Ostomies are surgically created openings through the body wall that are used for putting substances (fluids, nutrition, medication) into and/or removing substances (stool, urine, gastric contents, gas) from the body. The ostomy’s use impacts the kinds of skin breakdown that can occur. For example, the friction associated with frequently using a gastrostomy tube (G-tube) (see Feeding Tubes & Gastrostomies in Children) for feedings can lead to skin breakdown. Leaking stomach contents can irritate the site, and spilled or leaked formula can support the growth of bacteria and/or yeast, leading to infection. Colostomy sites are exposed to myriad microbes; whereas, vesicostomies are generally exposed to sterile urine. Recent use of antibiotics can predispose wet areas to yeast infection. Forceful removal of adhesives or reactivity to skincare products can also cause skin irritation and breakdown.

1. A new ostomy needs time to heal. The surgeon who places the ostomy should explain expectations for healing and provide instructions for post-op care and response to problems, such as when a G-tube gets pulled out.
2. Make sure that there are adequate emergency supplies at home in case a tube replacement is needed. Gastrostomies can close rapidly, so it is important to replace a tube quickly if dislodged.
3. Make a plan for care of the stoma and surrounding skin. For many people, regular cleaning with gentle soap and water or saline and drying is adequate to prevent skin irritation and breakdown. For others, a barrier may be needed, such as a diaper rash ointment or skin protectant. There are many commercial products, such as hydrogel, that some experts recommend to reduce the need for frequent dressing changes; however, there is no clear evidence for using one over the other. Not all methods will work for every person. [Pars: 2018]
4. For ileostomies and colostomies, crusting (using stoma powder layered with skin barrier wipes) can create a protective barrier that the stoma wafer (an item that sticks to the skin on one side and anchors the ostomy bag on the other) can adhere to instead of adhering directly to the skin. This may be helpful for some children, especially during times of inflammation, although there is little evidence for its routine use in pediatrics.
5. For tracheostomy and gastrostomy sites, pads, adhesives, ties, protective clothing, or binders can be used to stabilize the tube and reduce friction at the site, which can lead to leaking and irritation. Leaking tubes should be replaced and refitted as necessary to ensure a good fit.
6. Granulation tissue can occur where the skin has been irritated repeatedly. This is a type of interim skin that grows in during early wound healing; when it overgrows, it can be uncomfortable and unsightly and can bleed easily, and too much of it can block the tube site. Once formed, granulation tissue can be treated with topical steroids, such as triamcinolone cream, or with silver nitrate sticks. A small, non-randomized study in Japan offered an alternative approach using a small amount of salt on the granulation tissue. [Tanaka: 2013] There is a lack of high-quality evidence to guide selection of one of these approaches over another. [Townley: 2018] Depending on the clinician's evaluation, further interventions including antibiotics, antifungals, acid suppression, steroid injections, and surgery may be considered. Poor response could result if there is infection, ongoing irritation, or too large a mass of tissue. Treatment should address the likely cause(s), and surgical consultation may be needed if overgrowth continues.