This topic is about a parent dealing with a challenging situation involving their baby girl, who has an ileostomy due to Hirschsprung’s Disease. The baby is experiencing high stoma output, which has led to dehydration and a hospital stay. The parent is seeking advice on how to manage this situation safely and effectively. Here are some insights and advice shared by others:

1. Replacing electrolytes and slowing output in infants can be tricky since most advice is aimed at adults. It's important to consult with healthcare professionals who specialize in pediatric care.

2. The parent is keen to avoid additional surgeries, such as TPN via Broviac or a G-tube, and wants to explore all medical and dietary options first.

3. Understanding which medications or thickeners are safe and effective for infants is crucial. The baby has been using pectin powder, Imodium, and Nexium, along with baby cereal and formula fortification to thicken the output.

4. The hospital involved is a dedicated children’s hospital with a pediatric GI on the case, but the cause of the high output is still unknown.

5. The medical team has suggested interventions like TPN via BROVIAC and a G-tube, but the parent has agreed only to an NG tube for continuous feeds.

6. The target set by the medical team is to reduce the output to less than 10 mL/kg/day before reintroducing milk.

7. The parent is feeling the mental strain of repeated trials and is looking for experienced specialists, possibly out-of-state.

Advice and insights from others include:

- Involve the right specialists immediately. A dedicated pediatric gastroenterologist should lead the case, with support from a colorectal surgery team. A dietitian can help tailor fluid, electrolyte, and formula composition.

- Seek centers with expertise in Hirschsprung’s Disease and colorectal issues. Some recommended centers include Nationwide Children’s Hospital, and major programs in Boston, Philadelphia, and Seattle. In Florida, options include Advanced Pediatric Gastroenterology Specialists and Orlando Health Arnold Palmer Hospital for Children.

- Keep frontline staff engaged. Bedside nurses and NICU/PICU staff can offer practical tips and advocate effectively with physicians.

- Medication and thickening strategies already in use include pectin powder, baby cereal, and formula fortification. Loperamide (Imodium) is used at the maximum pediatric dose, and Nexium is used to reduce gastric hypersecretion. It's important to monitor for any changes in bowel motility and ensure dosing stays within neonatal safety limits under physician guidance.

- Many people have expressed empathy and support, reinforcing that the parent is doing an excellent job managing the situation and advocating for their child.