Hernias in infants (babies and children) is a relatively common condition, but can also be experienced by adults too. It’s caused by a weakness or defect in the abdominal wall.
Hernias are especially common in premature infants (babies born early). It’s not known why, but hernias are more common in baby boys than baby girls and affect approximately 6 in 100 children.
Related reading: Premature Babies – What To Expect Week By Week.
What causes hernias in infants?
Hernias happen when an internal part of the body pushes through a weakness or small gap in the abdominal wall or surrounding tissues. This means that fatty tissue or internal organs (often intestines) can push through the weak spot, causing a lump or soft bulge on the skin.
It’s not always known why a hernia occurs, but we do know that it’s nothing to do with anything that happens during pregnancy or birth.
Hernia risk factors
There’s a number of factors that increase a child’s likelihood of developing a hernia:
- Birthweight. Hernias are more common in premature and low birth weight babies
- Gender. Inguinal hernias are more common in boys
- Genetics. Hernias are more common in those who have a family history of hernias
- Medical conditions. Certain medical conditions, such as undecended testes or cystic fibrosis, make it more likely for a child to develop a hernia.
Related article: Hydrocele In Newborn And Babies | What You Should Know.
What are the different types of hernias?
There are different types of hernias and they affect different areas of the body. The most common types in babies and children are inguinal hernias (approx 80%) and umbilical hernias (approx 10-30%).
1. What causes inguinal hernias?
Inguinal hernias occur more commonly in male infants but they are possible in females, too. There’s something known as the inguinal canal – a passage from the abdomen to the genitals. In male infants, the testicles develop inside the abdomen.
Towards the end of pregnancy each testicle travels down through the inguinal canal into the scrotum. The inguinal canal closes shortly after birth but if it fails to close this can causes an inguinal hernia. Some of the abdominal lining or a loop of intestine pushes through, causing a lump in the groin area at the top of the thigh.
2. Umbilical hernia
During pregnancy the umbilical cord passes through an opening in the abdominal wall. Shortly after birth this opening usually closes up but sometimes the muscles don’t seal completely. If this happens, it can leave a weak spot in the abdominal muscle wall.
This allows the abdominal lining or a loop of intestine to poke through the weak area in the muscles. The belly button can appear enlarged or swollen. This type of hernia is common in newborns and babies under six months.
In most cases umbilical hernias resolve and heal by the time a child is about a year old. If it’s still present by the time a child is about 4 or 5 years old, surgery might be needed to correct it.
Adults can also be affected by umbilical hernias but they are more likely to be caused by repetitive strains.
Related reading: How Long Is The Umbilical Cord?
3. Epigastric hernia
Some babies are born with epigastric hernias. Epigastric hernias occur when the tissues that join the abdominal muscles do not form properly while the baby is growing in the womb. This allows tissue to push through the opening, causing a bulge or swelling in the abdomen at any point in a straight line between the chest bone and the belly button. These openings will not close by themselves.
4. Hiatus hernias
Hiatal hernias occur when the stomach pushes up into the chest by squeezing through an opening in the diaphragm, which separates the chest and the tummy. Babies with hiatus hernia are usually born with the condition and it is often associated with reflux.
If you think your little one has reflux, read our article Reflux In Babies | 10 Common Questions Answered.
How are hernias diagnosed?
Your child’s healthcare provider will diagnose a hernia by doing a physical exam.
Hernias are characterized by an obvious lump or bulge in the skin, typically measuring between 1 and 5 cm.
Although the hernia will always be there, there might be times when the lump isn’t clearly present. You might find it gets bigger during certain activities, such as when your baby cries or poops.
In older children, it might become more prominent when they laugh, cough or go to the toilet. The lump often shrinks or disappears when children are lying down or relaxing.
Your baby might be born with a hernia, but it might not become visible until the child is older.
Hernia symptoms in infants and children
Many hernias happen in newborns but you might not be aware of them straight away.
