By Gina Roberts-Grey
Hernias have a reputation as an adult condition, something that happens when grown-ups lift heavy boxes or furniture. But hernias can also afflict very young children, “including when they are in their mothers’ womb, during childbirth and during the first six months of childhood,” says Dr. Charles Shubin, Director of Pediatrics at Mercy Family Care in Baltimore.
There are two common types of hernias that occur in children: umbilical hernias and inguinal hernias. Umbilical hernias are relatively common and affect 20 percent of all babies. This type of hernia, which is seen or felt near the navel, is the result of a hole that occurs as a natural defect in the abdominal wall. Umbilical hernias are often found upon examination by a doctor or may be noticed by a parent. “A lump may be visible in the belly button area because part of the child’s intestine bulges through the abdominal muscles via the hole,” Shubin explains.
Inguinal hernias occur when part of the intestine protrudes down into a pouch, appearing as a lump in the child’s groin. According to Dr. Shubin, “when the baby’s abdominal wall is forming in utero, there are two holes in the lower abdomen called the inguinal rings. These rings allow the testicles forming in the upper abdomen of boys to pass out of the abdomen and into the scrotum. And, even though girls don’t need these rings, their abdominal walls go through the same formative stages.” The rings are supposed to close; however, when the inguinal rings don’t close, a hernia results.
Spotting a Problem
Swelling in the groin is the main concern that needs to be checked out promptly. Umbilical hernias that cause pain, especially if they can’t be pushed back, also need immediate evaluation.
Dr. Edmund Kessler is a neonatal intensive care surgeon at Columbia Eastside Medical Center in New York City. He says many parents first notice a hernia when a child is relaxing in the bathtub, crying or straining, or when they are changing a dirty diaper. “Hernias are usually seen and felt as an easily compressible soft tissue mass that is more obvious when the baby strains or cries,” he says. Shubin adds, “many hernias are found during a well baby visit.”
Because a majority of umbilical hernias close on their own by the time a child is 4 or 5 years old, most surgeons opt to “watch and wait.”
“However,” cautions Shubin, “if the area becomes red or swollen, or hard and tender, particularly if associated with intermittent colic and vomiting, this may indicate a serious problem which requires urgent attention.”
If an umbilical hernia does not close on its own by age 5, a minimally invasive, outpatient surgery is performed to repair the hole. The only method to treat an inguinal hernia is surgery. “Unless there is pain, a hard lump or swelling, this is not a medical emergency and can be performed as an elective procedure,” says Shubin.
Inguinal hernias may present on one side only but, Kessler says, “a child may also have an open sac on the other which may not be detected on clinical examination.” Advancements in hernia repairs have led to pioneering new procedures aimed at sparing children additional surgery or potential health risks.
“At the time of the surgery, a laparoscopy is performed to examine the patient’s other side to determine if surgical exploration is necessary. If the laparoscopy reveals a sac, the hernia can be repaired at the same operation avoiding another surgery at a later date,” explains Kessler, one of the first surgeons in the United States to perform this procedure.
If no hernia is seen during the laparoscopy, there is no need to explore the other side. This new technique saves unnecessary surgical exploration in 70 to 80 percent of infant hernia patients.
Gina Roberts-Grey is a freelance writer.