Umbilical Granuloma

Dear Lisa,

My three week old son’s belly button fell off a few days ago. It looks different than the way my daughter’s did when her belly button fell off. It looks like there is something shiny sticking out of it. He doesn’t have a fever and he’s been eating good. There’s no discharge or redness, so I don’t think that it’s infected but I don’t know what it is?

“Weird looking Belly Button”

Dear “Weird looking Belly Button”,

It sounds like your child may have an Umbilical Granuloma. In some cases, when a baby’s umbilicus (belly button) heals there’s an overgrowth of the umbilical stump. This umbilical tissue that persists after the belly button falls off usually appears white, smooth and shiny. Sometimes it looks pinkish or red in color. (1) An Umbilical Granuloma can be seen sticking out of the middle of the belly button. Many parents don’t notice it unless they push down gently on both sides of the belly button. It frequently has a “wet” appearance, but should not have an odor or discharge.

A discharge from the umbilicus, especially one with an odor is a sign of a belly button infection and should be seen by your child’s Pediatrician. Other signs of infection of the belly button include redness and warmth of the skin that surrounds the belly button, irritability, fever or difficulties feeding. If necessary your Doctor can do a culture of the belly button to determine if there is an infection.

You should bring your child in for an examination so that your Pediatrician or Nurse Practitioner can verify if your child has an Umbilical Granuloma. The treatment for an Umbilical Granuloma includes the application of Silver Nitrate which is a simple procedure that can be done right in the doctor’s office. (1) Silver Nitrate is a drying agent that serves to stop the overgrowth of the umbilical stump. This drying agent continues to work after the application therefore it is important not to clean the area after the visit. You should just leave it alone for approximately 24 hours.

This application is not painful, but many sometimes a baby cries during the procedure because they are cold from their clothes being removed. I myself have gotten Silver Nitrate on my skin during the application and it does not feel like anything at all. If Silver Nitrate touches the skin, a couple of hours later a brown stain will appear that will eventually go away on its own. It is common for the skin around the umbilicus to turn brown a couple of hours after the application of the Silver Nitrate. In addition, a small amount of grey colored liquid may ooze out of the belly button for the first twenty-four hours. This may stain the clothes grey and may be patted gently with a piece of gauze.

An Umbilical Hernia is another condition that causes the belly button to protrude. This has nothing to do with the healing of the belly button itself. Instead, it is due to the incomplete closure of the umbilical ring inside the baby's abdomen during fetal development. (2) During fetal development, the intestines return to the abdominal cavity around the 11th week of fetal life. An Umbilical Hernia occurs when the umbilical ring fails to close completely. As a result the intestines slide in and out of the defect which causes bulging around the belly button. (2) A parent may notice this bulging when there is increased abdominal pressure such as when the baby cries a lot, coughs or has a bowel movement. (3) If you put gentle pressure on the belly button the protrusion seems to “deflate” and appears flat again. The difference between the appearance of an Umbilical Granuloma and an Umbilical Hernia is the Umbilical Granuloma is an overgrowth that sticks out of the inside of the belly button and the area around it appears normal. When there is an Umbilical Hernia, the area around the belly button sticks out and many times pops out of the top of the diaper.

In 90% of the cases an Umbilical Hernia resolves on its own. (2) In most cases the Umbilical Hernia resolves by 2 years old, but in African American children it tends to not resolve until they are older. (3) If a child’s Umbilical Hernia is still present by 5 years old it is a good idea to see a Pediatric Surgeon for an evaluation. (2) In the past it was a common practice for parents to bind the abdomen or tape a quarter over the belly button in the attempt to cause the Umbiical Hernia to heal. This is not recommended because it has never been documented that these remedies aid in the closure of the defect. (2) In addition, the application of tape and binders cause irritation and may lead to infection. (2)

References:
(1) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 275-276.
(2) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1458-1459.
(3) Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:423-426.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Babies Healthy