What is it? Umbilical hernias form when the umbilical ring is delayed in closing/fails to close completely. More common in: premature infants, low weight infants, children of African descent, hypothyroidism, children with certain syndromes e.g. T21 (Down syndrome)
How does it present? Most commonly presents as a reducible painless bulge at umbilicus. Can be more prominent when the baby or child strains or cries.
How to assess:
Thorough history: Exclude red flag symptoms of vomiting/constipation.
Systematic examination: particularly looking to exclude red flag signs of pain on examination, irreducibility of hernia & colour change of overlying skin.
Red flags: The following complications are extremely rare in umbilical hernias.
When/who to refer to?
What is it? An umbilical granuloma is an overgrowth of tissue during the healing process of the stump. It usually looks like a soft pink/red lump and can be wet or leak small amounts of clear/yellow fluid. It is most common in the first few weeks of a baby’s life. Granulomas can take months to resolve.
Red flags: Signs of infection such as fever, spreading erythema, offensive smell/discharge. See umbilical infection section.
Treatment:
When/who to refer to? If signs of umbilical infection (see below), refer the child for urgent assessment at PAU.
What is it? Umbilical stumps can often appear moist & generally take 5-15 days to detach. Importantly, this must be discriminated from infection. Omphalitis is when the cord and/or surrounding skin becomes infected, and can cause the child to become systemically unwell. The most common sign of infection is purulent/offensive discharge from the umbilicus.
Red flags:
When/who to refer to?
What is it? The urachus is an embryological remnant connecting the bladder to the umbilicus. This usually closes at birth, but in some cases persists as a fistula between the two. These often present as persistent drainage of fluid (urine) from the umbilicus. An ultrasound can confirm the presence of a patent urachus.
Red flags: Urinary tract infection or umbilical infection, particularly if signs of being systemically unwell (as above).
When/who to refer to? If evidence that child is systemically unwell, please arrange an urgent referral for paediatric review via switchboard (0208 5467711) – this will be to a phone during daytime and registrar bleep out of hours.
If confirmed patent urachus but no red flags: routine referral to paediatric urology (usually requires excision to avoid malignancy in later life) – usually at St George’s Hospital.
Supporting Information
The following are useful resources for parents:
Umbilical hernia & repair information
Umbilical granuloma
