Umbilical Hernia in Babies

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 the bulge at your baby's belly button becomes:

• Firm, hard or tender, or your baby cries when it is touched.
• Red, purple or dark, with shiny or discoloured skin over it.
• Stuck out and impossible to flatten when your baby is calm and lying down, having previously softened away.
• Accompanied by vomiting, especially green vomiting, a swollen tummy, or refusal to feed.

This is rare with umbilical hernias — far rarer than with hernias in the groin — but it is the one scenario that cannot wait, because it means something is trapped and losing its blood supply.

Otherwise this is a routine appointment rather than an urgent one. See a GP or paediatrician if the bulge is getting bigger rather than smaller after the first year, if it is still present as your child approaches school age, if there is a bulge above the belly button rather than at it, or if you are simply not sure what you are looking at.

What it is

The umbilical cord passes through a small opening in the abdominal muscles. That opening normally closes soon after birth. If it does not close completely, a little fatty tissue or a loop of bowel can push through it, producing a soft bulge at the belly button.

You will notice it most when your baby cries, coughs, strains or sits up, because those raise the pressure inside the tummy. When your baby is calm and lying down, it usually flattens or disappears entirely, and you can often feel a small gap in the muscle underneath.

It is common, particularly in babies born prematurely and in babies of low birth weight, and it is more common in some ethnic groups. It has nothing to do with how the cord was cut or cared for, and nothing you did caused it.

Does it hurt?

No. An uncomplicated umbilical hernia is not painful and does not make a baby cry. Parents often have this the wrong way round, assuming the crying is caused by the bulge, when in fact the crying is what makes the bulge appear.

If your baby genuinely is in pain and the hernia is tender, that is the emergency picture described above, and it is a different situation altogether.

How long it takes to close

Most close on their own without any treatment. The NHS advice is that they often need no treatment, and Great Ormond Street Hospital notes that many close during the first few years of life. The usual guidance is to expect closure by around the age of four or five, with surgery considered after that, or earlier if the defect is large or the hernia is causing problems.

The size of the bulge is less important than the size of the gap in the muscle underneath, which is what a clinician assesses. A dramatic-looking bulge over a small defect usually closes; a modest bulge over a wide defect may not.

What not to do

Do not strap, tape, bind or belt the belly button. Coins taped over the navel, belly binders and umbilical belts are all still recommended by well-meaning relatives and by parts of the internet. They do not speed up closure, they can irritate or break the skin, and they can hide the very changes you are meant to be watching for.

Do not try to push the bulge back in repeatedly, and do not massage it. Do not restrict crying, tummy time or normal activity in the hope of protecting it; nothing your baby does makes an umbilical hernia worse.

Living with it

Carry on as normal in every respect. Bath as usual, use nappies as usual, do tummy time, use a sling or carrier, and let your baby roll, sit and crawl. Check the belly button at nappy changes so that you would notice a change in colour or firmness, and take a photograph every month or two so that you can see the trend rather than relying on memory.

Mention it at routine reviews so that it is recorded and measured. If a referral is made, the conversation is usually about watchful waiting with a review point, rather than about immediate surgery.

When surgery is offered

Repair is a small, common operation, usually done as a day case under general anaesthetic, in which the muscle opening is closed with stitches. It is generally offered if the hernia has not closed by school age, if the defect is very large, or in the rare case of complications.

Recovery is quick. Expect a small dressing, some bruising, and a few days of taking things gently. The scar is usually hidden in the belly button.

The bulge that is not at the belly button

A bulge in the midline above the belly button is an epigastric hernia. These are usually small, often contain a small amount of fat, and do not close spontaneously in the way umbilical hernias do, so they tend to be repaired if they cause symptoms. A bulge running down the midline of the tummy when a baby lifts their head is usually a normal separation of the abdominal muscles rather than a hernia. Either is worth showing to a clinician for identification, without alarm.