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Paediatric umbilical hernia

OVERVIEW

An umbilical hernia is a condition that occurs in infants and young children, where a bulge or protrusion appears around the belly button due to a weakness in the abdominal wall. This weakness allows a part of the intestine or fatty tissue to protrude through the abdominal muscles, causing a visible bulge that can sometimes be pushed back in or disappear when the child is lying down.

Umbilical hernias are quite common in infants and young children, with some estimates suggesting that up to 20% of newborns may have an umbilical hernia. In most cases, umbilical hernias are not dangerous and often resolve on their own as the child grows. However, in rare cases, umbilical hernias may cause complications such as pain, bowel obstruction, or strangulation, which require medical attention. Thus, it's crucial for parents to recognise the indications and manifestations of umbilical hernias and consult a healthcare provider if they have any concerns.

Signs and symptoms of umbilical hernias

The most common sign of a paediatric umbilical hernia is a visible bulge or protrusion around the belly button area, which may become more noticeable when the child is crying, coughing, or straining. The bulge may be soft or firm and can usually be pushed back in, or it may disappear when the child is lying down. Other signs and symptoms of a paediatric umbilical hernia may include the following:

Pain or discomfort in the belly button area, particularly when the hernia is touched or pressed
Swelling or tenderness around the belly button
Nausea or vomiting, which may indicate a bowel obstruction or strangulation (a medical emergency)
Changes in bowel movements or difficulty passing stool
Irritability or fussiness, particularly if the hernia is causing discomfort or pain.

It's worth noting that, typically, umbilical hernias in children don't cause any symptoms or complications and may spontaneously resolve without treatment. However, if parents notice any of the above symptoms or are concerned about their child's umbilical hernia, they should seek medical attention from a healthcare professional.

Treatment

In most cases, paediatric umbilical hernias do not require any treatment and may resolve on their own as the child grows. Nonetheless, if the hernia is causing discomfort or pain or if it persists beyond the child's age of 4-5 years, the healthcare provider may suggest treatment. The treatment options for paediatric umbilical hernias may include the following:

Watchful waiting: The healthcare provider may monitor the hernia and recommend watchful waiting to see if it resolves on its own as the child grows.
Surgery: If your child is experiencing discomfort or pain, or if the hernia has not resolved by the time the child is 4-5 years old, the healthcare provider may recommend surgery to repair the hernia. This is typically done on an outpatient basis, and the child can usually go home the same day.
Supportive measures: In some cases, the healthcare provider may recommend using a supportive device, such as a truss or abdominal binder, in order to support the abdominal wall muscles and reduce the hernia's size. However, these measures are typically only used in cases where surgery is not an option.

The decision to treat a paediatric umbilical hernia depends on factors like the size and severity of the hernia, the child's age and overall health, and the presence of any symptoms or complications. It is important for parents to discuss treatment options with their child's healthcare provider and to make an informed decision based on their child's individual needs and circumstances.

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Dr Mangray, the founder of KZN Specialised Paediatric Surgical Service, and his associates, Dr Ngobese, Dr Govender and Dr Dube-Zvirikuzhe, have a well-established reputation for caring for children right until late adolescence.

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