Step One – Remove the old bag and clean baby up. I generally use a warm wet washcloth. Find the area where the bag is coming off of the skin and gently remove the bag from the skin. Similar to a Band Aid, once you get under the bag and have a firm grasp, it is best to quickly “tear it off like a Band Aid”. We keep a grocery bag close by to dispose of the old bag and any trash from the bag change so we can tie it up and put it outside in the trash when we’re done.
In the beginning we solely gave Jack a sponge bath. Then at about 8 weeks, we got brave and put him in the bathtub. He LOVES the bath! Don’t be afraid to bathe your baby just like any other child. You can do it with or without the bag. We prefer to do it without. Just be careful with the stoma, do not rub or scrub the stoma, work around it. Soap and water will not hurt it.
Step 2 – Dry your baby off carefully and swaddle his/her arms. Our home nurse taught us this trick on her first visit. See Infant Arm Swaddle post for directions. Swaddling has a calming effect on most infants and it helps to restrain their arms while you are working on their tummies. A pacifier and some gripe water in a syringe are also helpful tools to keep baby calm while you are changing the ostomy bag.
Step 3 – Dry the area surrounding the stoma. We use a soft cotton clean dry washcloth to pat the skin dry surrounding the ostomy. Then, we take the hairdryer, put the temp on cool and setting on low, gently dry the area around the stoma, working around the stoma.
NOTE: Jack’s skin surrounding his stoma is more red than usual in this picture. This pic was taken when Jack was 6 weeks old and going through a fussy period related to a growth spurt. One thing to keep in mind is that the more baby fusses and cries, the more belly movement is created, which in turn will cause the wafer to come off of the skin and the ostomy bag to leak. We were changing bags several times/day during this time. Thankfully growth spurts don’t last very long. You kind of have to just ride it out. That being said, a lot of people gave us the old fashioned “cry it out” advice. Right or wrong for most babies, “cry it out” is not a great option for babies with ostomies or their mom’s and dads who have the nerve wracking task of dealing with leaky bags in the middle of the night. Less crying = less bag changes. You will have nights where you are up all night comforting a fussy newborn and you will feel like you are losing your mind. It will pass, rock that baby, nurse him/her, do what you have to do to keep them calm. It will benefit you and your sanity in the long run.
Step 4 – Apply ostomy powder to the skin surrounding the stoma (ONLY use powder specific to ostomies from your medical supplier, DO NOT use baby powder). Use your clean dry finger to spread the powder around the skin making sure to cover the whole area that the wafer will cover right up to the edge of the stoma. The powder helps to protect the skin from the adhesive, while creating an extra dry surface that will also help the adhesive to bond better. It seems counterintuitive, but it works!
Before applying the wafer brush or lightly blow off any excess powder from the skin.
Step 4 – Prepare the wafer. Start by cutting a hole in the wafer to match the size of the stoma using a small pair of scissors. By the time you leave the hospital, you usually have a template created by your nurses. If you do not, ask them to help you make one before you leave.
Once you have your hole cute, remove the paper backing. Turn your hair dryer on med-high heat and warm up the wafer. Warming the wafer up before applying will help to soften it and make it sticky to adhere to the skin. Just make sure that you check the temp of the wafer before applying to baby’s skin. You want to make sure it is not hot, just slightly warm and soft.
Just before applying the wafer, using a 10mL syringe, apply a loop of ostomy paste around the inner circle of the wafer. I like to apply it to the side that sticks to the skin. This creates a seal between the stoma and the wafer and the skin. It helps to keep the poo away from the skin. Before applying to the skin I like to give the wafer with the paste applied one quick pass with the hair dryer just to get everything soft and sticky.
Step 5 – Carefully apply the wafer to the skin surrounding the stoma. The stoma should sit, sealed by the paste, sticking out of the middle of the wafer.
Step 6 – Smooth the wafer to make sure that it is flat, sealed and sticking to the skin at all points surrounding the stoma.
Sometimes when baby is really little, it’s hard to get it to lay flat because there isn’t much surface area to work with. As the baby grows, this will be come less of a problem. For some people, cutting small slits around the outside of the wafer helps it to lay flat. For us, the area right at his belly button and directly opposite of that, at the bend of his hip, were the most problem areas. I would make sure that I applied a little extra attention to those areas by holding the wafer down a little bit longer there.
Step 7 – Remove the backing from the foam gasket of a new clean ostomy bag.
This is where you kind of have to pick up the pace so you don’t end up with a poop volcano and have to start all over. Don’t linger too long perfecting Step 6, once you have the bag on you can always go back to inspect the wafer and reinforce.
Carefully center the foam gasket, sticky side down, over the stoma and apply to the wafer. Be careful to get it flat so that it doesn’t bubble. Smooth it around the stoma onto the wafer to create an airtight (and poop tight) seal.
Inspect your work. Most importantly, make sure that the wafer is not coming off of the skin, bubbling or folding. If there is an area or areas that have not yet adhered to the skin, use your hand or a dry warm (not hot) washcloth (warm it up w/the hair dryer) and hold the wafer down on the skin to help it stick. (DO NOT use a hot hair dryer directly on the baby’s skin)
Step 8 – Add a clean diaper and let him/her loose!
Getting the news that your baby needs a colostomy is difficult. Being a new parent and having to learn these new skills along with the adjustments of parenting a new baby is stressful. Reach out for help, ask lots of questions, and if there is any way that I can be of help to you, please feel free to email me: firstname.lastname@example.org . Parent to parent support has been the most valuable support I have found on this journey. I am happy to pay it forward in any way that I can. Good luck moms and dads!