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The Informed Parent

Umbilical Hernia

by John H. Samson, M.D., F.A.A.P.
Published on Apr. 08, 2002

Grandmother Clare accompanied Mom and the newborn infant to the office for the first visit. She showed grave concern for the baby’s navel. Whenever Joey cried the navel would bulge out. In the old country these infants were taped or belly banded in order to keep the navel from popping out. In fact, Joey’s daddy had such a condition and because he used a bellyband the bulge was gone by his second birthday.

I attempted to explain to both Mom and Grandmother that it was common practice to tape down or tie down an umbilical (navel) hernia thirty years ago. Physicians advised parents to do this until it was gone. Thus, it was generally agreed that using a “truss”, as it were, caused the hernia to close. Others used to keep the hernia contents from protruding, and therefore protect against “strangulation” of the hernia sack contents.

In the past some presumably untraditional physicians noted that the hernias closed spontaneously, and that umbilical hernias rarely incarcerated or strangulated. Therefore, by the time I attended medical school we were taught to leave an umbilical hernia alone, and nature would close it just fine.

Indeed, my experience certainly supports the “leave-alone” approach. As a general rule an umbilical hernia that has not closed by age four should be considered a candidate for surgery. Those that have not disappeared by age four years usually do not close spontaneously. Another rule of thumb that has been helpful in predicting the ultimate need for surgery is the “two-finger rule”. If the defect is wide enough to allow two adult fingers to enter, it is very likely the hernia will not close spontaneously. You can still wait until age four years, but surgery will most likely be needed.

This is not the same for inguinal (groin) hernias. Inguinal hernias do not spontaneously close, and frequently incarcerate, or strangulate, necessitating emergency surgery.

There is no medical reason to use tape or a bellyband, but one must decide if you can withstand the family pressure. If one must surrender to keep the peace, do not use tape--that causes rashes. At least the bellyband is relatively innocuous. Let me encourage you readers to stand your ground. Do what is best for the infant. If one gives in now, other issues will come up later that will force the same type of situation. One might as well set the tone for your parental role now. It will be easier in the long run.

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