aseptic field, hand hygiene is performed, the stoma bag removed and then a pre-wash of Chlorhexidine 0.05% and Cetrimide 0.5% applied. A Raytec® (with the radio-opaque thread visible)
and a large waterproof dressing, such as a Tegaderm ™, are then placed on the stoma to seal the area prior to prepping. The Raytec® will be on the surgical count.
If the patient’s stoma is to be closed, hand hygiene is performed, the stoma bag removed and then a pre-wash of Chlorhexidine 0.05% and Cetrimide 0.5% applied. The stoma site is left undressed.
If the patient’s stoma is not within the surgically draped aseptic field, the stoma bag may not be removed - instead left in place and draped over appropriately.
View the evidence table for this guideline
Please remember to
read the disclaimer
The development of this nursing guideline was coordinated by Ret Pinnuck, Stomal Therapy/Continence CNC, and approved by the Nursing Clinical Effectiveness Committee. Updated March 2023.