Umbilical Cord Care: What's Normal, What Isn't, And The Coin Myth

Turning your baby’s umbilical cord into art has gained a following in the West but would you pay hundreds of dollars for this piece of art?

The cord stump is the first thing on a newborn that most parents are frightened to touch. It looks alarming, it turns black, and it smells slightly. Nearly all of that’s normal.

Dry cord care is the current guidance: keep it clean and dry, and otherwise leave it alone.

Routine swabbing with alcohol is no longer recommended in settings like Singapore. It doesn’t reduce infection and it delays the stump falling off. Water only, and only if it’s soiled.

Looking after it

Fold the nappy down below the stump so it isn’t covered, rubbed or soaked in urine. Some nappies have a cut-out; otherwise just fold the waistband over.
Loose clothing, and let air get to it. In this climate that’s easy.
Sponge baths until it falls off. No submerging in the bath.
If it gets soiled, clean gently with plain water and let it air-dry completely.
Never pull it, even when it’s hanging by a thread. It comes off on its own.
Expect it between about 5 and 15 days. Later than that’s usually still fine, but mention it at a check-up.

What’s normal even if it looks alarming

Turning brown, then black, then shrivelled
A slightly unpleasant smell in the last days
A small amount of dried blood, or a spot of blood on the vest when it comes off
A little clear or yellowish ooze at the base as it separates

When it isn’t normal

See a doctor the same day if you see any of these:

Redness spreading onto the skin of the abdomen around the base
Swelling, or skin that’s warm and firm around it
Pus, or a foul smell
Bleeding that doesn’t stop with gentle pressure
Fever, poor feeding, unusual sleepiness or floppiness: a newborn who’s simply not themselves
Pain when the area is touched

Infection of the cord stump is uncommon but can become serious quickly in a newborn. This is one of the few things to go in for instead of waiting to see.

After it falls off

A small pink lump that won’t dry up is usually an umbilical granuloma: harmless, common, and easily treated at the clinic. Show it to your doctor, don’t treat it yourself.
An outie is just a shape. It isn’t caused by how the cord was cut.
A soft bulge that pops out when they cry is usually an umbilical hernia. Very common, especially in babies of Asian and African descent, and it nearly always closes on its own by one or two.

Don’t tape a coin, a button or a belly band over a hernia. It’s a widespread traditional practice in this region and it doesn’t work. The muscle closes on its own timetable regardless. What it does do is trap moisture and cause skin irritation and infection under the tape. If a hernia is very large, is still there past about four or five, or ever becomes hard, painful or discoloured, that needs a doctor.

Two decisions made at the birth

Delayed cord clamping

Waiting a minute or more before clamping allows more blood to pass to the baby, which improves iron stores in the first months. It’s now standard practice in most uncomplicated births, but put it in your birth plan and ask about it.

Cord blood banking

Two different things, often conflated:

Public donation: free, and the unit goes to a registry available to anyone who needs a match. In Singapore this is the Singapore Cord Blood Bank.
Private banking: you pay a collection fee and annual storage to keep the unit for your own family.

Be clear-eyed about the odds. The likelihood of a family ever using its own privately banked cord blood is very low, and for several conditions a child’s own cells couldn’t be used anyway. Private banking is most defensible where there’s a known family history of a condition treatable by stem cell transplant, a case to discuss with your doctor, not with a salesperson at an antenatal fair. Public donation costs nothing and is more likely to help someone.

Keepsakes

Some families keep the dried stump, and there’s a small trade in turning cords into artwork or jewellery. It’s entirely a matter of taste, but if you’re keeping it, dry it completely first and store it somewhere sealed and dry, because this climate is unforgiving of anything organic.

Frequently asked questions

How do I care for the umbilical cord stump?

Keep it clean and dry and otherwise leave it alone. Fold the nappy below it so it isn’t rubbed or soaked, dress the baby loosely, and give sponge baths instead of submerging until it comes off. Clean with plain water only if it’s soiled, and never pull it, even when it’s hanging by a thread.

Should I clean the cord with alcohol?

No. Routine alcohol swabbing is no longer recommended in settings like Singapore. It doesn’t reduce infection and it delays the stump separating. Water only, and only when needed.

When does the cord stump fall off?

Usually between 5 and 15 days. Longer than that’s often still fine, but mention it at a check-up.

What does an infected cord look like?

Redness spreading onto the abdominal skin, swelling, warmth, pus, a foul smell, bleeding that won’t stop, or a baby with a fever who’s feeding poorly or unusually sleepy. Infection is uncommon but can become serious quickly in a newborn, so see a doctor the same day.

My baby has a bulge at the belly button. Is that serious?

Usually an umbilical hernia, which is very common and nearly always closes by itself by one or two. Don’t tape a coin or button over it: that’s a common practice in this region that doesn’t work and causes skin irritation and infection. See a doctor if it’s very large, still present past four or five, or ever becomes hard, painful or discoloured.

Is private cord blood banking worth it?

For most families, the odds don’t support it: the chance of ever using your own stored unit is very low, and for several conditions a child’s own cells couldn’t be used. It’s most defensible where there’s a known family history of a condition treatable by stem cell transplant. Public donation through the Singapore Cord Blood Bank is free and more likely to help someone. Discuss it with your doctor, not at an antenatal fair.

What to remember

Clean, dry, nappy folded down, sponge baths, and hands off. It goes black and smells a little. That’s the process, not a problem.

Go the same day for spreading redness, pus, a foul smell, or a baby who isn’t themselves.

And never tape a coin over a hernia. It does nothing but cause a skin infection.