UMBILICAL HERNIAS ("OUTIES") (Birth-12 Months) What is happening inside my baby's body? A pair of stomach muscles runs down the belly from the ribs to the pelvis.
These muscles are the same ones that you can see on a bodybuilder's abdomen.
The muscles are parallel and are joined together from top to bottom by their surrounding thick tissues.
Newborns have these muscles, but the connecting tissue is not entirely attached.
This makes sense, because the umbilical cord comes out through the space between these muscles.
When your baby was inside the womb, if these muscles had been attached, then they would have cut off the blood exchange between mother and child.
The two muscles and their accompanying tissue attach above and below the belly button but remain unattached right around the umbilical cord until after delivery.
Once your baby is delivered and the umbilical cord is cut, it is safe for the muscles to attach themselves.
If, after the umbilical stump falls off, the muscles still haven't attached themselves, then the intestines can protrude through this hole and the belly button will look like an "outie," also known as an umbilical hernia.
The actual hernia is made of a sac protruding through this opening between the pieces of muscle and tissue in the abdominal wall.
This opening is called the umbilical ring.
Some babies have small hernias and some have large ones.
The hernia always pops out when a baby cries because the pressure generated by crying causes the intestines to push out through the umbilical ring.
The hernia may also look quite prominent when a baby strains.
Sometimes hernias can get stuck.
Umbilical hernias are seen in more than 10 percent of normal Caucasian babies and an even higher number of African American babies.
They are more common in premature than full-term babies.
What can I do? You need not - and really cannot - do anything to help an umbilical hernia.
It is an age-old myth that one can tie a coin to a string and wrap the contraption around a baby's waist to push the belly button back in.
Given the reason why umbilical hernias exist in the first place, you can easily see why this does not work.
When does my doctor need to be involved? Hernias pop out - sometimes a remarkable amount - but should be easily flattened: with gentle pushing, a parent should be able to maneuver the hernia back down.
When a baby is crying, it is difficult to push the hernia in; but when a baby is calm, it should be quite easy.
Hernias need to be seen by a doctor when they cannot be pushed back in easily or when the area around them becomes red and hot.
Sometimes they are incarcerated - the intestines get stuck in the muscle and cannot be pushed back in because they are swollen.
When this happens, they can become strangulated.
This is when the blood supply to the part of the intestine that is stuck is compromised and that part of the intestine is starved of important nutrients, including oxygen.
This can cause vomiting and remarkable pain.
Both incarcerated and strangulated hernias are medical emergencies.
Strangulated hernias must be treated immediately with surgery, because if the part of the intestine deprived of oxygen dies, then that piece of bowel must be removed before life threatening consequences set in.
Incarcerated hernias may not require urgent surgery, but they need to be examined by doctors (often surgeons) quickly in order to prevent strangulation.
What tests need to be done, and what do the results mean? The only test is to apply gentle pressure to the hernia to see if it can be pushed back in (in medical terms this is called reduced).
You or your doctor can perform this test.
If a hernia can be easily reduced, then it is normal.
If it cannot, then it may be incarcerated or strangulated.
In the case of a strangulated or incarcerated hernia, an ultrasound may help determine whether or not there is still blood flowing to the part of the bowel stuck in the hernia.
What are the treatments? The treatment for a normal, reducible hernia is time.
By two years of age, 95 percent of all umbilical hernias close on their own.
If a hernia has not closed by kindergarten, then you may choose to have it surgically closed for cosmetic reasons.
All strangulated hernias and some incarcerated hernias must be treated surgically.
The piece of intestine stuck in the gap between the muscles needs to be pushed back behind the muscles, and then the gap can be sewn closed.
Sometimes the bowel is swollen or has had minimal blood flow while entrapped.
In very extreme cases, when a segment of bowel has been so severely deprived of oxygen that it is no longer functional, it needs to be removed.
What are the possible complications? Incarceration and strangulation are very, very rare.
Babies with trapped hernias will almost always have pain and vomiting.
Remember, when a baby is crying, a hernia will always be difficult to push back in.