A Lump in a Baby's Groin

When to get help

Go to an emergency department or call emergency services — 999 in the UK, 112 or 999 in Ireland and across the EU, 911 in the US and Canada, 000 in Australia, 111 in New Zealand — if a lump in your baby's groin or scrotum is any of these:

• Firm, hard, tender or painful, or your baby cries when you touch it.
• Red, purple or discoloured, or the skin over it looks shiny and tight.
• Will not go back in when your baby is calm and lying down, having previously disappeared.
• Present alongside vomiting, particularly green vomiting, a swollen tummy, refusal to feed, or screaming in bouts.

That combination suggests the hernia has become trapped, which cuts off the blood supply to whatever is inside it. It is a surgical emergency and it is time-critical.

Otherwise, arrange a prompt appointment — GP in the UK or Ireland, paediatrician in the US or Canada, GP in Australia or New Zealand — for any groin or scrotal lump in a baby, even one that comes and goes and causes no distress. Great Ormond Street Hospital notes that inguinal hernias in babies do not resolve on their own and are usually repaired surgically, and that the risk of the hernia becoming trapped is highest in the youngest babies. That is why a referral tends to move faster than you might expect from a lump that seems to bother nobody.

How to check it

Undress your baby completely from the waist down and look at both sides in good light. Compare left with right. Look for a bulge in the crease of the groin, or in the scrotum in a boy, or over the labia in a girl.

Watch during a cry, a cough or a strain. A hernia typically becomes more obvious when the pressure inside the tummy rises, and disappears when your baby is relaxed and lying flat. Photograph it when it is visible, because it has a habit of vanishing in the waiting room.

Feel it gently. Note whether it is soft and squashy or firm, whether it moves, whether your baby reacts, and whether it goes away when they settle. Do not try to push it back in yourself.

Inguinal hernia

Before birth, a passage runs from the abdomen down into the groin, and in boys the testes travel through it. It normally closes around the time of birth. If it stays open, abdominal contents can slide into it, producing a bulge in the groin or scrotum.

The classic description is a soft swelling that appears when a baby cries, strains or stands, and goes away when they are calm or asleep. It is more common in boys and much more common in babies born prematurely. It can be on one side or both.

The treatment is an operation to close the passage, and it is generally done sooner rather than later in infancy precisely to avoid the emergency scenario. It is a common, well-established procedure, often as a day case.

Hydrocele

A hydrocele is fluid collecting around the testis, and it produces a smooth, painless swelling of the scrotum that is often present from birth. It does not usually change dramatically with crying, though some do vary through the day if the passage is still open.

Clinicians often shine a small torch against the swelling: fluid transmits light and glows, whereas bowel does not. That is a useful clue rather than a definitive test, and it is not something to attempt at home with a phone torch pressed against a baby.

Most hydroceles present at birth settle on their own during the first year or so and need nothing but review. One that appears later, grows, or becomes tender needs assessing, because the distinction from a hernia matters.

The other things a groin lump can be

Lymph nodes in the groin swell with any infection of the leg, foot or nappy area, including a bad nappy rash. They feel like small rubbery beads, often several together, and they move under the skin. The NHS notes that most lumps are harmless, but that a lump which is getting bigger, is hard, does not move, or comes with a fever or weight loss should be checked.

In a boy, a testis that is undescended can sit in the groin as a small movable lump, and a retractile testis moves up and down. In a girl, an ovary can occasionally be the contents of a hernia, which is one reason girls with groin swellings are assessed rather than watched.

What to expect at the appointment

Expect a hands-on examination with your baby both calm and, if necessary, crying, and a look at both sides. An ultrasound scan may be used if the diagnosis is not clear, though many hernias are diagnosed on examination alone. If a hernia is confirmed you will usually be referred to a paediatric surgical service and given a timeframe.

Ask two practical questions before you leave: exactly what would count as an emergency for your baby, and who to ring out of hours. Then write the answers on the fridge, because that information is worth nothing at three in the morning if it is in a leaflet in a bag.

While you wait for the operation

Carry on normally — feeding, bathing, nappies, tummy time and slings are all fine, and no position causes or worsens a hernia. Check the area at each nappy change so that any change is caught early. There is no belt, truss or binder for babies, and taping a coin over a hernia, which occasionally still gets suggested, does nothing except irritate the skin.