Dr Dana Elliott Srither, a certified Family Physician, answers a reader's question on her baby's bloated stomach.
My baby is 7 weeks old and his stomach ( which is the navel side) is bloated. Is it because he cries too much?
After birth, when the end of the umbilical cord dries up, a small opening is left in the abdominal wall. Failure of the muscles to close around this opening causes an umbilical hernia. Because the skin is intact and the size of the hole is relatively small this is the mildest form of abdominal wall defect. The opening usually is noticed within a few weeks after separation of the cord.
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At times, the skin over the umbilical hernia may become severely stretched and resemble a mushroom. When an infant strains or cries, the umbilical hernia may become tense, but with relaxation the contents of the hernia may be easily pushed back into the abdomen. The skin overlying the umbilicus, although stretched out, is usually otherwise normal.
As most umbilical hernias close spontaneously, no treatment is usually necessary in the first three to five years of life. Umbilical hernias rarely cause abdominal pain so children with umbilical hernias who develop pain should be evaluated for a cause other than the hernia.
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Umbilical strapping with a coin or other object placed over the hernia to maintain it in a reduced position has not been shown to promote earlier closure and is rarely recommended because of the discomfort to the child and the likelihood of skin irritation and erosion.
Surgical repair of umbilical hernias is reserved for three groups: patients whose hernias have become stuck out (incarcerated); patients with large, protruding hernias; and patients with hernias that are not closing. Repair is also considered appropriate for children with a large hole in the abdominal wall of greater than 1.5 cm or ¾ inch who are older than three years. In most children with umbilical hernias who require an operation, the hole has simply not closed by itself by the age of four to five. After that age closure of the hole is unlikely to occur on its own and the hernia may remain open into adult years, when complications are more frequent and serious.
In general, it is preferable to repair all umbilical hernias before school age, when children begin to participate in physical activities.
What your baby’s condition is, it is not an omphalocoele, which is when the gastrointestinal structure protrude through a totally unclosed umbilical ring. This is a more serious anterior abdominal wall condition and occurs in about 2.5 of 10,000 births. This needs immediate surgical repair after birth.
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