An umbilical hernia is a small hole in the abdominal wall at the umbilicus (belly button). It is often most visible when the child cries or strains, as the pressure pushes the abdominal contents or fluid through the hole causing it to bulge. The size of the umbilical hernia is determined by feeling the opening in the abdominal muscle, not by the amount of skin protruding (or sticking) out.
Most umbilical hernias have no symptoms. Generally those concerned about the umbilical hernia are the parents and grandparents. The hernia gets tight when the child strains or cries but usually causes no pain to the child. Some parents express feelings of quilt, but should not because the cause is unknown. Incarceration (abdominal contents getting stuck in the hernia) are very rare.
Treatment of umbilical hernia is observation. More than 95% of these hernias will close by the age of 5 years. More than 90% will close by the age of 3 years. Large hernias greater than 2.5cm (1 inch) may be closed surgically due to the less likely chance they will close on their own. Once again, incarceration of these hernias is very rare. Surgical treatment is not attempted in small umbilical hernias due to the risks of anesthesia when the hernia will close on its own. We want to reassure you that we will be happy to follow the child as he/she grows to see if repair is necessary. We also want you to know that various methods of compression such as banding, tape, strapping or application of plaster have not been shown to be effective. This does not speed up closure and can cause infection and skin irritation. If the hernia is quite large or if the child is over 4-5 years old, surgery may be suggested. The operation is a same day surgery and most children do quite well afterwards.
Most children are aware after their procedure, however, some children may remain sleepy for hours. Your child will be able to return home when he or she is awake, able to drink, and is stable. Your child may eat what he or she desires once he or she is able to tolerate clear liquids. Please encourage your child to drink fluids.The Steri-StripsTM on your child’s incision should remain in place and kept dry until they fall off on their own, usually in seven to 10 days. Give your child sponge baths until the dressing is removed. Your child may need pain medicine the first few days after surgery for pain control. Your child’s care team will provide you with prescriptions and specific instructions on administering your child’s medications in the recovery room prior to discharge.
Your child should avoid rough play for several days, but can resume most normal activities as soon as he or she feels well enough. Your child should not straddle toys or bicycles for a week. School-aged children can return to school within three to four days.
Call your child’s doctor immediately if your child has pain that is not controlled by acetaminophen (Tylenol®); a fever over 101°F (38°C); any excessive bleeding from the wound; pus draining from the wound; a large red area around the wound or if he or she has not urinated in a 12-hour period.
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