Umbilical Hernia in Babies : Is That Bulge Normal?
One of the most alarming things for a new parent can be seeing a bulge suddenly appear at the baby's belly button, particularly when the baby cries.
In most cases, this is an umbilical hernia, a common condition that is usually harmless and tends to improve naturally with time.
What is an umbilical hernia ?
Before birth, the umbilical cord passes through an opening in the baby's abdominal wall. After birth, this opening normally closes as the abdominal muscles develop.
Sometimes the opening around the umbilicus does not close completely. A small amount of abdominal tissue or intestine can then push through this opening, producing a soft bulge at the belly button.
What does it look like ?
The typical appearance is a soft, rounded bulge at the belly button.
Parents may notice that:
the bulge becomes more prominent when the baby cries or strains
it becomes smaller or disappears when the baby is relaxed
it is usually soft
it is generally painless
This changing size is typical of an uncomplicated, reducible umbilical hernia.
How common is it ?
Very common.
The American Academy of Pediatrics notes that umbilical hernia occurs in approximately 1 in 5 newborns.
Therefore, seeing a small bulge at the umbilicus in an otherwise well baby is not, by itself, a reason to panic.
Will it close on its own ?
In most children, yes.
Spontaneous closure is common because the abdominal wall continues to mature during early childhood.
The AAP reports that approximately 90% of umbilical hernias close spontaneously by age 4.
A large 2024 study published in JAMA Pediatrics, involving more than 167,000 children, found spontaneous closure in 88.6% by 5 years of age. Closure was somewhat more likely with smaller fascial defects than larger ones.
An important point for parents is that the size of the opening in the abdominal wall is more useful for predicting spontaneous closure than how prominently the hernia protrudes.
So, a hernia that looks quite prominent when a baby cries does not necessarily mean that surgery will be required.
Does my baby need treatment ?
For an otherwise well child with an uncomplicated umbilical hernia, usually not immediately.
Observation during routine pediatric visits is generally appropriate because most hernias close naturally and complications are uncommon.
Surgery may eventually be considered when a hernia persists beyond the usual period of spontaneous closure, or earlier when there are complications or specific clinical indications.
The decision should be individualized by the pediatrician/pediatric surgeon rather than based simply on how large the bulge looks.
Should parents put a coin or tape over the Hernia ?
No.
This is an important message for parents.
Putting a coin over the umbilicus, tightly taping it, or using abdominal binders does not make the hernia close faster. Such practices can also cause skin irritation or injury.
The best approach for an uncomplicated hernia is generally observation and appropriate follow-up, rather than trying to push or hold the umbilicus closed.
When should parents seek medical attention ?
Most umbilical hernias are uncomplicated, but parents should seek prompt medical assessment if the usual soft, intermittent bulge changes character.
Warning signs include:
the bulge becomes hard or very tender
it remains prominent and does not go back in
the skin becomes red or markedly swollen
the child develops significant pain
repeated vomiting occurs
the baby refuses feeds
the child becomes unusually irritable, lethargic or appears unwell
These features can indicate incarceration or, more rarely, strangulation and require urgent assessment.
The reassuring message for parents
An umbilical hernia can look dramatic especially when a baby cries, but appearance alone does not determine how serious it is.
For most babies :
Common → Usually painless → Usually uncomplicated → Often closes naturally
The important things are regular pediatric assessment and knowing the warning signs.
Take-home message
That bulge at your baby's belly button is often an umbilical hernia. Most are harmless and close naturally with time. Don't tape it or put a coin on it. If it becomes hard, painful, red, stays out, or your baby becomes unwell, seek medical care promptly.
Dr. Neerupam Gupta
Consultant Pediatrician
Comments