Because babies and infants cannot explain what they’re experiencing, it’s important for parents to be able to spot the signs or pick up on clues.
Common symptoms or signs of hernia are:
- An abnormal bulge or swelling in your baby’s abdomen, groin or scrotum, or around your child’s belly button
- Persistent crying
- A lump that changes in size and is worse when the baby cries or strains and less visible when the baby relaxes or lies down
- Pain or tenderness around the area.
Is a hernia serious?
In most cases, hernias are not a cause for concern. However, in some instances they can lead to serious complications.
Complications occur when the tissue or organ that pushes through the hernia becomes blocked or trapped.
Worrying hernia symptoms
A child with a hernia might need to be seen straight away to prevent further complications. Contact your child’s healthcare provider immediately if your little one has been diagnosed with a hernia and has any of the following symptoms:
- Sudden or severe pain
- Sudden or severe vomiting
- Difficulty pooping or passing gas
- The hernia becomes firm and/or tender
- The bulge cannot be pushed back into the abdomen.
Possible hernia complications
If any of the above occur, your child’s symptoms might point towards a strangulated hernia or an obstructed hernia, both of which can be very serious and are classed as a medical emergency.
- Strangulated hernia. This occurs when a section of bowel, organ or other tissues becomes trapped, cutting off the blood supply to the area. If left untreated, the tissue will begin to die
- Obstructed hernia. This is when the intestinal loop has entered the hernia and is blocked. The bowel becomes stuck outside the abdomen, and this can cause severe nausea, vomiting and pain.
Both of these situations require immediate medical care and emergency surgery within hours to save the affected section of bowel.
Can a hernia go away on its own?
A hernia can resolve on its own but this will depend on the type of hernia. Umbilical hernias will often resolve by the time your child is around a year old. But if it’s still present at 4-5 years, your child’s healthcare provider might recommend surgery.
Inguinal hernias in the groin or scrotum (inguinal area) require surgery to prevent further complications, such as strangulation.
What happens if a hernia is left untreated?
Not all hernias require surgery. It will depend on the type and content of the hernia. Some hernias are more prone to further complications, such as strangulation or obstruction. The decision to operate or not will also depend on whether symptoms of the hernia are affecting day to day activities and general health.
Most hernias will not get better on their own; however, they do not necessarily get worse.
If the hernia has a good blood supply, is not causing pain or discomfort and can be gently pushed back into the abdomen, then surgery might not be needed.
Talk to your child’s healthcare provider to discuss the best option.
If your child requires surgery, the process is relatively simple. The aim of the surgery is to make a small incision in order to push the intestine or tissue back into the abdomen and to strengthen and repair the surrounding belly muscles.
Surgery should take about 20-30 minutes but will depend on your child’s condition and individual circumstances. It will be performed under general anesthesia, which means your child will be asleep throughout the operation.
Normally, your child will be able to go home later that day, after recovering from the anesthetic and after having something to eat and drink.
As with all surgery, there are risks, which include:
- The hernia might return.
When should I speak to my child’s provider?
It’s important to look out for warning signs for a few weeks following your child’s surgery. The following symptoms can indicate an infection or post-operative complication:
- Fever or chills
- Increased swelling, redness or pain
- Persistent vomiting
- Shortness of breath
- Difficulty passing urine or fewer wet diapers
- Slow or absent bowel movement.
How long does it take a child to recover from hernia surgery?
It’s normal to expect your child to feel sore and uncomfortable afterwards; bruising and localised tenderness are common. The child might also feel quite sleepy or cry a little more often than normal.
Your care team will make sure your child goes home with adequate pain relief to keep him comfortable as he recovers.
It will take around 2 weeks to recover from the operation. It might be necessary to keep the child home from school or nursery during the recovery period to aid healing. The child will also need a follow up appointment to make sure he’s recovering as expected.
If you have any concerns about your child’s recovery, speak to a care provider and ask for further advice.