Umbilical hernia in babies under one year old is a problem that causes well-founded concern and anxiety in parents. Why it appears and how to treat it is a question that worries all mothers and fathers whose babies suffer from such a pathology. Whether such a children's hernia can go away on its own without surgery, we will tell in this article.
What it is?
Umbilical hernia, like all other types of hernias, is a sign of weakness of the abdominal wall. It is the exit of some internal organs, which normally should be located in the abdominal cavity, outward without damaging the integrity of the skin and subcutaneous tissues. This becomes possible when there is an opening in the abdominal wall.
It can be both pathological (with muscle divergence, a large "gap" between tissues), and quite natural, which is the umbilical opening.
In newborns, the umbilical wound is formed for completely physiological reasons. When the baby is in the womb, the umbilical cord connects it to the placenta. The baby seat nourishes the baby, provides him with oxygen and nutrients necessary for normal growth and development. The umbilical cord is a kind of transport route through which food and oxygen are supplied to the baby, it also performs the function of removing waste carbon dioxide, as well as metabolic products.
Inside the umbilical cord there are two arteries and a vein, blood enriched with oxygen and nutrients from the mother flows through the arteries, and what the baby no longer needs is drained through the vein - waste products. After birth, the umbilical cord is no longer necessary, because placental respiration at the moment of birth changes to pulmonary, and from that moment the child can eat in a completely familiar way - through the mouth. The umbilical cord is cut off, the section is clamped to avoid blood loss, and tied.
However, a part of the umbilical cord remains inside the abdominal cavity in boys and girls. From the moment of birth, it is called the navel ring. Normally, this inner part of the umbilical cord should be covered with connective tissue during the first month of life, while the baby is considered a newborn. However, this process can be complicated by many factors as a result of which complete closure does not occur.
Thus, the umbilical ring continues to communicate directly with the abdominal cavity, and part of the internal organs, such as the bowel loops or the omentum, can go out through this communicating "channel". This happens if the pressure in the abdominal cavity exceeds the peritoneal ability to resist.
A hernia consists of a hernial sac, represented by that very weak peritoneum and its contents - those organs or their parts that have come out. At the same time, the umbilical ring acts as a hernial gate - a place through which an exit became possible. It is important to remember these terms in order to understand what is happening with the child and what the help should be. According to statistics, a hernial pathology of the navel occurs in every fifth full-term baby.
Among the babies who rushed and came to this world before the time allotted to them by obstetricians, hernial formation is observed in about every third toddler.
An umbilical hernia is one of the few hernias in the human body that can "dissolve" on its own, the vast majority of babies do not have a trace of it by the age of one year. Naturally, parents will have to put some effort into this. Only 3-5% of children have the problem up to 5 years. But modern medicine can help them too.
Causes and mechanism of occurrence
A hernia of the navel may be an indication that something went wrong in the child during fetal development, and the abdominal wall did not form properly. Muscle weakness and weakness of the connective tissue leads to defects in the development of the peritoneum, as a result of which part of the baby's internal organs "presses" on the junction with the umbilical cord even before birth. This pathology is called a congenital hernia.
With the acquired form of hernial disease, the baby may begin to suffer if the obstetricians made a mistake when cutting and clamping the umbilical cord, if an infection occurred, and due to the fact that the umbilical ring did not overgrow and close in the first month of independent life.
A simpler form of hernia is straight. The hernial sac, together with its contents, “looks out” directly through the navel ring. In a more complex - oblique form - the hernial contents in the bag first pass through the "pocket" between the transverse fascia and the white line of the abdomen and only then go out through the ring.
Hernial umbilical formations in infants are almost always distinguished by a fair amount of mobility - they can be adjusted without much effort. However, although rarely, children have complex uncontrolled hernias. The ability of the sac to move is due to the size and elasticity of the hernial orifice (in this case, the umbilical ring). Narrow gate - less mobile hernia, wide - more mobile.
A hernia always leaves under internal pressure, which forms in the abdominal cavity.
This pressure in a child rises sharply in certain situations:
- with strong hysterical crying and screaming;
- when pushing during bowel movements, especially if this requires exertion (constipation, for example);
- with a strong cough;
- with a distended tummy in children with increased gas production and severe infant colic.
If there are prerequisites (weak umbilical ring, slow overgrowth of the navel from the inside, congenital weakness of the abdominal wall), then such situations most often lead to the loss of part of the organs and the formation of a hernia. Separately, the cause of the pathology should be put, in which there is a share of the parents' fault. The baby is planted and upright too early. For these purposes, moms and dads have a lot of devices in their arsenal, for example, walkers and jumpers.
However, in an upright position, the pressure in the abdominal cavity increases, and this is a factor that provokes the appearance of pathology.
Until the child is 9 months old, it is safer to trust nature, and she arranged everything so that before taking an upright position on her own two feet, the child goes through several preliminary stages - crawling and sitting, it is they that allow the muscles of his tummy to get stronger and accept later increased internal pressure without the formation of hernias.
