What is Pediatric Umbilical Hernia?
Umbilical hernias typically appear as a noticeable bump around the belly button of a newborn baby. This bump is often more visible when the baby cries or strains. The observation of this bump often happens during routine wellness check-ups with a baby’s pediatrician in the first few months after birth.
First-time or inexperienced parents may express worry when they see this bulge in their baby’s belly button because they might not be familiar with it and could feel anxious. In addition, they might worry about potential severe complications from the umbilical hernia and wonder if there are steps they can take to lower any risks.
Doctors must properly educate parents about the natural development of the condition. The good news is that more than 90% of umbilical hernias in newborns and young children do not cause any symptoms and naturally heal by the time the child reaches five years old or even earlier. Parents should also be taught when early intervention might be necessary and how to spot signs that could indicate serious complications, such as the umbilical hernia becoming trapped or squeezed (these are terms doctors use to refer to the condition called “incarceration” or “strangulation”).
When it comes to the specifics of the belly button’s structure, it’s made up of four parts:
1. Cicatrix: This is deep, thick scar tissue at the very middle of the navel. It’s the meeting point of different layers of fetal tissue.
2. The cushion: This is a small, slightly raised area that forms the outer edge of the belly button.
3. Furrows: These are the creases and dips within the belly button.
4. Mamelon: This is the central lump, bump, or dip in the belly button.
The shape of the belly button at birth might be able to predict the chance of a child having a lasting umbilical hernia. More than 60 normal variations in belly button shapes have been identified. An interesting study found that babies with belly buttons that stick out or are crescent-shaped may have a higher chance of developing umbilical hernias than those with the more typical inward-curving belly button shape.
What Causes Pediatric Umbilical Hernia?
In kids, umbilical hernias develop when the belly button’s natural muscular opening doesn’t completely close after birth, allowing parts of the abdomen to poke through. Normally, this opening should close thanks to the growth of the abdomen’s muscles. But if something disrupts or slows down this process, it can lead to an umbilical hernia.
The exact cause of why this happens isn’t certain, but it’s thought to involve issues with a part of the belly button opening related to a vein.
Being premature or having a low birth weight may increase the risk of umbilical hernias in children. Other conditions that are also connected to these hernias include:
- Liquid building up in the abdomen (Ascites)
- Genetic disorders where a child has an extra chromosome, like trisomy 13, 18, or 21
- Childhood obesity
- Genetic disorders that affect physical appearance (like Beckwith-Wiedemann, Down, Ehlers-Danlos, and Marfan syndromes)
- Underactive thyroid (Hypothyroidism)
- Mucopolysaccharidoses, a group of metabolic disorders
- Treatment involving a procedure to remove waste products from the blood (Peritoneal dialysis)
Sometimes, the hernia can also start just above the belly button, where it’s more accurately called an epigastric hernia.
It’s important to note that the method doctors use to clamp or cut the umbilical cord at birth does not influence the risk of developing an umbilical hernia later on.
There are also other disorders related to the belly button, such as a patent urachus, umbilical polyp, cysts, granulomas, urachal remnants, and omphalomesenteric fistula. You can find detailed descriptions of these in the umbrella article “Anatomy, Abdomen, and Pelvis: Umbilical Cord” on StatPearls.
Gastroschisis and omphalocele are two abdominal wall disorders that are somewhat similar to umbilical hernias. Gastroschisis involves a defect near the belly button where the intestine can poke through. Omphalocele is when parts of the abdomen poke through the belly button and are covered by only a thin layer of tissue. Detailed descriptions of these can be found in the respective articles on StatPearls.
Risk Factors and Frequency for Pediatric Umbilical Hernia
Umbilical hernias, or belly button hernias, are a common condition in children, notably among newborns. In the U.S., about 15-23% of all newborns, or roughly 800,000 babies per year, have umbilical hernias. However, by the time a child turns 1-year old, this percentage decreases to roughly between 2% and 10%.
Both boys and girls can have umbilical hernias; there’s no major difference between the number of cases seen in each gender. Some groups are more affected than others. For instance, the likelihood of having an umbilical hernia is much higher in African-American babies, with as many as 26.6% reported to have this condition, though experts aren’t exactly sure why this is the case.
