Enterostomy care in pediatrics involves managing a surgically created opening (stoma) from the intestine to the abdominal wall, allowing stool and gas to exit the body. This care is essential for maintaining skin integrity, preventing infection, and supporting the child’s comfort and development.
An enterostomy is a surgical procedure in which the small intestine is diverted to an artificial opening in the wall.
Indications for Enterostomy Care in Pediatrics
| Condition | Rationale for Enterostomy |
|---|---|
| Intestinal atresia or malrotation | To bypass or decompress obstructed or malformed bowel segments |
| Necrotizing enterocolitis (NEC) | To divert stool from inflamed or necrotic bowel and allow healing |
| Hirschsprung’s disease | Temporary diversion before or after pull-through surgery |
| Anorectal malformations | To allow stool passage before definitive repair |
| Perforated typhoid ileitis | To manage peritonitis and prevent fecal contamination |
| Intestinal gangrene or ischemia | To remove nonviable bowel and divert fecal stream |
| Anastomotic dehiscence | To protect surgical sites and prevent leakage |
| Abdominal trauma | To manage bowel injury or perforation |
| Short bowel syndrome | To manage high-output states or facilitate adaptation |
Equipment Needed
- Drainage pouch
- Adhesive skin barrier
- Ostomy ring
- Skin barrier powder
- Pair of gloves
- Gauze pieces in a bowl
- Receptacle for collecting waste
- A jar with warm water
Procedure
- Wash hands and wear gloves.
- Remove the pouch and skin barrier gently by holding the barrier with one hand and pushing the skin with other hand.
- Keep a gauze piece over the stoma to contain bowel contents during the change of appliance.
- Remove if there is any residue present on the skin with dry gauze piece.
- Wash the skin around the stoma with warm water and dry.
- Apply the adhesive skin barrier firmly to the infant’s skin.
- Apply the drainage pouch to the barrier device.
Aftercare
- Clean and replace the articles.
- Wash hands.
- Document the procedure with the date of changing the appliance.
- Mention the observations made.
Nursing Considerations
The condition of stoma should be assessed during each shift. Inspect the stoma for the following:
- Color: Should be bright pink to beefy red and moist.
- Size: the stoma becomes edematous when exposed while changing the pouch and resolves quickly when it is replaced.
- Function: Note the consistency, color, and amount of drainage.
- Skin: Note the integrity of skin surrounding the stoma.
- Check the pouch frequently for any leakage.
- Report to the doctor if there is any prolapse of stoma (>1 inch above the skin level) or if there are any abnormal findings such as rashes, skin damage, and bleeding.
- Ostomy usually becomes active for drainage within 48-72 hours after surgery.
- If the pouch is heavily soiled or foul smelling, then need to rinse it thoroughly and reuse.
- Pouch should be changed prior to feeding child so that drainage from stoma can be reduced during appliance changes.
Special Considerations
- Neonatal skin is fragile—use pediatric-specific products.
- Stoma swelling is normal for 6–8 weeks post-op.
- Avoid pressure on the stoma site during diapering or positioning.
- Report any stoma prolapse (>1 inch), retraction, or bleeding.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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