Caring for newborn's umbilical cord stump usually not difficult
Parents usually don't panic over their child's minor coughs and fevers, but blood, even a small amount of it, grabs their attention. So, when my little patient started bleeding from her navel, her mom and dad were both concerned enough to bring her in to have the area checked out.
This situation was actually not unusual, as the little girl was only 5 days old and her umbilical cord was still attached. The small amount of bleeding we were all seeing at the base of her drying umbilical stump occurred because the cord was on its way out and slowly separating from the child's skin. While bleeding does not always occur with this separation, it certainly can be seen and is OK as long as it's limited to a little bloody ooze and is not a major gush.
Newborn umbilical cord care, like circumcision care, makes many new parents more than a little squeamish. The good news is that caring for cords is pretty straightforward and lately has gotten even simpler. Many mother-baby units have dropped the familiar alcohol cord cleaning routine from their hospital protocol. Though wiping the base of the cord with alcohol makes parents feel like they're doing something to help their little baby lose that umbilical stump, recent studies have shown no real benefit to its use in cord care.
When dealing with the umbilical cord, a parent's main job is to keep the area dry and watch for any signs of infection. Health care workers generally advise keeping the top of the diaper folded under the navel and giving sponge baths instead of full immersion baths until the cord completely separates and the belly button looks dry - usually by about two weeks of life.
The umbilical cord is made up of an interesting gel-like substance known as Wharton's jelly. To a parent who's never seen a normal cord in the process of "disintegrating," this moist yellow material often looks alarmingly like pus.
Umbilical infections, while very rare, can occur and require prompt medical attention. Warning signs of infection include redness on the surrounding abdominal skin, a foul odor or real pus coming from the base of the stump or the open belly button.
When the cord falls off, a moist scar tissue remnant referred to as an umbilical granuloma is sometimes visible. This granuloma will usually dry up within a few days. If it stays moist, a simple office procedure can speed the drying process as the doctor carefully cauterizes the remaining tissue with a silver nitrate stick.
Less frequently, babies can have umbilical growths or polyps that need to be removed surgically. Belly buttons that leak a thin yellow fluid also need to be investigated as they may signal a connection with urinary structures - a condition also requiring surgery.
After the cord falls off, approximately 15 percent of infants will be noted to have umbilical hernias. These hernias are belly button bulges that result from a defect or lack of closure of a small portion of the abdominal muscle wall. Abdominal contents and fluid leak through this muscle weakness causing bulges that range in size from tiny little bumps to long, protuberant hernias.
Fortunately, unlike hernias in the groin area, umbilical hernias rarely cause trouble. As long as they remain soft and reducible - you can actually gently push with a finger and feel a squish as the structure gives way and flattens out - repair can wait.
Don't put any stock in the old wives' tale about putting a coin, tape or an elastic band over the hernia. Binding the area will do nothing to fix the underlying defect. If the hernia does not flatten out and close on its own, surgical correction can be scheduled when the child is several years old.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.