Hernia in Children: Symptoms, Types, Treatment and When Surgery Is Needed

## Hernia in Children: A solvable problem - Dr Vinayak Rengan - Pediatric surgeon talks ## Heading A swelling in your child’s groin or around the belly button can be worrying. It may appear when the child cries, coughs or strains, and disappear when the child relaxes. One common cause of such a swelling is a hernia. Hernias in children are different from those seen in adults. Most childhood hernias occur because an opening that should have closed before or shortly after birth remains open. They are not usually caused by lifting something heavy, excessive crying or parental care. Some hernias can be safely observed. Others require surgery after diagnosis. Knowing the difference is important. ## What is a hernia? A hernia occurs when tissue from inside the abdomen pushes through an opening in the surrounding muscle or tissue. The swelling may become more visible when a child: * Cries * Coughs * Laughs * Strains during a bowel movement * Stands or becomes physically active The two commonest hernias in children are inguinal hernias, which appear in the groin, and umbilical hernias, which appear at the belly button. ## Inguinal hernia in children An inguinal hernia appears as a swelling in the groin. In boys, it may extend into the scrotum. In girls, it may appear near the labia. During development, a small passage connects the abdomen to the groin. This passage normally closes around the time of birth. If it remains open, the bowel, fatty tissue or, in girls, an ovary may enter it and produce a swelling. Inguinal hernias are more common in boys, premature babies and children with certain developmental conditions. They can occur on either side and may occasionally be present on both sides. ### What does an inguinal hernia look like? Parents may notice: * A soft swelling in the groin or scrotum * A swelling that appears during crying or straining * A swelling that disappears when the child sleeps or relaxes * Intermittent discomfort in an older child * One side of the scrotum appearing larger than the other Sometimes the swelling is not visible during the consultation. A photograph taken when the swelling is clearly present can be helpful to the paediatric surgeon. ### Does an inguinal hernia close by itself? No. Unlike many umbilical hernias, an inguinal hernia in a child does not usually close on its own. Surgery is recommended because abdominal contents can become trapped within the hernia. This is known as incarceration. If the blood supply is affected, it is called strangulation and requires emergency treatment. The operation is generally planned soon after diagnosis. The timing depends on the child’s age, whether the baby was premature, the symptoms and the surgeon’s assessment. ## Umbilical hernia in children An umbilical hernia appears as a swelling at the belly button. It occurs when the opening through which the umbilical cord passed does not close completely after birth. The swelling may become prominent when the baby cries or strains. It is usually soft and painless. ### Does an umbilical hernia need surgery? Most umbilical hernias in young children close naturally as the abdominal muscles develop. Observation is usually appropriate when the hernia is painless and uncomplicated. Surgery may be considered when: * The hernia remains open at around four to five years of age * The opening is large or is not becoming smaller * The child develops pain * The swelling becomes trapped * The overlying skin becomes damaged * The appearance causes significant concern to the child or family The decision should be based on the size of the actual opening in the abdominal wall, not simply how far the skin bulges outward. Placing a coin, tight band or adhesive tape over the belly button will not help the opening close. These methods may also irritate or injure the child’s skin. ## Other hernias seen in children ### Epigastric hernia An epigastric hernia appears as a small lump between the breastbone and the belly button. It usually contains fatty tissue rather than bowel. Surgery may be advised if it causes pain, becomes more prominent or produces a visible swelling that concerns the child or family. ### Incisional hernia An incisional hernia develops through the site of a previous abdominal operation. It is less common in children and requires individual assessment. ### Diaphragmatic hernia A congenital diaphragmatic hernia is a very different condition. It occurs when abdominal organs enter the chest through an opening in the diaphragm. It is often detected during pregnancy or soon after birth and requires specialised neonatal treatment. ## When is a child’s hernia an emergency? Seek urgent medical attention if the swelling: * Becomes painful, hard or tense * Does not disappear when the child relaxes * Suddenly becomes larger * Develops redness or discolouration * Is associated with repeated vomiting * Is accompanied by abdominal swelling * Occurs with unusual crying, irritability or lethargy * Is associated with refusal to feed Do not repeatedly press or force a painful swelling back into the abdomen. The child should be assessed urgently by a doctor or paediatric surgeon. ## How is a hernia diagnosed? Most hernias in children can be diagnosed through the history and a physical examination. The surgeon may examine the child while standing, coughing or gently straining. In babies, the swelling may become more obvious during crying. An ultrasound scan is not routinely required when the clinical findings are clear. It may be advised when the diagnosis is uncertain, the swelling is not visible during examination or another condition needs to be excluded. ## How is hernia surgery performed in children? Inguinal hernia repair is performed under general anaesthesia. The open passage is identified and closed so that the abdominal contents can no longer enter the groin. The operation may be performed through a small groin incision or using laparoscopic surgery through tiny abdominal incisions. Both methods are effective. The most suitable approach depends on the child’s age, size, clinical findings and the surgeon’s assessment. Dr Vinayak Rengan is an laparoscopic pediatric surgeon but in smaller children prefers open method for hernia surgery. This is becasue the open incisions are very small ( hardly1.5cm ), the surgery is shorter and the incision disappears in the skin crease. Unlike adult hernia repair, mesh is generally not required for routine inguinal hernia surgery in children. This is because the problem is usually an open developmental passage rather than weakness of the abdominal wall. Umbilical and epigastric hernias are repaired by closing the opening in the abdominal wall with stitches. ## What can parents expect after surgery? Many children can return home on the same day after a routine hernia operation. Very young or premature babies and children with additional medical conditions may need longer observation. Mild pain, bruising or swelling around the incision can occur during the first few days. Pain is usually controlled with medicines prescribed by the surgical team. Parents will receive instructions regarding: * Feeding after anaesthesia * Wound care * Bathing * Pain relief * Return to school * Physical activity * Follow-up Most children recover quickly. The exact period before returning to sports or strenuous activity should be discussed with the operating surgeon. ## Frequently asked questions about hernias in children ### Is a hernia caused by excessive crying? No. Crying can make an existing hernia more visible because it increases pressure inside the abdomen. It does not usually create the underlying opening. ### Can constipation cause a hernia? Straining may make the swelling more prominent, but it is not usually the primary cause of a childhood inguinal or umbilical hernia. ### Is a hydrocele the same as an inguinal hernia? No. A hydrocele is a collection of fluid around the testis. An inguinal hernia allows abdominal contents to enter the groin or scrotum. They are related developmental conditions, but their treatment and timing may differ. ### Can my child play normally before surgery? A child with a painless, reducible hernia can usually continue normal daily activities while awaiting planned treatment. Specific restrictions are rarely required. Any new pain, vomiting or persistent swelling requires urgent assessment. ### Can an inguinal hernia return after surgery? Recurrence is uncommon, but it can occur. The risk may be higher in premature babies and children with certain medical conditions. ## When should you consult a paediatric surgeon? Arrange an assessment if your child has: * A recurrent swelling in the groin or scrotum * A swelling around the belly button that persists as the child grows * Pain associated with a visible lump * An uncertain groin or abdominal swelling * A previously diagnosed hernia that has changed in size or appearance Early evaluation helps confirm the type of hernia and determine whether observation, planned surgery or urgent treatment is appropriate. ## Paediatric hernia consultation in Chennai Dr Vinayak Rengan is a Paediatric and Neonatal Surgeon in Chennai with experience in open and minimally invasive surgery for infants, children and adolescents. Drop a whatsapp message on +91 99412 75775 to learn more about hernias If you have noticed a swelling in your child’s groin, scrotum or belly button, you can arrange a consultation for a detailed assessment and an individual treatment plan. *This article provides general medical information and does not replace an examination or personalised advice from your child’s doctor.* **Author:** Dr Vinayak S. Rengan, MS, MCh, MRCS