How to care for umbilical cord

In the womb, the umbilical cord delivers the oxygen and nutrients needed to allow your baby to grow in the womb. After birth, the cord is clamped and cut, leaving a umbilical cord stump. This eventually falls off, healing to form the umbilicus (belly button). There are ways for you to prevent problems during healing.

After birth, the doctor or midwife cuts your baby’s umbilical cord from the placenta and puts a clamp on the remaining umbilical cord stump to pinch it off. When the umbilical cord is cut at birth, a small umbilical cord stump is left attached to baby’s tummy. Umbilical cord stumps are initially glistening blue or white in color. Upon contact with air they quickly dry and within twenty-four (24) hours become stiff and a dull yellow-brown. Later it may turn black-brown and shrivel considerably. After a day or two, once the umbilical cord has dried, you can take the clamp off. The umbilical cord stump separates from the umbilical area by a process of dry gangrene. This usually occurs five (5) to ten (10) days after birth. The baby belly button is what’s left of the umbilical cord stump after it falls off in about 5 to 15 days after birth.

During the first few days after birth, the umbilical cord stump will get darker and shrivel, and will eventually fall off. Sometimes it takes a week or two. If the umbilical cord stump hasn’t fallen off after more than two weeks, you can check with your child’s doctor and family health nurse.

While the umbilical cord stump is drying up and just after it falls off, you might notice some oozing around the baby belly button. This might be clear, sticky or brownish, and it might leave a mark on your baby’s clothes or nappy. It might also smell a little. This is a normal part of the healing process.

Note: Never attempt to remove the cord forcefully

Procedure for Umbilical Cord Care – cleaning and caring for your baby’s belly button

1. Remove nappy.
2. Wash your hands before handling the cord stump, and avoid touching it whenever possible.
3. Use water to keep your baby’s belly button area clean. You don’t usually need to use soap, creams, antiseptics or alcohol to clean it, and you don’t need to bandage the belly button.
4. Observe the cord area, after bathing and with each nappy change.
5. Make sure the umbilical cord stump dries properly after bathing. The stump will dry and heal much faster if you expose it to air as much as possible. Try not to cover it with plastic pants and nappies. Fold nappies down and away from the stump if you can.
6. After each bath dry the skin/cord junction thoroughly with a cotton bud.
   • Note: Parents should be advised to dry baby after a bath with a towel and around the umbilical area. Cotton buds are not used – the skin/cord junction is not disturbed to allow natural separation to occur.
7. If the area is soiled, e.g. with urine or poop, wash it off using clean water and a pH-neutral cleanser. Look for ‘pH-neutral’ on product labels, or ask your pharmacist or child and family health nurse to recommend a product. It can be hard to clean poop off with just water because baby poo has a lot of fat in it.
8. Replace nappy, leaving umbilical cord area exposed.
   • If skin/cord junction has a heavy discharge or is foul smelling notify the medical officer, and obtain a dry swab.
   • Clean the skin/cord junction with 0.5% aqueous chlorhexidine solution using cotton buds, repeat this every four hours until the area is clean and dry
9. Never try to pull the umbilical cord stump off yourself, even if it looks like it’s ready to fall off.

How long does the newborn umbilical cord stay attached for?

The newborn umbilical cord stump usually stays attached for 5 to 15 days. Over this time, the newborn umbilical cord dries, shrinks and turns black. Sometimes, especially in the day or so before it falls off, the umbilical cord stump can ooze a little and may leave marks on your baby’s clothes.

Do not pull the umbilical cord stump off, even if it looks like it will come off easily, as this can prolong healing time and cause scarring. Let the cord stump fall off by itself in its own time.

When the umbilical cord stump falls off, there is sometimes a little bleeding at the stump site. This is normal and it should stop quickly.

Please see your doctor or maternal and child health nurse if you have any concerns or questions.

How to tell if the umbilical cord is infected

Signs of an infection of the belly button may include:

• redness, swelling, stickiness or a bad smell on or around the belly button
• fevers, poor feeding and tiredness in your baby

If you think your baby’s umbilical cord stump or belly button is infected, see your doctor as soon as possible.

Umbilical cord care after stump falls off

Wash the umbilical cord stump as part of your baby’s usual bathing routine.

Make sure you wash your hands first. Use only water and cotton pads, and dry it carefully. If urine (pee) or poop (stools) gets on the umbilical cord stump, you can use a mild soap to help clean it off. You don’t need to use antiseptics and alcohol.

