Umbilical cord care, and umbilical hernia

What to do

Keep it clean and dry. That is the whole method. Current guidance for babies born in a clean hospital setting is dry cord care — nothing applied at all.

Fold the nappy down below the stump so it is not covered, and so urine does not soak it.

Let air get to it. Loose clothing, and no binder or belly band tied over it.

If it gets dirty with urine or stool, clean it with plain water and let it dry fully. Pat, do not rub.

Sponge-bathe until the stump falls off rather than immersing the baby. Once it has fallen off and the area is dry, normal baths are fine.

Let it come off on its own. Never pull it, even if it is hanging by a thread.

It usually falls off between about five and fifteen days. A little dried blood, a slightly sticky patch, or a small amount of discharge as it separates is normal.

In settings where the birth was not in a clean facility, WHO recommends applying chlorhexidine — this is a specific medical recommendation, not a general one, and your doctor will tell you if it applies.

What not to put on it

Nothing. Not oil, not ghee, not turmeric, not ash, not cow dung, not talc, not surma, not breast milk, not antiseptic powder, not a coin taped over it, and not a belly band.

These are all traditional in different parts of India, and they are collectively the reason umbilical infection — omphalitis — remains a cause of newborn sepsis and death here. The cord is a direct route into the bloodstream.

Do not use spirit or antiseptic routinely either. Modern guidance moved away from alcohol swabbing because it delays separation without reducing infection in clean settings.

Belly binders and coins do not correct an outie or prevent a hernia. They trap moisture, which is the opposite of what the stump needs.

If a relative insists, the useful line is that the doctor asked for it to be kept dry and uncovered. It is short and it is true.

Umbilical hernia

An umbilical hernia is a soft bulge at the navel that becomes more obvious when the baby cries, strains or coughs, and flattens when they are calm or lying down.

It is common, particularly in preterm and low-birth-weight babies, and it is caused by a small gap in the abdominal muscle rather than by crying, by how the cord was cut, or by anything anyone did.

Most close on their own, usually by around one to two years and often later. Surgery is generally considered only if it has not closed by around four to five years, or if it is very large.

Do not strap, tape, bind or press a coin over it. These do not help it close and can damage the skin.

Crying does not cause it and does not make it worse.

It needs urgent attention only if it becomes stuck: a bulge that is hard, will not flatten, is tender or discoloured, with vomiting or a distressed baby. That is an emergency.

When to see a doctor

Go to hospital immediately for: a hernia bulge that has become hard, tender, red or dark and will not flatten, particularly with vomiting or a baby in pain. Also for any fever of 38C or above in a baby under three months, or a baby who is floppy, feeding poorly or breathing fast. Call 108 if travel is difficult.

See a doctor the same day for: redness spreading into the skin around the navel, swelling, pus or a foul smell, bleeding that does not stop with gentle pressure, the stump still attached after about three weeks, or a persistent moist pink lump after separation, which may be a granuloma and is easily treated.

Omphalitis moves quickly in a newborn. Redness spreading outwards from the navel is not something to watch overnight.

This article is general information, not medical advice, and has not been reviewed by a paediatrician. It is no substitute for personal medical advice.

Frequently asked questions

Q: Should I apply anything to the stump? — No. Clean and dry. Applying substances is the main cause of cord infection in India.

Q: When can I bathe the baby properly? — Once the stump has fallen off and the area is dry. Sponge-bathe until then.

Q: It smells slightly as it dries. — A faint smell as it separates can be normal. A foul smell, pus, or redness spreading into the skin is not.

Q: Will a belly band fix an outie? — No. Belly buttons look how they look, and binding does nothing except trap moisture.