Paediatric Hernia

During development, a channel runs from inside the abdomen down into the groin, and it is meant to close before birth. In a hernia it has stayed open, so abdominal contents slide into it and show as a swelling that appears when a child cries or strains and disappears when they are settled.

This is much commoner in boys, and commoner still in babies born early. A separate kind sits at the navel, where the ring the cord passed through has not tightened. The two behave differently and that difference decides the urgency.

A groin hernia does not resolve on its own and carries a real risk of bowel becoming trapped, which is why it is repaired once it is found. A navel hernia almost always closes by itself, and is left alone for the first few years however large it looks.

It is usually a clinical diagnosis. A surgeon examines the child standing and lying, and often asks a parent to describe or show a photograph of the swelling, because it has a habit of disappearing in the clinic room.

An ultrasound is used where the examination is uncertain or where the swelling is on one side and the other side needs checking. A swelling that is firm, tender and will not reduce, in a child who is crying inconsolably or vomiting, is treated as an emergency rather than a clinic problem, and needs assessment the same hour.

A repair is a day case in most children. They wake within the hour, drink soon afterwards and go home the same day.

Expect two or three days of discomfort managed with paracetamol and ibuprofen, and a return to nursery or school within a week. Babies need no restriction at all beyond keeping the wound dry. Older children are usually asked to avoid sport and climbing frames for two to four weeks.

The wound is closed with dissolving stitches under the skin, so nothing needs removing.