10 Tips for Your Baby’s Colostomy Care

By Bea Smith for Preemie Babies 101

Colostomy care.  Not exactly covered in any parenting class.  My son Caleb was born with VACTERL and required a colostomy at two days old.  He had his reversal at nine months old.  These are the tips and tricks I learned about colostomy care and bag changes.  Always discuss any change to your recommended or prescribed treatment with your health care provider.

1. Find what works for your baby.  Start by checking out the Hollister and Convatec websites.  There you will find information, instructional videos, printable pamphlets, FAQs, resources, supply catalog, and you can order free samples.  Your medical supply company will have a catalog and should be able to provide free samples as well.  The rest is trial and error.  We tried both pediatric starter packs from Hollister and Convatec, ordered free samples of products we thought might work, and tried different combinations before finding the right one for Caleb.  It is tedious, but it is worth it.
2. Speed and preparation.  Changing a colostomy bag in the NICU is one thing; changing a colostomy bag at home alone with a squirmy baby is another.  If you have other children, they will learn this is the opportune time for mischief.  Cut down on the steps required to change the bag.  Pre-cut the holes in the wafer, pre-stick the bag onto the wafer (if using a two piece system), and pre-feather the wafer.  Then mash the barrier ring onto the wafer.  Open anything you need open and have all your supplies within arms reach.  When it comes to changing time: toss the old, wipe with saline wipe, pat dry, apply skin protectant, apply barrier-wafer-bag combo, tape, and done.  Make packs of the wafer-bag combo, saline wipe, skin protectant wipe, barrier ring, gauze, and tape.  Put a few in the diaper bag and extras in each car.  Hand sanitizer and extra clothes are a must.
3. Dial soap and saline wipes.  Regular baby soap and wipes leave a film that make it harder for the wafer to stick to the skin.  Washing the stoma area with Dial soap or cleaning with a saline wipe will not leave a film and will help the wafer adhere better.  Dry well.
4. Filter.  A bag with a filter helps let the air out and prevents it from blowing the colostomy bag up like a balloon.  Genius.
5. Cut outside the lines.  Many wafers have a printed circle where you should cut the hole for the stoma.  For most wafers, the hole can be placed anywhere and the wafer can be trimmed to a more suitable shape – as long as the bag can completely fit on the wafer.  If your baby has a mucus fistula, it may be located very close to the stoma for the colostomy.  Positioning and trimming the wafer along with strategic placement of the hole is key.  Bonus: a stoma and mucus fistula should not be bagged together.  If the mucus fistula does not produce a lot of discharge, a band aid is sufficient and the wafer can cover the band aid (reinforce with tape as that portion of the wafer will not adhere as well).  For those fistulas that require a bag, consider using one large wafer, cutting two holes in it, then bagging separately or try positioning, trimming, and strategically placing the hole on each.

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