Umbilical hernia

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AssessmentChoose one

Fascial defectChoose one

PlanChoose one

Referral if persistentChoose one

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Discussed the need for emergency evaluation today. Caregiver expressed understanding and agreement with plan. Answered all questions.

Note when inserted as is

Umbilical hernia
• Soft, easily reducible umbilical hernia
• Observation, since most close on their own by 4 years of age
• Pediatric surgery referral if still present at 4-5 years of age
• Follow up at the next well child check

Umbilical hernias are common in babies and almost never cause problems. The bulge gets bigger with crying or straining, which does not hurt the baby, and most close on their own by 4 years of age. Binders, coins, or tape over the belly button do not help and can irritate the skin. Return precautions given including a bulge that stays out when the child is calm, a bulge that becomes firm, tender, or discolored, vomiting, belly pain, refusing to eat, fever, new symptoms, prolonged symptoms, worsening symptoms, and other concerns. Caregiver expressed understanding and agreement with plan. Answered all questions.

What the sources cover

Easily reducible
Large but reducible
Incarcerated: firm, tender, does not reduce
Size of the fascial opening predicts closure
Observation; about 90% close by 4 years
Surgery referral if not improving by age 5; HC says closer to 4 years
Binders, coins and tape do not help
Natural history, low risk, return precautions

Return precautions in the template

a bulge that stays out when the child is calma bulge that becomes firmtenderdiscoloredvomitingbelly painrefusing to eatfever

Sources

HC Umbilical Hernia (Chang, AAP Section on Surgery)

Few formal guidelines cover this topic, so the template also leans on expert opinion.