Does Every Umbilical Hernia in a Child Need Surgery?

# Does Every Umbilical Hernia in a Child Need Surgery? Dr Vinayak S Rengan - Pediatric Surgeon in Chennai answers this question **The short answer is no.** Most umbilical hernias in babies and young children close naturally as the child grows. Surgery is usually considered only when the hernia persists beyond a certain age, causes symptoms, or develops a complication. ## What is an umbilical hernia? An umbilical hernia appears as a soft swelling at the belly button. It develops when the small opening in the abdominal muscles, through which the umbilical cord passed before birth, does not close completely. The swelling may become more noticeable when the child cries, coughs, laughs, or strains during a bowel movement. It often becomes smaller when the child is relaxed or lying down. In most children, an uncomplicated umbilical hernia is painless and does not interfere with feeding, digestion, growth, play, or physical activity. ## Will an umbilical hernia close naturally? In many children, yes. A large study published in *JAMA Pediatrics* found that approximately **89% of childhood umbilical hernias closed naturally by five years of age**. Even when a hernia was still present at three years, there remained a reasonable chance that it would close by the fifth birthday. Smaller openings are more likely to close naturally, but size alone does not determine whether a child requires surgery. Even some larger hernias close as the abdominal muscles develop. For a painless and easily reducible umbilical hernia, observation until around four to five years of age is generally considered safe. [JAMA Pediatrics](https://jamanetwork.com/journals/jamapediatrics/fullarticle/2815678) ## When is surgery recommended? An operation may be advised if: * The hernia remains open at around four to five years of age * The swelling becomes painful or tender * The hernia becomes stuck and cannot be gently reduced * The child develops repeated symptoms related to the hernia * The defect is very large or becomes more prominent with time * The skin over the hernia becomes repeatedly stretched, damaged, or troublesome * The hernia affects the appearance of the belly button significantly and is a concern for the child or parents * Another abdominal operation is planned and repairing the hernia at the same time is appropriate The timing should be individualised after examining the child and assessing the actual opening in the abdominal wall. Dr Vinayak Rengan, Chennai based pediatric surgeon follows these general rules. In children, most umbilical hernia surgery is done via open technique. ## When does an umbilical hernia become an emergency? Complications are uncommon, but parents should know the warning signs. Seek urgent medical attention if the child develops: * Sudden or severe pain around the belly button * A firm, tense, or tender swelling * A hernia that remains stuck outside * Red, purple, or dark skin over the swelling * Repeated vomiting * Abdominal distension * Unusual sleepiness, irritability, or refusal to feed These symptoms may indicate that intestine has become trapped inside the hernia. This is called incarceration. If its blood supply becomes affected, it is called strangulation and requires emergency surgery. The overall risk of incarceration or strangulation in a childhood umbilical hernia is low, occurring in fewer than one in 100 children. [American College of Surgeons](https://www.facs.org/for-patients/the-day-of-your-surgery/pediatric-umbilical-hernia/) ## Should we place a coin or tight bandage over it? No. Taping a coin, belt, or tight dressing over the belly button does not close the opening in the abdominal muscles. It may instead cause skin irritation, infection, or injury. The hernia should simply be kept clean and observed. There is usually no need to restrict a child’s normal play because of an uncomplicated umbilical hernia. ## What happens during umbilical hernia surgery? Umbilical hernia repair in children is usually a short procedure performed under general anaesthesia. A small incision is made near the lower edge of the belly button. The contents of the hernia are returned to the abdomen, and the opening in the muscle is closed with stitches. Mesh is generally not required for routine umbilical hernia repair in children. Most children can return home on the same day. Discomfort is usually mild and settles within a few days. ## Frequently asked questions ### Does crying make an umbilical hernia worse? Crying makes the swelling more visible because pressure inside the abdomen temporarily increases. It does not usually damage the hernia or prevent it from closing. ### Does the size of the swelling determine the need for surgery? Not always. The size of the opening in the abdominal muscle is more important than how large the skin swelling appears. A paediatric surgeon can assess this during a physical examination. ### Does every child need an ultrasound scan? No. Most umbilical hernias can be diagnosed by examination alone. An ultrasound is usually unnecessary unless the diagnosis is uncertain or another condition is suspected. ### Can an umbilical hernia return after surgery? Recurrence is uncommon but possible. Repair performed at the appropriate age generally has excellent results. ## The take-home message Most umbilical hernias in babies and young children do not need immediate surgery. If the hernia is painless, soft, and easily reducible, careful observation is often the best approach during the early years. However, a persistent, painful, stuck, or otherwise unusual swelling should be assessed by a paediatric surgeon. The decision to operate should be based on the child’s age, symptoms, size of the defect, and examination findings rather than the appearance of the swelling alone. *This article provides general information and should not replace an individual medical consultation.* For a consultation or an opinion regarding a child with an umbilical hernia you may contact: Dr Vinayak S. Rengan MBBS, MS, MCh, MRCS Paediatric & Neonatal Surgeon | Paediatric Surgical Oncology Email: vinayak.rengan@gmail.com | + 91 99412 75775