From the Guidelines
For a 2-month-old infant with an umbilical protrusion, the recommended approach is watchful waiting as most umbilical hernias in infants resolve spontaneously by age 4-5 years. No immediate intervention is typically needed unless complications are present. During evaluation, the provider should measure the size of the hernia (noting the fascial defect diameter), assess for reducibility, and check for signs of incarceration such as pain, vomiting, or skin discoloration 1. Parents should be instructed to monitor for these concerning symptoms which would require urgent medical attention.
Key Considerations
- The size of the hernia and the reducibility should be assessed during the evaluation
- Parents should be educated on the signs of incarceration, such as pain, vomiting, or skin discoloration
- Surgical referral is indicated if the hernia persists beyond age 4-5 years, if the fascial defect is larger than 1.5-2 cm, or if complications develop
- Parents should avoid placing coins, buttons or other objects over the hernia as these can cause skin irritation and do not promote closure
Monitoring and Follow-up
- Documentation of the hernia size at regular well-child visits is recommended to monitor progression
- The provider should assess for any changes in the hernia size or symptoms during follow-up visits
- Referral to a pediatric surgeon may be necessary if the hernia does not resolve spontaneously or if complications arise, as they have specialized training in the surgical treatment of children 1.
From the Research
Workup for 2-Month-Old Umbilical Protrusion
- The management of asymptomatic pediatric umbilical hernias is generally conservative, with most cases closing spontaneously by 4-5 years of age 2, 3, 4.
- Studies suggest that expectant management of asymptomatic hernias until age 4-5 years, regardless of size of hernia defect, is both safe and the standard practice of many pediatric hospitals 2, 3, 4.
- For a 2-month-old child with an umbilical protrusion, watchful waiting is likely the recommended approach, as the risk of complications from untreated umbilical hernias is low, with 1:1500 leading to incarceration of abdominal contents, and even fewer resulting in strangulation of the bowel 2.
- The shape of the umbilicus at the initial visit can be used to predict the future development of protuberant umbilici in pediatric patients with umbilical hernias, with certain shapes (e.g. highly inflated balloon type and crescent type) being more likely to develop into protuberant umbilici 5.
- There is no evidence to suggest that antibiotic prophylaxis is necessary for the management of umbilical hernias in children, unless surgical repair is planned, in which case a single dose of antibiotic prophylaxis may be beneficial in reducing wound infection rates 6.
Key Considerations
- The natural history of pediatric umbilical hernias, including the likelihood of spontaneous closure and the risk of complications, should be taken into account when deciding on a management plan 2, 3, 4.
- The size of the hernia defect and the age of the child should also be considered, although the current evidence suggests that these factors do not necessarily influence the decision to operate or not 2, 3, 4.