What is it?
Some babies are born with a swelling in the belly button (umbilicus). This condition is more common in the afro-caribbean people and in the premature babies.

Complications
Surprisingly, rare. Most umbilical hernias get better in the first 18 months. Surgery may be considered in older children, partly the timing depends on the size of the defect.

The commonest lump found in the neck is an enlarged lymph gland, which is surprisingly common in children between the ages of 3-10 years, particularly following an infection in the head and neck area. In most cases, the gland measures < 1cm and is soft. Larger glands, especially those that feel quite firm, may be indicative of a more sinister pathology like tuberculosis or malignancy.


Other lumps in the neck include branchial cysts or lymphangioma, which are typically found on one side of the neck. Midline neck lumps could represent dermoid cysts or thyroglossal cysts. All the lumps mentioned in this paragraph need surgery, except lymphangiomas which may respond to injection of sclerosants.

Presentation
Both conditions present with a swelling in the groin, often extending down into the scrotum. A hernia usually has loops of bowel which descend into the scrotum, while a hydrocoele consists simply of fluid around a testis.

Complications
A hydrocoele is usually innocuous, while a hernia may obstruct and result in a very sick child with severe tummy pain and vomiting.

Is treatment required? 
If a hydrocoele is persistent, then it may need surgery anytime between 3-5 years of age , depending on the size. We strongly recommend that a hernia is fixed within 2-3 weeks of diagnosis, to prevent it from obstructing in the future with grave consequences.


Inguinal herniotomy in young infants with particular emphasis on premature neonates.  D.Misra, V.Boston. J. Paed. Surg 1994, 29:1496-8.

Dr Devesh Misra
Consultant Paediatric Surgeon and Paediatric Urologist