• After surgery on the small intestine, a large number of babies will have a temporary intolerance to lactose (Shaw & Lawson 2007). Ileostomy output is normally loose; however, if lactose intolerance occurs, the effluent will be extremely loose/watery, greater in volume, and test positive to sugar, increasing the risk of dehydration and failure to thrive. Many will initially be fed by total parenteral nutrition (TPN). Enteral feeding is slowly introduced using a hydrolysed or amino acid formula such as Pregestimil (Mead-Johnson) or Neocate (SHS). These milks are easier to absorb as loss of intestinal length results in loss of surface area for absorption and loss of digestive enzymes (Shaw & Lawson 2007).

• Sodium depletion can be a common problem for babies and children with ileostomies. The ileum is important in absorption of fluid and electrolytes. Losses can be high, especially in sodium (Shaw & Lawson 2007).

• Dehydration can occur very quickly: if the stools are very loose and an adequate oral intake cannot be taken, especially in the case of gastroenteritis, intravenous therapy will be needed (Shaw & Lawson 2007).

• Children with urinary diversions may benefit from eating foods with a high vitamin C content, which helps to keep urine acid. By doing this and drinking plenty of fluids, especially in hot weather, urine is prevented from becoming concentrated. There is some evidence to suggest those prone to recurrent urinary tract infections may benefit from taking cranberry juice, but studies are few in the paediatric population (Kemper 2006). Cranberry also helps to reduce mucus production but is contraindicated if on anticoagulant therapy such as warfarin, as it may enhance its effect (CSM 2004). Diabetics must be aware to take the low sugar variety. Older children may wish to manage their colostomy by means other than a pouch, e.g. colostomy irrigation. This is done by the instillation of warmed water or saline through the stoma via a cone and irrigation equipment. After evacuation of the bowel, a small stoma cap (Fig. 27.1) can then be used instead of a pouch. This system can be used to regulate the colostomy function; however, it is time consuming – up to 1 h – and may need performing daily (Williams 2004). A colostomy plug is again used to gain control over stoma function. This is a soft foam plug, gently inserted into the stoma, often used in association with irrigation (Williams 2004). A stoma nurse must first assess the patient, as not all patients are suitable for these procedures.