Umbilical Hernia

Dear Lisa,

My two year old son has had a herniated belly button since birth. Although it not much bigger than anyone who has an "outie" belly button, it still does not look entirely normal and if you apply just a little bit of pressure, you hear a gurgling sound. The dr does not seem concerned about this in the least and has always said that he would probably outgrow it. Should I be concerned though or getting a second opinion?

“Second Opinion”

Dear “Second Opinion”,

An Umbilical Hernia occurs when there is incomplete closure of the umbilical ring within the abdominal cavity. (1) During fetal development, the intestines return to the abdominal cavity around the 11th week of fetal life. An Umbilical Hernia develops when the umbilical ring fails to close completely and the intestines slide in and out of the defect. This sliding of the intestines in and out of the opening results in a bulging of the belly button area. (1)

When a child has an umbilical hernia, it is normal for the belly button to make a gurgling or deflating sound when gentle pressure is applied to the area. The hernia can become more noticeable when there is increased intra-abdominal pressure as in the case of a child who cries a lot, strains to have a bowel movement, coughs or is constipated.(2) When these situations occur it is common to see the belly button protrude to the point that it sticks out of the top of the diaper.

Umbilical hernias are pretty much a benign condition where 90% of the cases resolve on their own without treatment. (1) In most cases the Umbilical Hernia goes away by the time a child is 2 years old. In African American children the umbilical hernia tends not to resolve until an older age, sometimes up until the age of 7. (2) 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. (1)

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 Umbilical Hernia to heal. This is not recommended because it has never been documented that these remedies aid in the closure of the defect. (1) In addition, the application of tape and binders cause irritation and may lead to infection. (1)

It sounds like the Umbilical Hernia that your son has is small and barely noticeable. It probably is resolving on its own. I have taken care of plenty of children with an Umbilical Hernia and in the majority of the cases the Umbilical Hernia resolved on its own. On a few occasions I did need to refer a child to a surgeon, but these children also had a Supra-Umbilical Hernia or Ventral Hernia as well as an Umbilical Hernia.

A supra-umbilical hernia is a weakness in the abdominal wall above the belly button. A ventral hernia is a weakness in the abdominal wall.

So to answer your question, it doesn’t seem that a second opinion is necessary.

References:
(1) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1458-1459.
(2) Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:423-423-426.

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

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