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Umbilical care and umbilical hernia

Child; hernia; umbilicus; umbilical; belly; button; belly button; navel; umbilical hernia; infant; baby; cord; gramuloma; tummy;

After the cord is cut at birth, your baby will be left with a short stump of cord attached to the umbilicus. (Other words for umbilicus are navel, tummy button or belly button.)

Contents

Caring for your baby's umbilicus

  • One or two days after your baby's birth the midwifr will take the clamp off as the cord is now dried and sealed.
  • The short stump of cord soon dries up, turns brown to black, then falls off. This may happen in a few days or may take as long as a week or two.
  • As the cord is separating, and for a few days after it comes off, the umbilicus can look raw and sticky. There may be some discharge (yellow to dark brown), which may smell strange. This is normal and it doesn’t need any special treatment.
  • All you need to do is keep the area clean with normal washing or bathing and dry it carefully. Fold the top of your baby's nappy back, so that the cord is not covered by the nappy.  
  • Do not bandage it or put any antiseptic lotions or creams on it.
  • Do not try to pull the cord off even if it looks like it could come off easily. It will fall off by itself.
    • A few years ago, it was recommended that alcohol or a similar antiseptic be used. It is now known that this makes it take longer for the cord to come off as it kills off the normal skin bacteria (bugs) that help the cord separate.

Infection

  • If there is a sticky discharge or pus for longer than the first few days after the cord comes off, check with your doctor. There may be a mild infection that does need treatment with an antiseptic or antibiotic cream.
  • At any stage if you notice redness, heat or swelling of the skin around the umbilicus, especially if the baby is unwell (feverish, poor feeding), see a doctor as soon as possible because antibiotics may need to be given quickly.

Granuloma

  • Sometimes after the umbilicus is healed, there will be a small, pink, moist lump in the middle. This is likely to be a granuloma.
  • It is quite harmless, but it may stay there for a long time unless it is treated. Ask your doctor to look at it, perhaps at the 6 week check-up.

Umbilical hernia

An umbilical hernia is very common in children. It appears as a small soft lump near the umbilicus (navel or belly-button). It usually causes no problems and goes away as the child grows.

  • A hernia is the lump that appears when part of the body pushes through an opening or weak spot in a muscle wall.
  • This happens most often around the abdomen (tummy area): 
    • an inguinal hernia (in the groin)
    • a hiatus hernia (where part of the stomach pushes up through the diaphragm into the chest area),
    • an umbilical hernia.
  • An umbilical hernia happens when the muscles around the umbilicus (belly button) have a gap between them, so that part of the gut or other tissue in the abdomen can poke through particularly when pressure in the tummy rises (such as when a child cries or coughs). This can be pushed easily back into the tummy, but it does not matter if some usually stays pushed through the hernia.
  • An umbilical hernia is quite common in young children, when the muscles are relatively weak, but a lot less common in older children and young adults because the muscles become stronger, closing off the gap.
  • Some adults develop an umbilical hernia when the pressure in the tummy is greater than the strength of the muscles which close off the gap (eg during pregnancy or in an older, overweight person). There can be health problems for adults, and an operation may be needed.

Problems from an umbilical hernia

  • Umbilical hernias in babies very rarely cause problems and are best left alone.
  • The main problem with an umbilical hernia is the appearance of a bulge or lump. Young children do not have any discomfort and are not worried by the appearance, but many parents would prefer that the bulge was not there.
  • Some hernias - but not umbilical ones - can cause problems when part of the bowel gets caught in the hernia. Inguinal hernias are usually operated on as soon as they are found, because it is quite common for bowel to get trapped in them.

What treatment is needed?

     all
  • If a baby has an umbilical hernia, nothing needs to be done, as almost will close by themselves.
  • As children get older and their tummy wall muscles get stronger, the gap will usually close, and the bulge goes away. While this often happens before the age of one, it may not happen until the child is four or five years old.
  • If it does not close by itself, the gap can be closed by an operation if the appearance causes distress to children when they begin to be self aware (usually not until they are around 6 years or older). The operation is simple and quick, and usually the child will not need to stay in hospital for more than a few hours. But still it is usually recommended that it is done when the child is old enough to be able to understand what is happening, and when an anaesthetic can be given very safely (when the child is at least 4 years old).
  • If the umbilical hernia does cause problems (it becomes painful and it cannot be gently pushed back into the tummy), the child needs to be checked urgently by a doctor. This is rare.

Treatment that does not work for umbilical hernia

In the past some people recommended strapping the tummy or placing a coin on the hernia and then putting on strapping. These seemed to work, because the hernia did eventually go away, but it has been shown by research that the gap which causes the hernia will close just as quickly without strapping.

More to read

Pregnancy, birth and baby Pregnancy, Birth and Baby is a national Australian Government service providing support and information for expecting parents and parents of children, from birth to 5 years of age.
http://www.pregnancybirthbaby.org.au/

Raising Children Network Raising Children website is produced with the help of an extensive network including the Australian Government.
http://raisingchildren.net.au/ 

The Sydney Children's Hospital Network
 https://www.schn.health.nsw.gov.au/ 

Better Health Channel 
https://www.betterhealth.vic.gov.au/ 

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The information on this site should not be used as an alternative to professional care. If you have a particular problem, see a doctor, or ring the Parent Helpline on 1300 364 100 (local call cost from anywhere in South Australia).

This topic may use 'he' and 'she' in turn - please change to suit your child's sex.

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