Hernia in Children

A hernia is the bulging of an organ or tissue through a weak spot in the muscles of the abdomen (abdominal wall). Hernias develop most often near the belly button (navel) or the area where the leg meets the lower abdomen (groin).

There are several types of hernias in children. Common ones include:

• Umbilical hernia. This type develops near the navel.
• Inguinal hernia. This type develops in the groin or scrotum.
• Femoral hernia. This type develops under the groin, in the upper thigh area.

Umbilical and inguinal hernias are the most common hernias that develop in babies and children.

What are the causes?

In children, hernias develop when a natural opening in the abdominal wall fails to close properly. Different types of hernias may have different causes. Some children are born with a hernia. Other children may have a hernia that develops slowly.

What increases the risk?

Umbilical hernia is more likely to develop in:

• Infants who have a low birth weight.
• Infants who are born before the 37th week of pregnancy (premature).

Inguinal hernia is more likely to develop in:

• Boys.
• Infants who are premature.
• Children of African-American descent.
• Children who have cystic fibrosis.

What are the signs or symptoms?

The main symptom is a skin-colored, rounded bulge in the area of the hernia. However, a bulge may not always be present. It may grow bigger or be more visible when your child cries, coughs, or strains (such as when lifting something heavy or having a bowel movement).

A hernia that can be pushed back into the area (is reducible) rarely causes pain. A hernia that cannot be pushed back into the area (is incarcerated) may lose its blood supply (become strangulated). A hernia that is incarcerated may cause:

• Pain.
• Fever.
• Nausea and vomiting.
• Swelling.

How is this diagnosed?

Hernias in children are usually diagnosed based on:

• Your child’s symptoms and medical history.
• A physical exam. Your child’s health care provider may ask your child to cough or move in certain ways to see if the hernia becomes visible.

How is this treated?

Treatment depends on the type of hernia your child has. Strangulated hernias are always treated with surgery. This is done because lack of blood supply to the trapped organ or tissue can cause it to die. Femoral hernias are always treated with emergency surgery because that type has a high risk of strangulation.

An umbilical hernia or inguinal hernia may not need medical treatment if it is small and painless. Your child’s health care provider may recommend monitoring the hernia as your child ages. Surgery may be needed if:

• The hernia is incarcerated.
• The hernia is unusually large.
• An umbilical hernia does not close on its own by the time your child is 4 years old.

Surgery may be done immediately or later, when your child is older. Surgery to treat a hernia involves pushing the bulge back into place and repairing the weak part of the muscle or abdominal wall.

Follow these instructions at home:

• You may try to push the hernia back in place by very gently pressing on it while your child is lying down. Do not try to force the bulge back in if it will not push in easily.
• Do not let your child lift anything that is heavier than 10 lb (4.5 kg), or the limit that you are told, until your child’s health care provider says that it is safe.
• Have your child avoid straining (such as during a bowel movement).
• If your child is scheduled for hernia repair, watch the hernia for any changes in shape, size, or color. Tell your child’s health care provider about any new symptoms or changes.
• Give your child over-the-counter and prescription medicines only as told by your child’s health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child becomes unusually irritable.
• Your child will not eat.
• Your child has a fever.

Get help right away if:

• The hernia:
  • Changes in shape, size, or color.
  • Feels hard or tender.
• You cannot push the hernia back in place by very gently pressing on it while your child is lying down. Do not try to force the bulge back in if it will not push in easily.
• Your child vomits repeatedly.
• The hernia bulge remains out after your child has stopped crying, stopped coughing, or finished a bowel movement.
• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
• Your child has more pain or swelling in the abdomen.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services.

Summary

• A hernia is the bulging of an organ or tissue through a weak spot in the muscles of the abdomen (abdominal wall).
• Different types of hernias have different causes. Some children are born with a hernia. Other children have a hernia that develops slowly.
• Treatment depends on the type of hernia that your child has.
• An umbilical hernia or inguinal hernia may not need medical treatment if it is small and painless.
• If your child is scheduled for hernia repair, watch the hernia for any changes in shape, size, or color.