You look down and notice that a day after your two-week-old infant’s umbilical cord fell off, it looks odd. You have been keeping the belly button clean and dry, giving only sponge baths, and have not submerged the belly button in the tub, as you were advised. You are not sure what is wrong, but you know something is not right. You take your infant to your pediatric health care provider. You are told that there are two main issues that occur routinely with an infant’s umbilicus (belly button). They are umbilical granulomas and umbilical hernias.

An umbilical granuloma is a type of scar tissue. It appears as a moist reddish lump of tissue at the site where the umbilical cord stump has fallen off. There may be clear or yellowish discharge. It may be oozing. Umbilical granulomas occur around 1-2 weeks of age. They affect one in 500 newborns. The area is not painful. If you notice an umbilical granuloma, see your pediatric health care provider. This needs to be treated to prevent infection.

Umbilical granulomas are treated by your pediatric health care provider with silver nitrate to chemically seal the area. The silver nitrate will dry up the area, and it will form a scab over a few days. Keep the diaper rolled down to leave the area uncovered by the diaper. Wait until after the scab falls off and the area is dry and well healed to bathe your baby. Occasionally this area may need to be treated a second time with silver nitrate if it remains moist. Surgical intervention is rarely needed.

Any fever (a temperature at or above 100.4 degrees F) in an infant under two months is a medical emergency, and the infant must be taken immediately to the emergency department. Watch for swelling, pain, tenderness, foul-smelling discharge, or a rash in infants with umbilical granulomas, and see your pediatric health care provider immediately should these occur.

An umbilical hernia will look like a bulge at the umbilicus (belly button). During pregnancy, the fetus had an opening between the abdominal muscles which allowed the umbilical cord to pass through. After birth, that opening usually closes. If it doesn’t close, a loop of intestine can push through that opening causing an umbilical hernia. The hernia may be more noticeable when the baby is crying, coughing, or straining during bowel movements. It may be less noticeable when the baby is quiet and lying down.

Twenty percent of babies are born with umbilical hernias. It is more common in infants less than six months of age, as well as premature infants or low birth weight babies. Boys and girls are equally affected. Most umbilical hernias are painless, harmless, and will close spontaneously by one year of age. Most umbilical hernias do not require treatment. Do not put anything on the hernia.

If you are concerned that your baby may have an umbilical hernia, see your pediatric health care provider. They will take a complete history and do a thorough physical examination. They will attempt to “reduce” the umbilical hernia by gently massaging the area in an attempt to push the intestine back in. If it goes back in, the hernia is said to be “reducible” which means that the umbilical hernia is not incarcerated (stuck out). A reducible hernia is benign (not harmful).

Complications of an umbilical hernia are rare, but an umbilical hernia can become incarcerated. This means that the intestine becomes trapped and cannot be pushed back in. Watch for signs of incarceration such as a red or purple color at the site of the hernia, increased size, hardness or swelling of the hernia, inability to reduce the hernia, abdominal pain and tenderness in that area, fever, vomiting, or constipation. Seek immediate emergency medical care if you have concerns that your child’s umbilical hernia has become incarcerated (stuck out). This would require an immediate trip to the emergency department.

Ninety percent of umbilical hernias will close by the time the child turns four or five-years-old. If a hernia remains past that age, your pediatric health care provider will refer you to a pediatric surgeon for a consultation to have the hernia repaired. Surgical repairs are only needed for incarcerated umbilical hernias or for those that remain past four to five years of age.