Introduction
This leaflet provides information on the use of sodium supplements in babies and children who have a stoma (colostomy or ileostomy). This leaflet is intended to supplement advice already given by your doctors and nurse specialists.
What is sodium chloride?
Sodium chloride, also known as salt, is used by your body to help:
- Absorb and transport nutrients
- Maintain blood pressure
- Prevent dehydration
- Transmit nerve signals
- Contract and relax muscles
What is sodium supplementation?
Sodium supplementation is the term used for giving your child a prescribed medicine form of salt called ‘sodium chloride oral solution’ which is taken in addition to any salt included in their normal diet.
Why does my child need sodium supplements?
Supplements are needed when your child’s level of sodium is lower than it should be. There are known links between low sodium levels in the body and slowed growth. By giving a sodium supplement we can help prevent slow growth and maintain normal weight gain.
It is common for children with an ileostomy (stoma formed from small bowel) to need sodium supplements. Some children who have a colostomy (stoma formed from large bowel) will also need supplements.
The faeces that are passed through the stoma are usually of a liquid consistency (especially when the stoma has been formed using the small bowel). This type of stool contains higher concentrations (levels) of sodium than stool which passes through the whole length of the bowel and exits through the anus. Your child is therefore losing more sodium than usual.
How often will I need to give my child the sodium supplements?
Sodium chloride is usually given twice a day, once in the morning and once in the evening. Ideally these doses should be evenly spaced 10-12 hours apart, so usually first thing in the morning and just before bedtime. Sometimes babies and children need more frequent doses, and in that case staff will explain when to administer them during the day.
How will I give sodium supplements to my child?
The sodium chloride is a liquid medicine (‘oral solution’). Unfortunately, because of its salt content it does not taste nice. Attempts at trying to disguise the taste by further diluting the medicine in milk feeds is unhelpful. If you mix the sodium chloride with your baby’s entire feed, not only will your child be unlikely to complete the feed, they may also be put off their feeds for the rest of the day.
We advise that you mix the sodium chloride with a small amount of their milk, or if they are older, a small amount of juice. You can then offer the remainder of their feed straight after.
What are the alternatives?
In older children who refuse to take supplements, additional salt needs to be added to all of their food. This method is less effective than taking the sodium chloride medicine so is usually reserved as a last resort and, when used, is under close review by a children’s dietician.
How long does each bottle of sodium chloride last?
The bottles of sodium chloride oral solution you will be given by your pharmacy can only be used for 7 days once the bottle has been opened.
How do I obtain further supplies?
Further supplies of sodium chloride oral solution can be prescribed by your GP and dispensed by your local pharmacist. Sometimes sodium chloride oral solution may have to be ordered specially and will not be in stock immediately in your local pharmacy.
Please obtain your GP prescription well in advance. If your initial supply of sodium chloride oral solution was supplied by the hospital, it is worth also showing your GP and pharmacist the bottles, which will help them to prescribe and dispense the medication.
How will my child’s sodium levels be checked?
The most effective way to check your child’s sodium level is via a urine test called a ‘urinary sodium level’. This is because any extra sodium that our bodies do not need leaves our body in our urine, and will show up as ‘urinary sodium’. A low urinary sodium result will indicate the need for the dose of sodium chloride oral supplement to be increased.
You will need to collect, or ‘catch’ your child’s urine specimen, and then deliver it to your GP surgery for them to send to the hospital laboratory for testing.
Before you collect the urine sample, we advise that you contact your GP surgery to enquire at what time their specimens are collected each day. This is because the results of urine sodium levels are most accurate when the urine sample reaches the laboratory with the least delay. You therefore need to be able to collect your child’s urine sample and deliver it to the GP just in time for their daily collection. For example if their collection is at lunchtime, you will need to collect and take the sample to the surgery in the morning, but if it is not collected from the surgery until 16:30, then you will need to collect the urine after lunch.
You will need to remember to ask for a new specimen pot every time you deliver a urine specimen to the GP surgery so you are prepared for the next test.
How should I collect my child’s urine?
How the urine sample is collected will depend on your child’s age.
| Age of child: | Method: | Description: |
|---|---|---|
| Age of child: Older child who is toilet trained: | Method: Mid-stream urine collection: |
Description:
- Child’s genitals are cleaned with warm soapy water. - Child begins to wee into the toilet. - Part way through passing urine the urine is collected in a sterile container. - The last part of the wee is passed into the toilet. |
| Age of child: Non toilet trained child: |
Method:
‘Clean catch collection’ (preferred method) |
Description:
- Child’s genitals are cleaned with warm soapy water. - Part way through passing urine the urine is collected in a sterile container which is being held under (but not actually touching) the child. |
| Age of child: |
Method:
Use of cotton wool balls in nappy NOTE: This method must not be used when collecting urine for reasons other than to check sodium levels. |
Description:
Child’s genitals are cleaned with warm soapy water and dried. Do not apply any creams or ointments. - Place 2-3 cotton wool balls in the nappy. - Check the nappy regularly and once cotton balls are wet, wash your hands and squeeze the balls over the specimen container to release the urine. - If the cotton balls are stained with faeces, discard and try again. |
How often will urinary sodium checks be needed?
Following discharge from hospital, checks are usually required every one to two weeks. Once the sodium levels are stable, and your child is shown to be gaining weight well, the frequency of the urine tests will decrease to every three to four weeks. Checks continue until supplements are no longer required (for example, after the stoma has been closed).
What other checks will my child require?
Babies and children with normal urinary sodium levels will usually gain weight and grow normally. Babies and children with low urinary sodium levels tend to not gain weight, and may even lose weight. It is therefore very important that you have your baby weighed regularly either by your health visiting team or at your GP surgery.
Your child’s GP or hospital care team will also need to be informed of your child’s weight in order to be able to calculate the correct dose of sodium chloride to prescribe.
Advice should your child become unwell with a vomiting or diarrhoea illness:
Children with stomas, especially an ileostomy, are at increased risk of becoming unwell due to dehydration when they experience a diarrhoea and / or vomiting illness. Fluid losses that result from the vomiting and diarrhoea lead to the increased loss of sodium. The following are signs to look out for which suggest that an urgent medical review is needed:
- Increased amounts faeces or ‘poo’ – you may notice that you need to empty the stoma bag more often.
- Fewer wet nappies than usual
- Parched, dry mouth
- Fewer tears when crying
- Sunken soft spot of the head in a baby or toddler
- Excessively sleepy
- Sunken eyes
- Cool, discoloured hands and feet
Chaperoning
During hospital visits your child will need to be examined to help diagnosis and to plan care. Examination may take place before, during and after treatment. The examination is performed by trained members of staff and will always be explained to you beforehand. A chaperone is a separate member of staff who is present during the examination. The role of the chaperone is to provide practical assistance with the examination and to provide support to the child, family member / carer and to the person examining.
Who should I contact if I have any queries, concerns or questions?
For further information/queries please contact:
Your nurse specialist (Monday to Friday 08:00 to 18:00)…01223 586973
The ward your child was on …………………………….
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Smoking is not allowed anywhere on the hospital campus. For advice and support in quitting, contact your GP or the free NHS stop smoking helpline on 0800 169 0 169.
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Cambridge University Hospitals
NHS Foundation Trust
Hills Road, Cambridge
CB2 0QQ
Telephone +44 (0)1223 245151
https://www.cuh.nhs.uk/contact-us/contact-enquiries/