Dr Andy Raffles
Belly Button (Umbilicus) Worries
Updated: Sep 5, 2019
What exactly is the belly button?
During pregnancy the placenta and developing baby are connected to each other by the umbilical cord. The umbilical cord delivers oxygen and nutrition to the baby. After your baby is born the umbilical cord is clamped and cut. There is a 2-3 inch remnant left after the cut with a clamp attached. The mother delivers the placenta, and the rest of the umbilical cord. Over the next 7 to 10 days, what remains of your baby's umbilical cord dries out and the connection at the base of the cord dries out and the cord falls off. Skin grows over the area and then you have a belly button!
There are several different situations that can cause concern with respect to the newly formed baby belly button that may make you ask for advice and help. Some of these might or might not, require treatment but if you have any concerns then it would be worth talking to your Midwife, Health Visitor, GP or Paediatrician:
Umbilical Hernia - A protruding "outie" belly button
These are very common and result from the contents of the abdomen protruding into the healing scar forming the umbilicus. The protrusion is through a normal 'hole' in the base of the belly button, which previously allowed through the major umbilical blood vessels. After birth this small hole usually closes off and as as result the belly button heals up with no bulges. If the hole doesn't close then abdominal contents can bulge through. Nonetheless these usually heal by themselves and over the next couple of years, the protrusion or hernia, gets smaller and is usually gone by age 5 years. However if the protrusion or hernia doesn't go away this may need a relatively simple operation to close the hole in the tummy wall. There are several variants of this and if the hole is beside the belly button rather than in the centre of it, this is called a para-umbilical hernia and doesn't usually go away by itself. If in doubt do ask for a referral to a Paediatrician or a Paediatric Surgeon for an opinion.
As long as your baby isn't troubled by the hernia and is comfortable and the bulge doesn't get tender or extremely swollen and remains soft - leave it alone. It is rare for even a large umbilical hernia to cause any problems and the majority will heal up in their own time.
Omphalitis - Belly button infection
Occasionally the healing scar tissue of the belly button can get infected - and this usually shows as redness around the base of the belly button. There is sometimes a discharge of pus, and your baby may be out of sorts - more irritable, have a fever and dislike the area being touched, noticeably at nappy changing time. You should watch for redness, warmth and what seems like pain in the belly button region.
Like many bacterial infections, Omphalitis is more common in babies who may have a weakened or deficient immune system, as may happen with prematurity or babies who are in hospital and subject to invasive procedures. Therefore, infants who are premature, sick with other infections such as blood infection (sepsis) or pneumonia, or who have immune deficiencies are at greater risk. Infants with normal immune systems are also at risk, especially if birth is complicated by infection of the placenta (chorioamnionitis), or have had umbilical catheters.
Newborn babies with omphalitis usually present within the first two weeks of life, with signs and symptoms of infection (cellulitis) around the umbilical stump (redness, warmth, swelling, pain), pus from the umbilical stump, fever, fast heart rate (tachycardia) and if the infection is particularly established, may have low blood pressure (hypotension), sleepiness, poor feeding and yellow skin (jaundice). Omphalitis can quickly progress to severe sepsis and presents a potentially life-threatening infection. Avoidance is better than treatment, and you can avoid infections of this area by good cord care, such as simple cleaning with water rather than applying any creams or other preparations. Treatment usually involves a visit to hospital and the use of antibiotics, either by mouth or by injections.
Occasionally the healing process of the stump of the umbilicus, results in a pearly pink or red pea sized lump appearing at the site of the belly button. Whilst this can look alarming, it is simply some scar tissue which hasn't quite formed the normal skin covering, which results from normal healing. As a result the deeper layers of normal skin are exposed, and are dark red or pink pearl in appearance. Often there is a slight yellowish discharge. These are called umbilical granulomas and are harmless and generally not infected Current treatment as per NHS Guidelines is to sprinkle a pinch (no more than 1/4 teaspoon) normal table salt on the little lump and cover with a damp swab for 10 mins - and do this several times a day, usually at nappy changing time. The healing process may take a week or so, but the granuloma will heal, leaving a normal belly button.
There are several other causes of a pink pea sized lump visible at the umbilicus and although these are very rare, if treatment as above doesn't work, you should seek further advice.