An umbilical hernia involves a distinctive protrusion near a baby’s navel, or belly button. Its size may range from half an inch to about 2 inches (1 to 5 centimeters) in diameter. It may only be noticeable when a child is crying, coughing or straining, and may become smaller when the child is quiet or still.

The navel is the place on the abdomen where the fetal umbilical cord enters the body. Before a baby is born, a muscular ring inside the umbilical cord normally closes. When this ring does not close, an umbilical hernia can develop.

Umbilical hernias are common in infants. In most cases, they cause no pain or harm, and resolve on their own (without treatment) by the time a child is 2 years old. They may occasionally remain until children are 3 or 4 years old.   

Umbilical hernias occur most often in infants under the age of 6 months. They also occur more frequently among babies who are premature and have a low birth weight and are of African American descent. The condition affects boys and girls equally.

Parents who suspect their child has an umbilical hernia should consult their child’s pediatrician. A physical examination is usually all that is needed to diagnose the condition.

No treatment is generally required for infants with umbilical hernias. A physician may recommend monitoring the condition while waiting for it to heal on its own. Folk remedies, such as taping coins to the area, have no effect on the hernia, and may actually cause skin infections.

When umbilical hernias remain beyond the ages of 4 or 5 years, or are accompanied by complications or swelling, surgery may be recommended. Surgical repair is usually performed as an outpatient procedure. A simple incision is made under the navel, and the bulging tissue is placed back inside the abdominal wall.

Umbilical hernias are a painless and common condition among infants. They are estimated to occur in one out of every six children, according to the National Institutes of Health.

An umbilical hernia occurs when abdominal tissue or portions of the small intestine bulge out into the navel, or belly button (umbilicus) area. It appears as a small, distinct bulge of skin under the navel. Protrusion may be most obvious when there is pressure in the abdomen, such as during crying, coughing or straining.

Abdominal contents protrude into the navel area through a weakened umbilical ring (the muscles around a small opening of the abdominal wall). The umbilical cord once passed through this ring into the abdomen of the fetus. The umbilical ring normally closes before birth, effectively sealing the opening into the baby’s abdomen. If the ring fails to completely close, or closure is delayed, it creates a weakness in the abdominal wall that can lead to an umbilical hernia. Why an umbilical ring may fail to properly close is not completely understood.

Umbilical hernias differ from inguinal hernias (protrusion of abdominal tissue into the groin area), which may also occur in children.

Umbilical hernias in infants rarely involve complications. When complications do occur, they require immediate medical attention. They may involve instances where the protruding tissue becomes:

• Incarcerated. Protruding abdominal tissue becomes trapped and is not able to be pushed back in. The protrusion will feel hard to the touch and may appear to cause the infant pain. An infant with incarcerated tissue will be irritable and may experience vomiting.
  
  
• Strangulated. When blood flow to abdominal tissue (including the small intestine) is cut off. When body tissue fails to get oxygen via the blood, the tissue dies. In these cases, the abdomen may swell and infants may experience vomiting, have a fever and appear to be in pain. Strangulation is an extremely rare complication of an umbilical hernia.

Umbilical hernias that occur in infants are caused by the imperfect closure of the umbilical ring, the muscles in the abdominal wall surrounding the navel that normally close before birth. The condition affects boys and girls equally. 

Factors that increase the risk of umbilical hernia among infants include:

• Age. Infants under the age of 6 months are more likely to experience an umbilical hernia.
  
  
• Low birth weight. Premature infants or those with a low birth weight have an increased risk of developing umbilical hernias.
  
  
• Race. Infants of African American heritage develop umbilical hernias more often than children of other races.

The most obvious sign of an umbilical hernia is a soft protrusion or bulge over the navel. The protrusion will appear when a child is crying, coughing or straining, but may not be noticeable when an infant is sleeping or resting. It may range in size from about half an inch to 2 inches (1 to 5 centimeters) in diameter. Hernias larger than 1.2 inches (3 centimeters) in diameter are rare.

Umbilical hernias are painless and common among infants. The bulging area is usually reducible (able to be pushed back in). If parents are unable to do this, or if touching the area seems to cause their child pain, immediate medical attention should be obtained. Other indications that a child may need medical attention include discoloration or swelling of the area, or vomiting.

Treatment is not generally necessary for umbilical hernias. In most cases, the hernia spontaneously disappears by the time a child is 2 years old. Occasionally, it may not go away until a child is 3 to 4 years old. There is no known way to prevent umbilical hernias.

Home remedies, such as taping or strapping coins to the area, are not recommended. These methods have no effect on umbilical hernias and may result in skin infections. Most umbilical hernias close by themselves with time, regardless of whether these methods are employed. Thus, the disappearance of hernias with use of these methods is only coincidence. Coins, tape and strapping have no effect on muscle weakness in the navel region. 

Although surgery is rare, it may be required in the following cases:

• If the hernia persists until a child is 4 or 5 years old.
  
  
• If complications develop (e.g., protruding tissue becomes stuck or strangulated).
  
  
• If swelling in the area is large (greater than 1.2 inches/3 centimeters in diameter) or gets larger after the first or secondyear.

Preparing questions in advance can help patients and parents have more meaningful discussions with physicians regarding their child’s treatment options. The following questions related to umbilical hernias may be helpful:

1. I notice that my baby’s belly button bulges out when he/she cries. Is this an umbilical hernia?
   
   
2. How serious is my baby’s umbilical hernia?
   
   
3. How do I know this hernia is not a symptom of a more serious disorder?
   
   
4. What treatment do you recommend for my baby’s umbilical hernia?
   
   
5. I’ve heard that placing a silver dollar on the belly button helps. Is there any harm in doing this?
   
   
6. Based on the size of my baby’s umbilical hernia, is it likely to go away on its own?
   
   
7. How long will it take to go away on its own?
   
   
8. What do we do if it doesn’t resolve on its own?
   
   
9. How will I know if my child has developed complications as a result of the umbilical hernia?
   
   
10. What symptoms, if any, should I report to you?
    
    
11. Can my child’s umbilical hernia recur after it goes away on its own?