What is an umbilical hernia?

An umbilical hernia appears as a soft bulge at the belly button. It happens because the opening through which the umbilical cord passed during pregnancy — the umbilical ring — has not fully closed after birth. Through this small opening, a loop of fat or intestine can push outward, creating the visible bulge.

The bulge becomes more prominent when the child cries, laughs, strains, or stands up — anything that increases pressure inside the abdomen. When the child is calm, it usually disappears or can be gently pushed back.

How common, and who gets it?

  • Frequency: Umbilical hernias are very common, especially in babies.
  • Premature infants: Almost all premature babies have one to some degree.
  • Ethnicity: Umbilical hernias are more common in some populations, including children of African descent.

The good news: most close on their own

Unlike inguinal hernias, umbilical hernias usually heal without any treatment. The vast majority close spontaneously as the child grows and the abdominal muscles strengthen.

  • Watchful waiting: The standard approach is simply to monitor the hernia.
  • Age 4 cutoff: If the umbilical ring is still open by age 4, spontaneous closure is unlikely and surgery is usually recommended.
  • Larger hernias: Very large hernias (over 1.5 cm wide) close less reliably and may be operated on earlier.
Old wives' tales — taping coins or tight bands: These traditional remedies do not help and may damage the skin. They have no place in modern care.

When is surgery needed?

Surgery is considered when:

  • The hernia is still present at age 4–5
  • The opening is unusually large from the start
  • The hernia causes the child pain (rare)
  • There is a sudden change — see warning below
Important — incarceration is rare but serious: Unlike inguinal hernias, umbilical hernias rarely become incarcerated. However, if the navel suddenly becomes painful, hard, red, or the child becomes unwell with vomiting, seek immediate medical attention.

What does the surgery involve?

Umbilical hernia repair is a routine, low-risk operation in experienced hands. The surgeon makes a small curved incision just below the navel, empties the hernia sac, and closes the opening in the abdominal wall with dissolvable sutures. The base of the navel is then reattached for a natural-looking final result.

Mesh is not needed in children — their abdominal wall heals strongly on its own. Most children go home the same day.

Recovery

Children usually return to gentle activities within days. Strenuous physical activity, sports, and swimming should be avoided for 1–2 weeks depending on the child's age, to allow the wound to heal undisturbed. Pain after the operation is generally mild and well controlled with paracetamol and ibuprofen.