Normal Umbilical Scar Appearance in Infants
A normal umbilical scar in infants appears as a small, dry depression in the center of the abdomen that is typically well-healed within 7-10 days after cord separation, with no redness, discharge, or swelling.
Normal Healing Process and Appearance
The umbilical cord typically separates from the infant's abdomen within 5-15 days after birth, leaving behind what becomes the umbilical scar. The normal appearance includes:
- Small, oval or t-shaped depression in the center of the abdomen 1
- Clean and dry appearance
- No active bleeding or discharge
- No redness or inflammation around the edges
- No foul odor
- No protrusion or bulging (which could indicate umbilical hernia)
- Symmetrical appearance
Timeline of Normal Healing
- Immediately after cord separation: Small raw area that may have minimal serosanguineous drainage
- 2-3 days post-separation: Area begins to dry and form a scab
- 7-10 days post-separation: Complete epithelialization with formation of the characteristic umbilical depression
- Fully healed appearance: A small, dry depression in the center of the abdomen
Signs of Abnormal Healing
It's important to recognize signs that may indicate complications:
- Omphalitis (umbilical infection): Characterized by redness extending to the abdominal wall, purulent discharge, foul odor, and sometimes systemic signs of infection 2, 3
- Persistent drainage: May indicate an underlying anomaly such as urachal remnant or omphalomesenteric duct anomaly 4
- Granuloma: Appears as small, pink/red tissue at the base of the umbilicus that may have slight drainage
- Umbilical hernia: Painless protrusion at the umbilicus that may increase with crying or straining
Care Recommendations
In high-resource settings like the United States, the American Academy of Pediatrics recommends:
- Dry cord care (keeping the area clean and dry) 2
- Avoid covering with diapers if possible
- Fold diaper below umbilical stump until healing is complete
- Sponge baths until cord falls off and area is completely healed
- Clean with water if the area becomes soiled
In low-resource settings with high neonatal mortality rates, application of 4% chlorhexidine solution or gel to the umbilical cord stump within 24 hours after birth is recommended 2, 3.
When to Seek Medical Attention
Parents should seek medical attention if they observe:
- Redness extending beyond the umbilicus to the surrounding skin
- Purulent or foul-smelling discharge
- Bleeding
- Persistent moisture or drainage after 2 weeks
- Signs of systemic infection (fever, lethargy, poor feeding)
Common Variations in Normal Appearance
The umbilicus can vary in appearance among infants while still being considered normal:
- Shape may be oval, round, or t-shaped
- Depth may vary from shallow to deep
- Position may be slightly higher or lower on the abdomen
- Small skin tags may occasionally be present
The umbilical scar serves as our first physiologic scar 5, 6 and its proper formation is an important developmental milestone in the neonatal period.