Large Umbilical Hernia in Newborns
The short answer
A large umbilical hernia in a newborn, while dramatic-looking, is still usually harmless. Even large hernias (over 2 cm) typically close on their own by age 4-5, though larger ones may take longer. Surgery is generally only considered if the hernia persists past age 4-5 or causes complications, which is rare in children.
Parents everywhere have the same worry. You are doing the right thing by looking into it.
By Age
What to expect by age
Large umbilical hernias can appear quite alarming, with the belly button protruding significantly, especially when your baby cries or strains. The hernia is a soft bulge caused by intestine or fatty tissue pushing through a gap in the abdominal wall muscles near the belly button. Even large hernias are soft, painless, and can usually be gently pushed back in (reducible). Do not put tape, coins, or belly bands over the hernia, as these do not help and can irritate the skin.
Your pediatrician will measure and monitor the hernia at well-child visits. Larger hernias (greater than 1.5-2 cm at the fascial defect) may take longer to close spontaneously but still have a high likelihood of resolution. The hernia may appear to grow as your baby gains weight, but what matters is the size of the abdominal wall opening, not the external bulge.
Continue monitoring. Many large umbilical hernias begin to decrease in size during the first year. The abdominal wall muscles strengthen as your baby becomes more active. Your pediatrician may discuss a timeline for resolution and potential surgical referral if the hernia remains very large.
Large hernias may still be present but should be slowly decreasing. Surgical referral is typically not considered until age 4-5 unless the hernia is very large (over 2 cm fascial defect), is enlarging, or shows signs of complications. Complications such as incarceration (trapped intestine) are very rare in children with umbilical hernias.
What Should You Do?
When to take action
- A soft bulge at the belly button that gets larger with crying or straining and reduces when baby relaxes
- The hernia is soft, painless, and can be gently pushed back in
- Baby is feeding well and having normal bowel movements
- The skin over the hernia appears normal without redness or discoloration
- The hernia seems to be getting significantly larger over time
- You have questions about whether surgery may be needed
- The hernia is difficult to push back in but baby is comfortable
- The hernia becomes hard, swollen, discolored, or very tender and cannot be pushed back in (incarcerated hernia requiring emergency evaluation)
- Baby is vomiting, extremely fussy, or refusing to eat with a firm, tender hernia
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
Worrying about your baby means you care. That is a good thing.
Related Medical Concerns
Umbilical Hernia (Belly Button Sticking Out)
An umbilical hernia is a soft bulge near the belly button caused by a small gap in the abdominal muscles where the umbilical cord was attached. They are very common, occurring in about 20% of babies, and the vast majority close on their own by age 4-5 without any treatment. They are almost never dangerous in children.
Inguinal Hernia in Newborns (Groin Hernia)
An inguinal hernia appears as a bulge in the groin or scrotum (in boys) that comes and goes, becoming more prominent when the baby cries or strains. Unlike umbilical hernias, inguinal hernias do not resolve on their own and require surgical repair to prevent complications. The surgery is safe and highly successful.
My Baby's Belly Button Bulges When Crying
This is almost always an umbilical hernia, which is very common (occurring in about 1 in 5 babies) and usually harmless. It happens when a small opening in the abdominal muscles near the belly button doesn't close completely after birth. The bulge you see is intestine pushing through when baby cries, strains, or coughs. Most umbilical hernias close on their own by age 2-5 without any treatment.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.