Hernias and children : A guide to Hernias

Much of the information in this guide talks about adult hernias but hernias do affect babies and children as well. The most common type of hernia in children is the umbilical hernia followed by an inguinal hernia.

Hernias are more common in boys than girls. Around one in 50 boys will experience a hernia. Hernias are more likely to develop in premature babies than those born after a normal period of time.

Types of hernias in children

These include:

• Umbilical
• Inguinal
• Femoral

The inguinal hernia occurs in more boys than girls which is due to the structure of the male anatomy. As you might imagine, this type of hernia is more prevalent in men than women.

The reason for this being the inguinal canal: a channel in the male reproductive system which enables the testicles to descend during development. But if this canal fails to close after these have descended then it is vulnerable to a hernia. Part of an internal organ or bodily tissue will push through a weak spot in the abdominal wall and into the inguinal canal where it forms a hernia.

This type of hernia slides in and out of the canal and is called a ‘reducible’hernia. But the most popular type of hernia –the umbilical tends to remain in position.

Hernias in babies

The umbilical hernia often develops in the newborn baby which is linked to the umbilical cord. This card passes through an opening in the baby’s abdomen but usually closes after birth.

However, if this fails to close then there is the risk of tissue or part of an internal organ pushing through a weak section in the abdominal wall. This usually occurs near the belly button.

This type of hernia appears as a bulge in the belly button which becomes bigger when the baby cries, coughs or has a bowel movement. It decreases in size when the baby is lying down.

This is known as a ‘reducible’ hernia.

The inguinal and femoral hernias look similar to the umbilical hernia but develop in different areas of the abdominal wall.

In most cases, this hernia can be pushed back into place or it often closes up of its own accord. This happens as the muscles of the abdomen develop and become stronger.

However, there are situations in which this doesn’t happen which means that surgery is required. But GP’s prefer to wait until the baby has reached the age of four before performing surgery. This is due to the fact that infants respond better than babies to surgery.

Hernias are easy to diagnose in babies: your GP will notice a small swelling or lump during a physical examination of your baby.

Hernias can become serious if they remain in position thereby cutting off the blood supply to the area of tissue or internal organ causing this problem. If the blood supply is blocked then this can damage the surrounding tissue or internal organ. This causes pain, vomiting and diarrhoea and is an extremely serious condition.

This is known as a strangulated hernia.

Surgery for hernias in children

This can be performed as a day case although in some cases, your child may have to stay in hospital for a few days.

Before surgery

Pre-surgery preparation will include a set of instructions on what to do before the operation which includes the time of the last meal your child can have before surgery.

Surgery day

On the day of the surgery your child’s surgeon will discuss the surgery with you before asking you to sign a consent form. Read this carefully and if you see anything you don’t understand then ask. Do not sign this until you are satisfied and fully understand it.

You and your child will be seen by the anaesthetist who will explain the type of anaesthetic he/she will use to you. If your child has undergone surgery before or has any medical conditions then please mention these.

The operation itself will involve the surgeon making an incision over the area where the hernia is located before pushing this back into position. He/she will repair the abdominal wall – possibly with a special nylon mesh before closing the incision with dissolvable stitches. This procedure takes around 30 minutes in total.

You will be given an outpatient’s appointment before you leave the hospital.

After surgery

Your child will feel stiff and sore afterwards and there may be some bruising in the treated area. Painkillers can be given although check with your surgeon first. Dress your child in loose clothing during this time until the soreness has eased.

Avoid bathing or washing your child for the first day or so but he/she can have a shower after then. Avoid swimming for the first week after surgery.

Keep your child off school for a week after this surgery. Ensure that they do not engage in strenuous activities or sports during this time until they have recovered from the surgery.

This type of surgery is usually successful and complications are rare. But if you notice anything untoward, for example bleeding or an infection, then contact your GP.