Module 6: Umbilical Cord Care, Granulomas, and Hernias

In utero, your baby gets nutrients and oxygen through the umbilical cord. After delivery, this cord is cut (which doesn’t cause any discomfort to your newborn) and clamped. A lot of parents have questions about the correct way to care for the cord until it falls off, and it’s actually really simple. The motto is, less is more.

When Does The Umbilical Cord Fall Off & What Does It Look Like?

The clamp is removed at 24-48 hours of life (usually while still in the newborn nursery). Afterwards, it starts to dry out and shrivel up, and the color transitions to yellow then black. It should fall off at about 1-2 weeks of life. You may see some mild bleeding afterwards, though it shouldn’t look significant or last for long. You may also notice a small amount of drainage at the separation site, which should dry up quickly.

How Should I Care For It?

Just keep it clean and dry! While it’s tempting to mess with it, especially as it’s close to falling off and dangling, it’s best to leave it alone until it completely separates.

• No Submerged Baths: The main thing we worry about with water getting into the umbilical area is creating a moist environment that attracts bacteria and leads to infections. If you want to cleanse, sponge-bathe and avoid the abdomen. Once the stump fully falls off, wait 24 hours for everything to dry out and heal, then feel free to do a submerged bath.

• Fold Down Diaper: I recommend folding down the top edge of the diaper so that it doesn’t rub against the cord, which can cause irritation. This also helps create a separation between diaper contents and the umbilical stump, so that urine or stool doesn’t leak out.

• No Alcohol: There’s a few generationally and culturally-specific treatments that are trialed with the umbilical stump, such as applying alcohol. The American Academy of Pediatrics advises against this, since it can kill the bacteria that help the cord separate. 

When Should I See The Doctor?

The thing we get most concerned about with the umbilical stump is infection. This looks like swollen, red, and tender skin around the stump or a large amount of yellow to green, foul-smelling discharge. An infection can occur with or without fever. We worry about this since in newborns, a skin infection can tunnel deep quickly. If you notice any of these signs, see your doctor urgently.

I also recommend seeing the doctor if the cord stays attached for more than 2-3 weeks, to make sure there’s no concerns about immune issues.

What About Granulomas?

A granuloma is a little piece of tissue that hasn’t fully healed after separation of the umbilical stump. It often looks fleshy and slightly wet or gooey, and is inside of the umbilical area. It can appear as a small lump, or a larger fleshy mass taking up the entire area. These sometimes resolve on their own. In other situations, they require intervention. Your doctor may use a substance called silver nitrate, which is a small wooden stick with a substance on the end that helps with wound healing. Once it’s applied, it should start to dry out and shrink within a week. Your infant may require multiple treatments spaced a few days apart. There may be some slight discoloration in the surrounding area, though if it looks severe, see your PCP since this can suggest that too much was applied, which may lead to skin injury of healthy tissue.

What About Hernias?

A hernia is a when a section of the intestine leaves the abdomen itself, and exits through an opening in weaker muscle in the abdominal wall. Infants’ muscles aren’t as strong as adults’, so hernias are relatively common. The typical areas for hernias to appear are through the umbilicus (where the stump falls off) and in the inguinal or groin area (where the thigh creases are or in males, within the scrotum). Hernias look like swelling, since there’s extra tissue in an area where there shouldn’t be. They’ll appear most obvious when your infant is bearing down, such as when they’re crying or straining to stool. They usually don’t cause discomfort, and are typically what we call reducible. This means that they go away with gentle massage or repositioning.

Hernias can be dangerous since the intestines have left their safe home inside the abdomen. Outside of that, they’re at risk of getting stuck or twisting, which can cut off circulation and lead to tissue death. If this happens, you’ll notice redness, extreme swelling, tenderness, and inconsolable fussiness. This is a medical emergency, and if you notice it, you should go to your nearest ER.

As the abdominal muscles strengthen over time, umbilical hernias often slowly disappear with age. Your PCP will refer to a Pediatric Surgeon if the hernia is larger than a certain size or lasts beyond a specific age (usually 5 years). As a note, inguinal (thigh crease) hernias typically don’t resolve over time, and due to the high risk of getting trapped and twisted, they’re always operated on. If one is noticed, you’ll be referred to a Surgeon to address it once old enough for surgery and anesthesia.

Note: In some cultures, it’s recommended to tape a coin over the hernia to keep it close to the stomach, with the rationale that it will help decrease the size. This can cause infection, so I advise against it in lieu of letting it heal naturally over time.