Symptoms and Signs
Congenital hernias, which appear in a child while still in the mother's womb, can also be seen by a diagnostician at the next ultrasound scan in a antenatal clinic or in a maternity hospital. Usually these are rather severe pathologies, in which the defect in the development of the peritoneum is extensive. Most often, several organs go into the hernial sac with such a congenital hernia - 2-3 intestinal loops, an omentum, a liver. But everything is not limited to hernial disease alone, and such babies in the overwhelming majority have gross genetic disorders, diagnoses that are incompatible with life. Acquired hernias in this regard have more positive prognosis.
It is possible to determine a navel hernia in an infant starting from the 30th day of his independent life outside the mother's abdomen. By this time, the neonatal period ends, the umbilical wound heals.
It is not necessary that the hernia appears immediately; it can form and be visualized at any time - both in a three-month-old child and in a six-month-old.
That is why it is important to be able to recognize pathology and take timely measures to prevent dangerous consequences. A hernia is always defined in the area of the umbilical ring. It has the appearance of a round or oval nodule, as well as an irregular shape. It can be quite insignificant - from half a centimeter in diameter to quite large, the diameter of which exceeds 5-6 centimeters.
When the hernial sac contains only intestinal loops, the formation looks slightly bluish, if you try very hard, you can see the intestinal wall through the delicate skin of the baby. When a part of the omentum, the liver, is in the sac, the node looks reddish. It looks, of course, frightening, but parents should understand that a hernia itself does not cause pain and suffering to the child. It does not hurt, does not itch, does not itch, and generally does not bother him much.
It is possible to determine an umbilical hernial pathology in an infant baby during periods of crying, coughing, when the baby poops. At other times, when he is calm and does not strain his tummy, the hernia is completely invisible. With a light, gentle finger pressure on it, adults may notice that it immediately goes back into the abdominal cavity, but then, unfortunately, it comes back again. Other symptoms raise many questions. So, some doctors say that an umbilical hernia affects the digestion and behavior of the baby.
They try to explain her restless sleep, poor appetite. However, this position does not stand up to criticism, because many children without such a pathology also have a bad dream, and they no less often demonstrate their unwillingness to eat.
Such a nodule in the umbilical region practically does not affect the intensity and frequency of colic, constipation and other typical infant problems. And frequent regurgitation and nausea are most often caused by overfeeding, and not by the presence of a hernial sac in the navel.
Symptoms in the form of vomiting, acute pain, bloating from gas overcrowding, are characteristic only of an infringement of the umbilical hernia. If, for some reason, the ring (hernial gate) is compressed or feces accumulate in the loops inside the sac, then the hernial sac is fixed outside, the organs in it are clamped. To the loops of the intestine and other contents of the sac, blood ceases to flow in the required amount.
The clamp causes a severe pain attack, the child cannot straighten out, he constantly screams. The hernia itself at these moments looks full, tense, painful. It is already impossible to enter it inside, and it is not worth trying. Since the child needs an urgent operation, the bill goes not even for hours, but for minutes.
The danger
A small unrestrained hernia does not pose any danger to the life and health of the baby. It is dangerous only because there is a risk of infringement. However, practice shows that pinching in children from 0 to 12 months is extremely rare, since both the umbilical ring and the intestinal loops are very elastic, mobile.
If infringement did occur, the list of possible threats expands dramatically. The contents of the hernial sac - internal organs and their parts, deprived of blood supply, rather quickly begin to “die off”.
Tissue necrosis develops rapidly, and during the operation the surgeon will have to completely remove not only the hernia, but also the dead parts of the intestine, omentum, and liver. Delay threatens the development of gangrene, which is deadly for a small child.
Diagnostics
A doctor-surgeon can give the child an appropriate diagnosis. He will examine the toddler in a horizontal position. Cough tests and vertical tests are not used on infants. Usually, a visual examination by a specialist is quite enough, in which he palpates the umbilical region and determines the approximate dimensions of the formation and the gate.
To understand whether it is straight or oblique, and, in addition, to clarify the location and the likelihood of infringement, an ultrasound of the abdominal cavity will be prescribed. An ultrasound scanner will allow you to accurately determine which organs are part of the bag. If there are fears of possible complications (adhesions, W-shaped bending of the bowel loops), the child will have to undergo a special examination method - irrigoscopy.
The procedure is not very pleasant, but necessary. The baby will be given an enema, for which not water will be used, but a special solution that will be visible on an X-ray. So the doctor will receive a detailed picture of what is happening inside, and will be able to decide on the tactics of treatment.
Treatment
Despite the seriousness of the situation, an umbilical hernia in a child under one year old does not require complex and specific treatment. After the diagnosis has been established, more than 95% of cases give preference to waiting tactics. The only way to deal with hernias of any origin and location today is a surgical hernia repair.