- Premature babies and those with low birth weight also tend to have a higher risk of developing umbilical hernias compared to full-term and normal-weight babies.
- The frequency of umbilical hernias can be as high as 84% in newborns weighing between 1,000 and 1,500 grams. This number drops to 20.5% in babies who weigh between 2,000 and 2,500 grams at birth.
Signs and Symptoms of Pediatric Umbilical Hernia
During a regular visit to the doctor for child check-ups, parents might notice a bump or swelling in their baby’s belly button area. This bulge often gets larger when the baby cries, coughs, or has to strain.
It’s not always possible to see the umbilical hernia right away when the doctor examines the baby. But, if the baby cries or seems uncomfortable when having a bowel movement or passing urine, it could be a sign of an umbilical hernia.
During the doctor’s assessment, it’s important to measure the size of the umbilical hernia, check if it can be moved back into place, and watch for any signs of it getting trapped or cut off. The size of the hole in the muscle wall is a better way to predict if the hernia will close on its own than the size of the hernia sack or how much it sticks out.
If the umbilical hernia gets trapped or the blood supply gets cut off, the person usually has serious stomach pain, feels nauseous, and throws up. When the doctor examines the stomach, it may be tender to touch, bloated, the skin may be redder than usual, and the stomach could be very painful.
Testing for Pediatric Umbilical Hernia
To diagnose umbilical hernias in children, doctors typically don’t need to run any specific tests or perform any particular imaging procedures. Instead, the diagnosis is mainly based on the information provided by the parents and the results of the physical examination.
There are certain conditions often found alongside this, but they’re rare. These include certain genetic disorders like trisomies (which are a kind of genetic disorder where a person has three copies of a particular chromosome instead of the usual two), and metabolic disorders like hypothyroidism (where your thyroid doesn’t produce enough hormones) and mucopolysaccharidoses (a group of metabolic disorders caused by the absence or malfunctioning of certain enzymes in the body).
Additionally, various syndromes, including Beckwith-Wiedemann (a growth disorder), Down syndrome, Ehlers-Danlos (a group of disorders that affect connective tissues supporting the skin, bones, blood vessels, and many other organs and tissues), and Marfan syndrome (a genetic disorder that affects the body’s connective tissue) have also been found in some children with umbilical hernias.
Although it’s important to point this out, it’s also important to remember that the majority of umbilical hernias in children occur in children who are otherwise healthy.
Treatment Options for Pediatric Umbilical Hernia
In babies, an umbilical hernia – a small bulge near the belly button where the intestines or fatty tissue protrudes through the abdominal wall – is often not a cause for immediate concern. In fact, around 90% of these hernias heal on their own by the time the child is 2 years old.
The size of the hernia can be a good indicator of whether it might close up on its own. Smaller hernias (with a ring diameter less than 1 cm) are more likely to resolve independently than larger ones (greater than 1.5 cm).
Generally, doctors tend to wait until a child is around 4 to 5 years old before deciding on surgery for an umbilical hernia, unless the child shows certain symptoms or complications, such as a hernia rupture, incarceration (when a section of the intestine gets trapped) or strangulation.
It’s also important to monitor the hernia for any changes. If it hasn’t closed or gotten better by the time the child turns 2 years old, especially if it sticks out like a trunk, surgery might be necessary. Other factors that can necessitate surgery include metabolic disorders, genetic syndromes, being on peritoneal dialysis or skin damage over the hernia.
As for the proper time for surgery, some experts recommend operating on hernias bigger than 1.5 cm in children older than 2 years. However, others suggest waiting until 5 years, unless there are other medical reasons to put the child under general anesthesia.
Interestingly, alternatives to general anesthesia, like local anesthetic or ultrasound-assisted rectus sheath blocks, can be used for young children. Rectus sheath blocks inject the numbing agent into the nerve between the abdominal muscle and its outer covering – it’s as effective as a local anesthetic and with the use of ultrasound, it’s safer than before.
