Umbilical hernias in children: does my child need surgery?

Umbilical hernias occur in children when the umbilical scar (where the umbilical cord was attached) hasn’t fully formed and has left a defect in the abdominal wall. They are quite common in young babies, particularly babies born pre-term.

In this article, one of our leading consultant general paediatric and vascular surgeons, Mr Dan Higman, explains what causes an umbilical hernia in children, the symptoms they could experience and when surgical treatment might be necessary.

What causes an umbilical hernia in children?

There is nothing that actually causes umbilical hernias in children; they appear to be a random and spontaneous occurrence that occur in some children from birth, and in that sense they cannot be avoided.

The majority of umbilical hernias are small defects, a few millimetres in diameter, and contain a small amount of fat from inside the abdomen. Larger umbilical hernias are much less common and may contain bowel. The contents of the hernia, whether fat or bowel, slide in and out of the umbilical defect, depending on the activity of the child, but can bulge out particularly when the child is straining or crying for other reasons.

What are the symptoms of an umbilical hernia?

Umbilical hernias do not generally cause any symptoms in themselves, but this can sometimes be difficult for parents and doctors to be sure about. Children often point to their umbilical area when they have tummy ache for other reasons; certainly the incidence of umbilical hernia contents becoming stuck or strangulated is extremely rare in children.

What precautions should a child take if they have an umbilical hernia?

Children with umbilical hernias do not have to take any particular precautions or have their activity restricted in any way. The old practice of applying bandaging and local pressure to the umbilical area (in the mistaken belief that this would reduce or heal the hernia) is to be condemned as a pointless, uncomfortable and possibly dangerous practice.

How are umbilical hernias treated in children?

The vast majority of umbilical hernias, even large ones, will completely resolve spontaneously over time and do not require any treatment. Certainly, children under the age of two years should not be treated for this condition.

Even if a child has a slightly protruding umbilicus with a small underlying hernia after this age, it may well be reasonable to leave it alone if the child is not bothered by it in any way. It may not be noticeable or even detectable later on in childhood.

Is surgery to fix an umbilical hernia necessary?

If a child still has a significant umbilical hernia after the age of three years, it may be appropriate to offer a surgical repair as the hernia is unlikely to spontaneously resolve and it may be causing annoyance or embarrassment for the child, although it is still unlikely to be causing any physical discomfort.

What does umbilical hernia surgery involve?

Surgical repair of an umbilical hernia is a straightforward day-case operation carried out under a short general anaesthetic.

The umbilical defect is identified and closed with a couple of stitches. When the child wakes up from the anaesthetic, they will not feel any discomfort due to an anaesthetic injection into the area during surgery, which gives effective pain relief for several hours. After that, the child can be given simple painkillers such as paracetamol, if required. The skin closure is performed with dissolving stitches under the skin and the small scar is barely noticeable after a few weeks.

The child can normally return to school or child-care after a few days and full normal activity after a couple of weeks.

If you are worried your child might have an umbilical hernia and would like to talk a specialist, head to Mr Dan Higman’s Top Doctors profile and book an appointment with him.