Though often linked with adults, hernias can also affect children, either present at birth or developing later. The most common types seen in kids are inguinal and umbilical hernias. While they are often harmless, proper medical care is essential to reduce the risk of complications.
What Are Paediatric Hernias?
Paediatric hernias happen when part of an organ or tissue pushes through a weak spot in the abdominal wall. Inguinal hernias appear as a bulge in the groin, while umbilical hernias appear near the belly button. These are often seen in infants and can be concerning for parents, but many resolve naturally.
What Causes a Hernia in a Child?
The causes of paediatric hernias are primarily congenital. Unlike adults, a child's lifestyle factors typically do not influence their development; instead, the root cause lies in their anatomical formation.
Inguinal Hernia in Infants and Children
An inguinal hernia in infants happens when part of the intestine or other tissue pushes through a weak spot in the abdominal wall in the groin area, creating a bulge. This is more common in boys and is often present at birth. It develops when the inguinal canal, which allows testicles to descend in boys, fails to close after birth, leaving an opening for tissue to protrude.
Umbilical Hernia in Infants and Children
Umbilical hernias occur when the umbilical ring, which normally closes after birth, fails to seal completely, leaving a weak spot near the belly button through which tissue or intestine can protrude. Most umbilical hernias are painless and typically close on their own by around age 4 to 5.
Which Children are at Risk for Hernia?
Children at risk for a hernia—especially inguinal hernias—are influenced by several congenital and acquired factors, with congenital factors being most significant in paediatric cases. Key risk factors include:
- Prematurity and Low Birth Weight: Premature and underweight babies are at significantly higher risk for hernias. The incidence of inguinal hernias increases up to 30% in extremely premature infants and is also heightened in babies born before 32 weeks of gestation.
- Gender: Inguinal hernias are much more common in boys than in girls. The male-to-female ratio is about 5:1 to 6:1 in children, and boys are up to eight times more likely than girls to develop an inguinal hernia overall.
- Genetics and Family History: A family history of hernias, especially in the mother, increases a child’s risk. Genetic studies show that the risk is notably higher if a close relative has had an inguinal hernia. A maternal history of hernia is associated with nearly three times the risk in children.
- Medical Conditions:
- Cystic Fibrosis: Children with cystic fibrosis may be at increased risk due to chronic coughing and straining.
- Developmental Dysplasia of the Hip (DDH): This congenital condition may be associated with a higher risk of hernias.
- Problems with Urinary or Reproductive Organs: Abnormalities in these systems can increase hernia risk, especially if they cause increased intra-abdominal pressure or are associated with connective tissue disorders.
- Connective Tissue Disorders: Inherited conditions such as Ehlers-Danlos syndrome and Marfan syndrome make children more prone to hernias due to weakened connective tissue.
- Other Factors: Chronic constipation, chronic coughing, and previous hernia or hernia repair also increase risk, but these are more relevant in older children or as acquired factors.
How to Diagnose Hernia in Children and Babies
Diagnosing hernia in children and babies involves a thorough physical examination and medical history, as well as imaging tests to confirm the diagnosis.
Physical Examination
The diagnosis of both umbilical and inguinal hernias is primarily based on a physical exam.
For umbilical hernias, a soft bulge at the belly button is observed, which may increase in size when the child cries or strains and usually disappears when the child is calm or lying down.
For inguinal hernias, a bulge in the groin or scrotum is seen, especially when the child strains, cries, or coughs. The bulge may disappear when the child is relaxed or lying down.
Ultrasound (if needed)
Imaging is rarely needed for diagnosis but may be used if the exam is unclear, complications are suspected, or the hernia is not reducible. Ultrasound can confirm abdominal contents in the hernia sac and check for complications like incarceration or strangulation.
When to See a Doctor
While many hernias in children are harmless and resolve naturally, a bulge that becomes hard, painful, or does not go away warrants immediate medical attention. This is especially true if it does not reduce when gently pressed, as these signs could indicate a more serious issue.
Contact a doctor immediately if your child has:
- Severe or sudden pain in the bulge area
- Vomiting or bloating that does not go away
- Redness or discolouration around the lump
- A bulge that is firm, tender, and does not go back in
These could be signs of an incarcerated or strangulated hernia, which occurs when a portion of the intestine becomes trapped and loses its blood supply. This is a medical emergency and requires prompt treatment.
Hernia Treatment for Children and Babies
Hernia treatment varies depending on the type of hernia and its characteristics, with options ranging from watchful waiting to surgical repair.
- Watchful Waiting: This approach is commonly used for umbilical hernias, especially small ones. Research suggests that about 85% of umbilical hernias smaller than half an inch close on their own within several years after birth. If the hernia persists beyond age 4 or 5, is large, or causes symptoms, surgery is recommended.
Surgical Repair: Hernia surgery can be performed using either an open technique or a laparoscopic (minimally invasive) method. The choice depends on the child’s age, the hernia’s location, and the surgeon’s expertise.
Open Surgery: Involves a small incision at the hernia site, either near the belly button for umbilical hernias or in the groin for inguinal hernias. The surgeon pushes the tissue back and closes the opening with stitches. This common method is effective, with recovery typically involving mild pain that improves within 1-2 weeks.
Laparoscopic Surgery: Involves tiny incisions in the abdomen and groin, using a small camera (laparoscope) to guide the repair. This less invasive approach often means less pain, faster recovery, and smaller scars, making it a great option for bilateral inguinal hernias or minimising visible scarring.
How Do I Care for My Child After Hernia Surgery?
Caring for your child post-hernia surgery is straightforward but important for a smooth recovery. Here is what to expect and how to help:
- Rest and Activity: Ensure your child rests when tired and gets adequate sleep. Encourage light walking to improve blood flow and prevent complications like pneumonia or constipation. Avoid strenuous activities, such as running or sports, until cleared by the doctor.
- Pain Management: Administer pain medications as prescribed, which may include prescription drugs or over-the-counter options like acetaminophen. Pain should decrease within a few days but may persist for up to 1-2 weeks for inguinal hernias or several days for umbilical hernias.
- Incision Care: Daily incision care involves washing the area with warm, soapy water and gently patting it dry; however, avoid using hydrogen peroxide or alcohol. If you have tape strips, leave them on for approximately one week or until they naturally fall off. If staples are used, they will be removed by the doctor within one to two weeks. Should the incision weep or rub against your clothing, cover it with gauze and change the dressing daily.
- Bathing: Sponge baths or showers are allowed 1-2 days post-surgery, but avoid baths or submerging the incision for 2 weeks or until the doctor approves.
- Diet and Hydration: Offer a normal diet as soon as your child is ready. If their stomach is upset, provide bland, low-fat foods like plain rice, broiled chicken, toast, or yoghurt. Ensure plenty of fluids to prevent dehydration and constipation.
- Bowel Movements: Monitor for regular bowel movements. If none occur after a couple of days, contact the doctor. Over-the-counter laxatives (e.g., Milk of Magnesia or Metamucil) may be recommended, especially if pain medications cause constipation.
Conclusion
Hernias in babies and children are not preventable, but early detection can make all the difference. Recognising the signs, such as a bulge in the groin or belly area, and seeking timely medical attention can prevent complications like incarceration or strangulation.
With the right diagnosis and care, most children recover quickly and completely. Whether your child needs monitoring or surgery, our paediatric specialists are here to help every step of the way.
Visit our hernia clinic or call us at 6235 4088 to schedule an appointment and ensure your child receives the professional care they deserve.