Umbilical pathology, in turn, is the only one of its kind, which can begin to reverse development, regress. Therefore, there can be only one indication for surgery in newborns and infants - infringement.
In all other cases, treatment is possible at home. At the same time, you will not have to treat something, you will not have to give medicines. But the problem needs to be carefully observed and some methods and techniques used that will make the reverse development of the hernia most likely.
- Sealing with a plaster. This method has worked well, however, there are several important points. The hernia must be fixed before gluing, and it is not recommended for parents to do this by themselves, so as not to harm the little one. Inept actions can provoke a spasm of the navel ring, which will inevitably lead to pinching and urgent surgery.
The surgeon must manually guide the bag through the skin. He will show parents how to do this and tell you how to properly seal the hernia with adhesive tape for a more reliable and safe fixation.
Then mom and dad will be able to change the patch on their own, carefully monitoring whether inflammation has begun under it, whether the child has a local allergic reaction.
From time to time, the child will have to be shown to the surgeon. If the hernia progresses or grows in size, another method of fixation may be chosen. Parents should definitely choose a high-quality and hypoallergenic sterile plaster. You can bathe a child with a sealed navel, but after water procedures, you should change the bandage.
- Bandage. Wearing such a special orthopedic belt allows you to reliably fix the hernial sac in the correct position, inside the abdominal cavity. The device allows you to balance internal pressure and external resistance.
You can wear a bandage after the operation, and before it, and even instead. But for this, the doctor must correct the hernia and show how to put on and fix the bandage on the baby's tummy.
The belt is soft, very elastic, it will not give the child any unpleasant sensations. You don't need to wear anything under it. Most of these products come with a set of special inserts for the problem area. A small hernia can successfully regress after a couple of months of wearing the bandage. It is contraindicated only for children with skin lesions in the area of contact of the product.
If there is an allergic rash, infectious rash, eczema on the abdomen, then the bandage should not be worn.
- Massage and gymnastics. Massage and gymnastics for a newborn and an infant, aimed at strengthening the abdominal muscles, can be done by the mother on her own. This does not require financial costs and a diploma of a masseur or doctor. Both the surgeon who made the diagnosis and the district pediatrician can show the techniques. The impact should be gentle and painless. Circular movements along the abdomen around the umbilical region are helpful.
Massage manipulations are combined with laying the toddler on the tummy.This allows you to strengthen not only the abdominal muscles, but also the oblique abdominal muscles.
Side flips from a supine position are also useful. To do this, it is enough to just slightly pull the baby by the opposite handle (so that he turns on his left side, pulls by his right hand). Gymnastics is more of a general strengthening measure. The main exercises are flexion and extension of the legs, bringing the legs to the stomach, raising the legs in an arc. Gymnastics is best done once a day, in the morning, and massage can be done before each feeding, but not after it, so as not to provoke regurgitation.
- Traditional methods. The most popular way among the people is to tie a five-ruble coin to the navel. He is known to everyone and, at first glance, does not raise questions. In fact, such "treatment" is quite dangerous and useless.
The piglet does not sufficiently fix the hernial sac in a stable position, and at the same time, the probability of infection of the navel is incredibly high.
If you really want to somehow fix the hernia, it is better to use safer methods - buy a bandage or adhesive plaster.
Tips to give your baby some rhubarb broths to drink, and to smear the navel with butter and propolis at night can only add to the hassle of the parents. After all, broths and propolis can cause severe allergies in babies.
At the same time, the benefits of such procedures have not been proven. The ability of a child's navel hernia to regress is often used by charlatans of various sizes, who offer to save the child from this misfortune once and for all for a certain amount.
Parents should not turn to such "healers", as this is always associated with the risk of pinching as a result of inept and incorrect actions of non-professionals.
- Operation. Planned hernia repair operations are performed if the hernia has not passed by the age of 6-7 years. In infants, there is no need to remove something as planned.
If there is no infringement and no emergency surgical care is needed, no one will operate on the baby. In emergency surgery, the hernioplasty method is used. In this case, doctors already during the operation decide whether to preserve the contents of the hernial sac or not. It depends on whether the internal organs are affected due to infringement. If not, the doctors will correct the hernia and suture the hernial orifice.
For fixation, either the child's own tissues (tension method) or a special mesh implant (tension-free method) are used. Today medicine can offer parents not only standard methods, but also laser surgeries.
Prevention
To prevent the hernia from developing, preventive measures should be practiced from the very birth of the child:
- Avoid long and hysterical crying.
- Avoid prolonged constipation, if necessary, use an enema or a mild children's laxative.
- With severe colic, you need to use a gas-reducing agent to prevent bloating.
- Starting from the age of one month, you can teach your child to swim, it allows you to quickly strengthen the abdominal wall.
- Timely and correctly treat respiratory diseases associated with the appearance of cough.
- Do not toss the baby up, as this dramatically increases intra-abdominal pressure.
- Do not get carried away with tight swaddling for too long.
For information on what hernias are in children and what to do with them, see the next video.
