Welcome to our weekly online series on parenting advice with local expert Dr. Deborah Wood.
Dear Dr. Debbie,
We went to the doctor about a cold and came away with much more than we were prepared for. My almost seven-year-old has an “outie” belly button that we have been advised needs surgery. Naturally, my daughter is very apprehensive about an operation, as am I. In fact, I was so stunned by the news that I barely heard what else the doctor was saying. I believe she called it a hernia. She also didn’t seem to think it was a big deal. What can I do to calm my daughter (and myself)?
Nervous Mother of the Patient
First you can get more information. We are more likely to be fearful of what we do not understand, especially when pain may be involved.
Your daughter’s condition is indeed called a herniated umbilicus. Before birth, there is a round gap in the muscles in the abdomen where the umbilical cord leaves the baby’s body and connects to the placenta in the uterus. The cord brings the baby nutrients from food eaten by the pregnant woman. Once a baby is born the cord gets cut and after about a week the stump dries up and falls off, leaving a “belly button” or navel. The muscles grow closer together until, usually by several weeks, there is no longer a gap. In about 10% of children, including your daughter, the umbilical ring remains, and there is a chance that when she cries or strains to have a bowel movement, a portion of the intestine will poke through the gap.
This condition may not be detected except in a doctor’s exam, or it may cause pain for the baby. In most cases, the muscles eventually close up and the condition is over. However, as in your daughter’s case, a child reaches five, six or seven years of age with no problem other than an obvious lump at her navel, and a very minor operation – a herniorraphy – is performed to close the muscle wall. She will be put to sleep (probably with a face mask), have a local anesthetic applied to reduce discomfort afterward, and in about 45 minutes the repair is made. About an hour later she will wake up. A little while later you take her home. There will be instructions given to you for giving her pain medication, changing her bandage, and keeping the incision dry. She might expect to stay home for a day or two, and stay on the sidelines during P.E. class for a week or so.
Be sure to ask questions of your child’s doctor until you are comfortable enough with the information to be able to assure your daughter that you and her doctor, and the doctor’s helpers, will make sure she is taken care of before, during, and after her procedure. Most important to her will be such things as: can she bring a stuffed animal or special blanket, will you be in the room with her (there may be a series of rooms, so be sure to ask which you can be in), and what discomfort/restrictions she can expect. Ask the doctor about food restrictions – likely she will be limited to clear liquids the night before and for a few hours after returning home – and review the options with your daughter so she can guide your shopping ahead of time. Try out some recipes in advance if she’s never had such things as plain chicken broth, fish broth, or apple juice gelatin before. Splurge on white grape juice. Heat up some apple juice. Food choices will give her a bit of control in an otherwise out-of-her-control situation.
Good advice for any child who is apprehensive about a medical procedure – even a check-up – is to “play doctor” at home. The two of you can perform a routine examination or operation on a baby doll or stuffed animal, or obliging family dog, using toy props or imaginary medical equipment. When he was a toddler, my son and I used empty paper towel tubes as stethoscopes on each other and on the dog. Works pretty well. More importantly, it worked to reduce his anxiety when we went through several doctor visits due to an irregular heartbeat that turned out, medically speaking, not to be a big deal.
What a doctor considers “no big deal” is usually a very big deal to a child, and, of course, to you. Your best tact with this parenting challenge is to support your daughter with information and reassurance, and motherly attention to her concerns and care.
Recipe for apple juice gelatin:
1 ½ Cup boiling water
3 envelopes unflavored gelatin (1/4 oz. each)
1 12-oz can of frozen apple juice concentrate
2 cans of water
Slowly stir the boiling water into a bowl with the gelatin powder. Dissolve completely. Add the frozen juice and use the juice can to add two more canfuls of water. Stir well. Pour into dessert bowls and let it set in the refrigerator for about two hours.
Dr. Deborah Wood is a child development specialist in Annapolis. She holds a doctorate in Human Development from the University of Maryland at College Park and is founding director of the Chesapeake Children’s Museum. Long time fans and new readers can find many of her “Understanding Children” columns archived on the Chesapeake Family Magazine website. You can find her online at www.drdebbiewood.com
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