However, the timing for umbilical hernia surgery can greatly vary with racial backgrounds, type of health coverage, location, and even the state the patient resides in. Even though these hernias can close on their own up to 14 years of age, due to these disparities, there aren’t any solid guidelines on when is the best time for surgery.
As for the surgery itself, it usually involves making a small incision below or above the belly button under general anesthesia. The hernia sac (the bulge) is located and separated from any tissue it’s attached to. Anything inside the hernia is returned back to the abdominal cavity. Then, the hole is closed with either a continuous or interrupted (series of knots) suture. For bigger hernias or repeat hernias, nonabsorbable sutures (those that remain in the body) are preferred. Mesh is sometimes used when the hole can’t be closed easily.
There are different ways to do an umbilical hernia repair, such as laparoscopic (using a camera and small incisions) or transumbilical (through the belly button) methods. These methods offer their own benefits like inspecting the abdomen for other problems or less visible scars, but tend to be costlier and take more time.
Also, it’s worth noting that there’s some debate over umbilical strapping (using a special bandage to promote hernia closure). Many experts do not find this method effective, and it can often cause skin irritation, but some studies suggest potential benefits. At the moment, there isn’t a final consensus on this under-researched method.
What else can Pediatric Umbilical Hernia be?
The diagnosis of certain medical conditions can sometimes be tricky because they may share similar symptoms. The following conditions are examples that might be mistaken for one another:
- Epigastric hernia (a hernia in the upper abdomen)
- Hernia of the umbilical cord (a bulge around the belly button)
- Omphalocele (a birth defect where organs protrude from the belly)
- Pediatric hydrocele and hernia surgery (surgery related to fluids around a testicle or a hernia in a child)
- Varicocele in adolescents (swelling of veins in the scrotum in young people)
What to expect with Pediatric Umbilical Hernia
The prognosis, or possible outcomes, for an umbilical hernia in children can be summarized as follows:
* Most umbilical hernias in children do not cause any symptoms; over 90% of these hernias self-correct, meaning they fix themselves naturally without any medical intervention, by the time the child turns 5 years old.
* If the hernia is causing symptoms before the child is 5 years old, surgery may be needed to correct it.
* The chances of an umbilical hernia coming back are more likely in those children who had surgery before they reached the age of 4.
* Overall, there are very few complications after surgery to repair an umbilical hernia.
Possible Complications When Diagnosed with Pediatric Umbilical Hernia
Research examining the complications of belly button hernias often has a selection bias as it mainly focuses on patients who have undergone surgical treatment, inadvertently leaving out a large number of patients without symptoms.
Experts agree that complications from a non-repaired belly button hernia are exceedingly rare. The overall estimated risk of the hernia becoming trapped, also known as incarceration, is generally considered to be between 0.07% and 2.77%.
Research has shown that in cases where surgery is performed for these types of hernias, the rate of complications is about 4 times higher in patients under 4 years old.
Common complications from belly button hernia surgery can include minor wound infections, which occur in less than 1% of cases, and incidents of bruises and fluid-filled swellings. If an infection pocket, or abscess, forms, it might be necessary to perform a surgical draining procedure.
Long-term studies indicate that the risk of the hernia reoccurring after surgery is approximately 2%.
There’s a chance of a prolonged delay in the return of normal gut function, especially in younger kids with bigger hernias.
Common Risks and Complications:
- Minor wound infections
- Bruises and fluid-filled swellings
- Possible need for surgical drain due to infection pocket
- Approximately 2% chance of hernia reoccurrence
- Possible extended delay in normal gut function
Preventing Pediatric Umbilical Hernia
If your child has a neonatal or pediatric umbilical hernia, don’t worry. These types of hernias are very common and rarely cause complications. In fact, over 90% of these hernias heal by themselves, usually by the time your child turns 2 years old.
If your child starts showing symptoms or if the umbilical hernia hasn’t healed by the time they are 5 years old, your doctor may suggest a small surgery as a potential treatment. This surgery usually doesn’t take more than an hour. It’s a relatively straightforward procedure with few side effects and complications reported.
