My baby has a bulging bellybutton

Routine check-ups are done on babies around six weeks of age and then again at three months. It is during these check-ups that many parents voice their concern about their baby’s bellybutton.

The medical name for a bulging bellybutton is an umbilical hernia and it affects about 20% of babies.

Let’s begin with some information about umbilical hernias.

What exactly is an umbilical hernia?

During pregnancy, the umbilical cord runs from a mother’s placenta, through a little hole in the baby’s tummy muscle, to her baby. The cord brings nutrition from mommy to baby. Once baby is born, the doctor will clamp the cord. After about a week or so the umbilical stump falls off. This is usually when parents begin to notice a bulge on their baby’s tummy.

Why is this so? While baby is still in the womb, the abdominal muscle (tummy muscle) begins to close just below the naval (bellybutton). This forms the umbilical ring.

The ring is supposed to close over time, once the cord is cut or clamped. With the muscle completely closed, the muscle forms a wall that hold the intestine in place in your baby’s tummy.

If the ring doesn’t close, the baby’s intestine can push through the little hole in the muscle. This causes the bulge around the bellybutton. The bulge is known as an umbilical hernia.

The hernia has nothing to do with how the baby’s cord was cut or clamped. If the muscle doesn’t close, then fluid or intestine can poke through the muscle and cause a hernia.

How is an umbilical hernia diagnosed?

The first step in the diagnosis is usually you, the parents. Parents notice a bulging bellybutton which gets bigger when baby cries, coughs or pushes to make a poo. When baby is calm or lying on his or her back the bulge gets smaller.

Your doctor will feel the area around the bellybutton. The doctor may see if the intestine can be pushed back into the abdomen. In rare cases, if the hernia appears to be causing pain, the doctor may suggest a CT scan to make sure there ae no complications.

What is the treatment for an umbilical hernia?

In most babies, absolutely no medical intervention is necessary. The hernia usually disappears by the time the child is two years of age.  In some cases, the hernia may only disappear around 5 years of age. This is all normal.

If the hernia has not resolved by the time your child is 5 years of age, then your doctor may suggest surgery.

Surgery is usually only considered before 5 years of age, if it is causing problems. The symptoms your doctor will be watching for are:

• Pain around the bellybutton




• Swelling in the area
• If the hernia is bigger than 1,5 to 2cm
• If the hernia isn’t getting smaller after the age of two
• If the hernia gets trapped in the tummy muscle and causes a blockage. This will usually be associated with pain, vomiting or a change in colour of the bellybutton.
• If the hernia ruptures.

What does surgery involve?

Your child will need to be admitted to hospital under the care of a surgeon. Your child will be put to sleep by an anaesthetist for the procedure.

The surgeon will make a little cut just underneath the bellybutton so that the intestine that is pushing through the muscle can be pushed back to where it belongs. The muscle will be stitched closed to make sure that the hernia can’t reform. The surgeon will most likely also stitch the skin around the bellybutton to make it flat.

The whole procedure takes about 45 minutes to 1 hour. Once the doctor is happy that your child is awake, he or she will be sent home.

Parents often ask questions like:

• “Is the umbilical hernia painful?”- Generally a hernia isn’t painful at all. If it does become painful then you should advise your doctor urgently.
•  “Will my baby suffer serious complications from the umbilical hernia? – 90% of hernias disappear without ever causing a moments trouble. In a small number of children, hernias may cause problems. If your child starts to experience pain and fever, a distended tummy, swelling or if the bellybutton changes colour then urgent medical care is necessary. Any of these symptoms may arise from the hernia being strangled. Surgery will be necessary to avoid further complications.
•  “Is there something I should be doing as the parent of a baby with an umbilical hernia?” – As stated above, the hernia is as a result of an opening in the muscle of the tummy. You as the parent never caused the hernia. There is nothing you can do to fix the hernia. In years gone by, parents did try to strap the hernia with adhesive tape. This resulted in a large number of skin complications. Remember that a baby’s skin is extremely delicate, and strapping may cause a rash or tearing of the skin. Allow the baby’s muscles to mature and thicken on their own. Most children will have no sign of the hernia by the time they turn two.

Conclusion

Umbilical hernias are a common finding in babies, especially those that are born prematurely. Surgery to repair an umbilical hernia is generally postponed until a child is four or five years old because they so seldom cause problems. Parents do get upset when a hernia appears.

This is usually because they took so much care to clean the cord before it fell off. Please be reassured, a hernia has nothing to do with how well you took care of the cord.

It is simply a part of the development process of a baby. If the wall didn’t close after baby was born, then chances are your baby will develop a hernia. As soon as the muscle has matured the hernia will resolve.

References

https://www.hopkinsmedicine.org/health/conditions-and-diseases/hernias/umbilical-hernia
https://www.ncbi.nlm.nih.gov/books/NBK555972/
https://www.stanfordchildrens.org/en/topic/default?id=inguinal-and-umbilical-hernia-90-P01998
https://www.nhs.uk/conditions/umbilical-hernia-repair
https://www.chop.edu/conditions-diseases/umbilical-hernia