Dawaa Reference

chronic

Umbilical hernia in infants

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources3 sources

Pediatric Umbilical Hernia - StatPearls (NCBI Bookshelf NBK459294) - https://www.ncbi.nlm.nih.gov/books/NBK459294/ · Umbilical hernia in infants - disease-level clinical article (umbilical-hernia-infant-full.txt) · Umbilical hernia in infants - disease-level clinical article (umbilical-hernia-infant-clinical.txt)

Verified against3 documents
  • Pediatric Umbilical Hernia - StatPearls (NCBI Bookshelf NBK459294) - https://www.ncbi.nlm.nih.gov/books/NBK459294/
  • Umbilical hernia in infants - disease-level clinical article (umbilical-hernia-infant-full.txt)
  • Umbilical hernia in infants - disease-level clinical article (umbilical-hernia-infant-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (4)

  • Severe abdominal pain, nausea, and vomiting are typical once the hernia becomes incarcerated or strangulated [abdominal pain · hernia · nausea · vomiting]
  • The usual picture is a bulge around the navel of a newborn that shows more when the baby cries or strains
  • More than 9 in 10 cause no trouble at all and close by themselves by age 5 or sooner
  • First-time parents are often badly frightened by it, so the explanation is part of the treatment

Signs — what you find (2)

  • Abdominal tenderness, distension, and skin redness over the hernia can signal incarceration or strangulation, sometimes with a fully acute abdomen [abdominal tenderness · hernia · redness]
  • The size of the opening in the abdominal wall, not the size of the visible bulge, predicts whether it will close on its own

Tests (1)

  • No specific testing or imaging is needed - the diagnosis rests on history and physical exam alone

If not this — what else fits (3)

  • An epigastric hernia is on the differential
  • A hernia of the umbilical cord itself is on the differential
  • Omphalocele is on the differential

SourceStatPearls "Pediatric Umbilical Hernia" - disease-level clinical article

Presentation findings are traced to the source above.

1

REASSURANCE AND WATCHFUL WAITING (NO DRUG THERAPY)

1st line
Dose source

Umbilical hernia in infants - disease-level clinical article (umbilical-hernia-infant-full.txt)

Why

The article's management is expectant and gives its reasons: repair in infancy is usually put off because complications are rare, and most paediatric umbilical hernias cause no symptoms at all - more than 90% close on their own, with no intervention, by the time the child is 5. The value of the consultation is the reassurance, delivered with the numbers behind it.

Cautions
  • WHAT TO TELL THE PARENTS - reassure them: an umbilical hernia in a newborn or a child is very common indeed, and it hardly ever causes trouble. Over 90% shut of their own accord, usually by the age of 2 years. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • Watching and waiting, where there are no symptoms, is safe up to the age of 4 or 5 years, and is what many paediatric hospitals treat as standard practice. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • MEASURE THE DEFECT, NOT THE BULGE - at the assessment, measure how big the defect is, check that it reduces, and look carefully for anything suggesting the hernia is incarcerated or strangulated. It is the size of the fascial defect, not the size of the sac nor how far it sticks out, that tells you best whether it will close on its own. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • THE NUMBER THAT PREDICTS CLOSURE - a ring measuring under 1 cm across is a great deal more likely to settle by itself than one above 1.5 cm. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • BINDING, COINS AND STRAPPING - the article will not endorse it: opinion is not settled, the prospective studies that would settle it do not exist, the condition itself is benign and closes spontaneously in most children, and the argument goes on - so no formal recommendation for umbilical strapping can be made as things stand. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • AND IT HARMS THE SKIN - the skin suffers fairly often: irritation, maceration and excoriation have been reported in around 25% of children strapped for an umbilical hernia. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294) Strapping may also hold back the normal working of the abdominal muscles. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294) One child in four gets a sore navel and no proven benefit.
  • NO TESTS ARE NEEDED - nothing needs testing or imaging to make this diagnosis; it rests on what the parents describe and on what you find when you examine the child. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • In most children with an umbilical hernia there is nothing else wrong. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
2

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Umbilical hernia in infants - disease-level clinical article (umbilical-hernia-infant-clinical.txt)

Why

Carries the emergency the family must be able to recognise at home, the surgical indications the article lists, and the associated conditions that change the answer from waiting to referring.

Cautions
  • RED FLAG - INCARCERATION OR STRANGULATION: the picture is severe abdominal pain, nausea and vomiting. On examination expect tenderness, a distended abdomen, reddened skin over it, and possibly an acute abdomen. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • A strangulated umbilical hernia goes to surgery straight away, with proper resuscitation alongside it. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294) One that is incarcerated is reduced, and the repair booked for the first convenient slot. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • TEACH THE SIGNS BEFORE THEY ARE NEEDED - the parents are told what would make an early operation necessary, and taught to spot the signs that the hernia has become incarcerated or strangulated. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • PUT THE RISK IN PROPORTION - incarceration is put, overall, somewhere between 0.07% and 2.77%. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294) Low, not zero: reassure and still teach the red flags.
  • WHEN TO REFER FOR SURGERY - the indications the article gives are: a fascial defect still open at 5 years of age (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294); a large trunk-like protrusion whose defect has neither closed nor improved by 2 years (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294); skin over the defect that is eroded, macerated or excoriated (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294); peritoneal dialysis (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294); ascites; a hernia that has ruptured; incarceration; strangulation; and any hernia causing symptoms.
  • SIZE AT AGE 2 - many would repair any umbilical hernia whose defect measures 1.5 cm or more once the child is over 2 years, since the odds of it closing by itself by then are slim. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294)
  • DO NOT OPERATE EARLY WITHOUT A REASON - these hernias come back more often in children repaired before the age of 4 years, and complications run about 4 times as high under that age.
  • LOOK FOR THE COMPANY IT KEEPS - the conditions occasionally found alongside it are the trisomies (13, 18 and 21) and the metabolic disorders - hypothyroidism and the mucopolysaccharidoses among them. Several dysmorphic syndromes have been seen with it too: Beckwith-Wiedemann, Down, Ehlers-Danlos and Marfan. (Pediatric Umbilical Hernia - StatPearls - NCBI Bookshelf, NBK459294) A large hernia with a big tongue, or with a constipated, slow-feeding baby, needs a thyroid check.

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