A hernia is a defect or weakness in of the abdominal wall where tissue — typically from the intestines — or fat can project through and cause a bulge. Hernias are more common in adults, but they can also affect children and babies.

Types of Hernias in Children and Babies

The most common hernias in children and babies are inguinal and umbilical hernias. 

Inguinal Hernias

Inguinal hernias are in the groin. They can appear as small bulges in the groin or extend all the way into the scrotum or labia. Most hernias in babies and children are inguinal hernias — they occur in about 1% to 5% of infants and children. They occur more frequently in infants who are premature and are more common in boys than in girls. 

There are two types of inguinal hernias:

• Indirect inguinal hernias. These are caused by an opening in the abdominal wall that is present at birth. Inguinal hernias in babies and children are almost always indirect.
• Direct inguinal hernias. These rarely affect children. The opening in the abdomen wall usually develops during adulthood, typically the result of age, overexertion, sports or heavy lifting.

Umbilical Hernias

Umbilical hernias develop where the umbilical cord was once attached at the navel (belly button). They usually occur when the muscles around the belly button (umbilical ring) do not close after the leftover umbilical cord falls off after birth. Sometimes, an umbilical hernia looks like an “outie” belly button. These hernias affect boys and girls equally, but vary among races. 

Incarcerated and Strangulated Hernias — Surgical Emergencies

Sometimes, part of the intestine gets stuck in the abdominal wall opening, a condition called “incarceration.” If tissue remains incarcerated for a long time, the blood supply to that part of the intestine is cut off, which is known by the term “strangulation.” This condition can result in loss of the strangulated intestine or the involved ovary, and sometimes, the testicle. This is a surgical emergency — strangulation of the bowel can be life threatening.  

Signs of a strangulated hernia include: 

• Bloating
• Fever
• Lump or bulge that is larger than before and does not become smaller on its own
• Nausea and vomiting
• Redness and tenderness around the hernia
• Sudden, severe abdominal or groin pain

Other Types of Hernias

Other, more uncommon, types of hernias in babies and children include: 

• Hiatal hernias: Hernias in the upper stomach and chest
• Incisional hernias: Bulges resulting from an incision (cut) from a past abdominal surgery
• Epigastric hernias: These are small bulges that occur in a straight line anywhere between the umbilicus and lower sternum. Unlike umbilical hernias, they will not close spontaneously. Typically, a small piece of fat protrudes from the opening and can be seen when the infant or child is straining.

What causes an umbilical or inguinal hernia in a child?

Openings in the abdominal wall are normal in babies, and they typically close before or right after birth. Hernias in babies and children usually develop when these openings do not close, allowing the intestines or other organs to push through the openings. The hernia might develop soon after birth or years later during childhood. 

Hernia Risk Factors in Children and Babies

Factors that increase a child’s risk of a hernia include: 

• Birth weight. Hernias are more common in premature, underweight babies. 
• Gender. Inguinal hernias are more common in boys. 
• Genetics. Hernias are more common if there is a family history.
• Medical conditions. Undescended testicles, cystic fibrosis, a need for peritoneal dialysis or shunt and other genetic syndromes, such Beckwith-Weidemann syndrome and trisomy 13, 18 or 21, increase the risk of a hernia.
• Race. Umbilical hernias are more common in children of African descent. 

Symptoms of Hernia in Children and Babies

Children are sometimes too young to describe hernia symptoms, so it is important for parents to know how to spot these signs. 

Symptoms of a hernia in a toddler or baby may include:  

• A lump or swelling near the groin or belly button
• Pain or tenderness around the groin or lower belly
• Unexplained crying or fussiness
• A visible bulge that gets bigger during straining, crying or coughing

In most cases, hernias are not cause for alarm. However, they can lead to serious health complications, so it is important for parents to talk to their child’s pediatrician right away if there are signs of a hernia. Surgical treatment may be necessary for umbilical hernias that fail to close by school age (about 5), and it is always needed for inguinal hernias because they never close on their own.

Do hernias in children go away?

Umbilical hernias often close on their own several years after birth. Small umbilical hernias (smaller than half an inch) have an 85% chance of closing without surgery. Large hernias, those that are symptomatic and those that fail to close by age 5 should be repaired with surgery. 

Inguinal hernias never go away on their own, and they have a higher risk of incarceration and hernia-related complications than umbilical hernias. 

Hernia Treatment for Children and Babies

Inguinal hernias and some umbilical hernias need surgery. During the procedure, the surgeon pushes the protruding tissue back into place and closes the opening with stitches. There are two surgical techniques for hernia repair for children: 

• Open surgery for umbilical hernias requires a small incision under or through the belly button. For inguinal hernias, a small incision is made in the groin, typically along a natural skin crease. 
• Laparoscopic surgery uses several tiny incisions in the abdomen and groin. 

Talk to your child’s doctor about the risks and benefits of hernia surgery.