Let the umbilical cord sit out of the nappy so it dries out in the air; this can be done by folding the nappy under the umbilical cord stump. There is no need to cover the umbilical cord stump with Band-Aids or bandages, as this stops airflow around the stump.

If you’re not washing the umbilical cord stump, try not to handle it.

How long does the belly button take to heal?

After the umbilical cord falls off, the belly button may bleed or ooze a little, but it should heal completely in days. If there is continuous stickiness or discharge, it may be infected, and you should show your doctor or maternal and child health nurse.

Sometimes the belly button does not heal completely and moist red tissue forms over the stump site, often with a lump present. This is called a ‘granuloma’. It is usually harmless, but you should ask your doctor or child and family nurse to have a look at it.

Umbilical granuloma

Once the umbilical cord stump has fallen off, some babies can develop an umbilical granuloma. This usually looks like a small pink or red lump where the belly button should be. Sometimes the lump might be oozing.

An umbilical granuloma is usually harmless, but you should ask your doctor or child and family nurse to have a look at it.

Umbilical hernia

If your baby develops a bulge, lump or swelling near his belly button, it might be an umbilical hernia. An umbilical hernia is often more noticeable when your baby cries or strains to do a poop. This usually isn’t dangerous, and it doesn’t hurt your baby.

An umbilical hernia will probably close on its own, but you should still see your doctor or child and family health nurse about it.

An umbilical hernia is very common in children. It appears as a small soft lump near the umbilicus (navel or belly-button). It usually causes no problems and goes away as the child grows.

A hernia is the lump that appears when part of the body pushes through an opening or weak spot in a muscle wall. Hernia happens most often around the abdomen (tummy area):

• an inguinal hernia (in the groin)
• a hiatus hernia (where part of the stomach pushes up through the diaphragm into the chest area),
• an umbilical hernia.

An umbilical hernia happens when the muscles around the umbilicus (belly button) have a gap between them, so that part of the gut or other tissue in the abdomen can poke through particularly when pressure in the tummy rises (such as when a child cries or coughs). This can be pushed easily back into the tummy, but it does not matter if some usually stays pushed through the hernia.

An umbilical hernia is quite common in young children, when the muscles are relatively weak, but a lot less common in older children and young adults because the muscles become stronger, closing off the gap.

Some adults develop an umbilical hernia when the pressure in the tummy is greater than the strength of the muscles which close off the gap (eg during pregnancy or in an older, overweight person). There can be health problems for adults, and an operation may be needed.

Problems from an umbilical hernia

• Umbilical hernias in babies very rarely cause problems and are best left alone.
• The main problem with an umbilical hernia is the appearance of a bulge or lump. Young children do not have any discomfort and are not worried by the appearance, but many parents would prefer that the bulge was not there.
• Some hernias – but not umbilical ones – can cause problems when part of the bowel gets caught in the hernia. Inguinal hernias are usually operated on as soon as they are found, because it is quite common for bowel to get trapped in them.

What treatment is needed for umbilical hernia?

• If a baby has an umbilical hernia, nothing needs to be done, as almost will close by themselves.
• As children get older and their tummy wall muscles get stronger, the gap will usually close, and the bulge goes away. While this often happens before the age of one, it may not happen until the child is four or five years old.
• If it does not close by itself, the gap can be closed by an operation if the appearance causes distress to children when they begin to be self aware (usually not until they are around 6 years or older). The operation is simple and quick, and usually the child will not need to stay in hospital for more than a few hours. But still it is usually recommended that it is done when the child is old enough to be able to understand what is happening, and when an anaesthetic can be given very safely (when the child is at least 4 years old).
• If the umbilical hernia does cause problems (it becomes painful and it cannot be gently pushed back into the tummy), the child needs to be checked urgently by a doctor. This is rare.

Treatment that does NOT work for umbilical hernia

In the past some people recommended strapping the tummy or placing a coin on the hernia and then putting on strapping. These seemed to work, because the hernia did eventually go away, but it has been shown by research that the gap which causes the hernia will close just as quickly without strapping.

Umbilical infection

If there is a sticky discharge or pus or a leak for longer than the first few days after the umbilical cord comes off, check with your doctor. There may be a mild infection that does need treatment with an antiseptic or antibiotic cream or other treatment.

At any stage if you notice redness, heat, or swelling of the skin around the umbilicus, especially if the baby is unwell (feverish, poor feeding), see a doctor as soon as possible because antibiotics or other treatments may need to be given quickly.