Umbilical hernia in children: a practical guide for parents

Umbilical hernia in children: a practical guide for parents

A bulge at the belly button is common in babies and children and may indicate an umbilical hernia. Here is what to look out for, when to seek specialist advice and why coins or plasters do not help.

In my daily practice, I often meet parents who are concerned because their child, frequently a newborn, has an umbilical hernia.

Many notice a clear bulge at the belly button, which tends to become more noticeable when the baby cries, strains or has a bowel movement. In other cases, the swelling is more subtle and is picked up by the paediatrician during a routine check-up.

An umbilical hernia is a congenital condition caused by incomplete closure of the abdominal wall after the umbilical cord stump falls off.

Unlike in adults, it is not caused by physical strain. When this opening remains, a small portion of the intestine or omentum – the fatty tissue that helps protect the abdominal organs – can protrude through the abdominal wall and lie just beneath the skin.

In most children, an umbilical hernia is completely asymptomatic.

The size of the swelling can vary depending on how much abdominal content protrudes through the opening. Occasionally, there may be some discomfort. Much more rarely, the belly button bulge becomes firm to the touch and is associated with symptoms such as vomiting, constipation or blood in the stool.

If you notice a bulge at your child’s belly button, it is always advisable to arrange an assessment with a paediatric surgeon.

The specialist can confirm whether it is an umbilical hernia or another condition affecting the umbilical area.

If the area becomes firm, tender or is associated with inconsolable crying, it is important to seek prompt assessment at a paediatric emergency department.

The diagnosis of an umbilical hernia is mainly clinical.

During the consultation, I assess the size of the opening in the abdominal wall, known as the hernia defect, whether the hernia is reducible – meaning whether the contents can move easily back into the abdomen – and whether it remains reduced or protrudes again straight away.

If there is any diagnostic uncertainty, an ultrasound scan may be requested.

It is important to understand that the size of the visible bulge does not determine the severity of the condition; what matters more is the size of the hernia defect. A smaller defect carries a greater risk of incarceration or strangulation.

In most cases, an umbilical hernia in children resolves spontaneously as the child grows.

A marked improvement, and often complete resolution, is commonly seen once the child begins to walk, as movement strengthens the abdominal muscles and progressively reduces the defect in the abdominal wall.

If the umbilical hernia persists as the child gets older, surgery is the only definitive treatment.

One question that still comes up quite often concerns traditional remedies.

Placing a coin on the belly button to keep the abdominal contents in place does not work. Likewise, applying a plaster over the belly button is not useful and may irritate or damage a newborn’s delicate skin.

For this reason, both placing a coin on the belly button and covering it with a plaster are practices that should be avoided.

An umbilical hernia is a benign congenital condition that, in the vast majority of children, causes no symptoms and tends to resolve spontaneously as the abdominal muscles develop.

Although complications such as intestinal obstruction are very rare, a specialist consultation can help confirm the diagnosis, explain what to monitor and give parents the information they need to manage the condition with greater reassurance.