Umbilical Hernia in Babies: Should You Worry?

The cord has fallen off, the belly button has healed, and yet, every time your baby cries, a small round, soft lump pokes out in the middle of their tummy. When they calm down, it goes back in. It is very probably an umbilical hernia, one of the most common minor anomalies in infants, and one of the least serious.

It looks impressive because it swells when your baby screams, and relatives often have a ready-made piece of advice, starting with the coin placed on the belly button. Here is what this hernia really is, why it is best left alone, how to tell it from a groin hernia, and the rare signs that call for an emergency visit.

What is an umbilical hernia?

It is a small bulge of the tummy's contents through the belly button. During pregnancy, the umbilical cord passes through the tummy wall via an opening. Normally, the muscles close around this passage after birth; when closure is slow, part of the bowel or some fat can slip in and push the skin outwards, explains the UK's NHS.

The result: a soft lump at the belly button, from the size of a pea to about 2 cm wide according to the NHS, sometimes a little more. It shows more when your baby cries, coughs or strains to pass stools, the MSD Manuals remind us, then goes back in when they relax. It is often there from birth, and the NHS's Healthier Together programme notes that it is particularly common in babies born prematurely (see our article on the premature baby).

Crying does not cause it: the cause is the opening at the belly button, and screaming only makes it more visible. So there is no need to feel guilty at every crying fit. If their crying worries you for other reasons, our article on why babies cry helps you decode it.

Will it close on its own?

Yes, in the vast majority of cases, as your baby grows and without any treatment. The sources agree on the principle, a little less on the timing:

The gap mostly comes from what is being measured: some sources speak of most hernias, others of the latest to close. Remember that closure is slow, over months, sometimes years, and that your paediatrician follows its progress at routine visits. Note its approximate size from time to time: you will see better whether it is shrinking.

Coin, plaster, band: should you bind the belly button?

No. Placing a coin on the belly button and holding it with plaster or a tight band is a gesture handed down from generation to generation, in Morocco as elsewhere. It does not make the hernia go back in faster. The MSD Manuals are clear: taping a coin or another object over the hernia does not work and can irritate the skin.

The risk is not just redness. A baby's skin is thin, the belly button stays a moist place, and adhesive left for days under nappies or in the heat can cause irritation and sores.

There is a nuance, and it is worth knowing. In Japan, some doctors apply medical adhesive strapping, supervised and monitored, to speed up closure. An article published in 2023 in the journal Cureus nonetheless points out that this practice is considered ineffective in Europe and North America, where watchful waiting is preferred, and reports complications such as skin infections, ulcers and one case of a trapped hernia in a 3-month-old baby. This has nothing to do with a coin placed at home.

When is surgery suggested?

Rarely, and never as an emergency in the usual situation. British and Canadian sources consider an operation when the hernia is very large or persists beyond a certain age:

• around age 3 according to AboutKidsHealth, if it has not closed;
• at 3 or 4 years according to Healthier Together;
• after age 4 according to Evelina London Children's Hospital, which otherwise suggests continuing to monitor;
• sometimes from age 2 for a very large hernia, according to the MSD Manuals.

The operation is short. Evelina hospital describes it like this: general anaesthetic, a small cut at the edge of the belly button, the opening closed with strong stitches, and home the same day in most cases. The belly button may look a little looser for some time, and a small scar remains. In Morocco, the paediatrician refers you to a paediatric surgeon, in a clinic or a hospital paediatric surgery department. Pain relief after the operation is prescribed by the team, who set the doses.

Umbilical hernia or inguinal hernia: what is the difference?

They have little in common except the name. An inguinal hernia is found in the groin crease or goes down into the scrotum in boys. It comes from a canal that should have closed shortly after birth.

Every inguinal hernia in a child must be operated on, stress AboutKidsHealth and Healthier Together, to prevent a loop of bowel from getting trapped. Cambridge University Hospitals specify that the timing of the operation depends on age, the youngest babies being the most at risk. In girls, it is sometimes the ovary that comes through. A lump in the scrotum can also have other causes: our article on the undescended testicle details another frequent reason for consultation in little boys.

Strangulated hernia: the signs that should alert you

Strangulation is rare, but it is an emergency. A part of the bowel stays trapped in the opening and no longer gets a good blood supply. The NHS describes it as very rare in children for a belly button hernia; the Cureus article puts the risk of getting stuck at between 0.07 and 0.3% of children's umbilical hernias. It is more frequent with a groin hernia.

The signs to know, according to the NHS, AboutKidsHealth and Healthier Together:

1. the lump no longer goes back in, even when your baby is calm or asleep;
2. it becomes hard, swollen, painful to the touch;
3. the skin around it turns red, purplish or changes colour;
4. your baby vomits, especially if the vomit is green;
5. they cry inconsolably, their tummy is swollen, and they no longer pass wind or stools.

In that case, do not try to push the lump back by force: go to the emergency department. For other reasons for a prompt consultation, see when to go to the paediatric emergency department, and for long-term follow-up, our pointers on choosing a paediatrician you trust.