Understanding and recognizing hernias in children

Monday, April 24, 2017 | 2 a.m.

We often think about hernias as they affect adults, but it is a common condition for infants and children as well. Unlike adult hernias that are usually caused by muscle strain, children are typically born with a hernia, which is an opening in the muscle wall of the stomach or groin.

“In some children, the umbilical hernia can be small and eventually correct itself, but in other cases, it can cause serious complications that require emergency surgery,” said Michael Scheidler, MD, pediatric surgeon at Sunrise Children’s Hospital.

While the prospect of surgery is scary for any parent, being able to recognize the condition early can prevent emergency medical intervention later on.

Types of pediatric hernias

Hernias occur when part of an organ or other bodily tissue is pushed through a hole in the muscle that is supposed to contain it.

“There are two main types we see in children: umbilical and inguinal. Umbilical hernias are found around the navel and inguinal hernias are found in or around the groin,” Scheidler said.

Both types can be retractable, meaning that they only appear during times of muscle strain, before slipping back into place. But umbilical hernias are more likely to correct themselves as infants grow and strengthen in their first two years, while inguinal hernias tend to be the main source of complications and require surgery once they’re discovered.

The British Hernia Centre reports that 3 to 5 percent of all healthy, full-term babies are born with inguinal hernias, and up to 30 percent of all premature babies are born with the same condition. The incidence rate also is much higher for male infants, with boys accounting for 80 to 90 percent of cases.

Recognizing hernias in children

Because children are born with hernias, the condition cannot be prevented. However, recognizing the hernia early can prevent the development of serious complications.

Pediatric hernias generally don’t cause pain until the tissue gets incarcerated but it can be hard to spot because the tissue retracts. “Umbilical hernias are more obvious—they cause a lump underneath the belly button, but many parents don’t realize that it’s a hernia causing it. Inguinal hernias are harder to find and most parents don’t notice until the child coughs, laughs or starts to move on their own,” Scheidler said.

If the hernia has escalated, symptoms will be more obvious such as abdominal pain, vomiting, constipation and irritability. The lump may also suddenly become hard, red and/or painful to the touch. If your child exhibits any of these symptoms, they need emergency medical care.

If you notice a lump that you suspect to be a hernia on your child, visit the pediatrician. Do not try to push the tissue back in on your own, or use any type of hernia supports or compresses. Doing so can cause injury and pain to the child.

Other signs may include:

• Some inguinal hernias may cause boys to pull at their testicles often

• Some babies might play with the protrusion, alerting parents to its existence

• Look for a soft lump in the groin or stomach area that disappears and reappears on an ongoing basis

Complications

There are two types of complications that require immediate attention.

Incarcerated hernias occur when the tissue does not retract and gets stuck on the outside of the muscle wall. If left untreated, it can escalate to a strangulated hernia, which occurs when the blood flow to the trapped tissue is severely restricted, eventually causing the tissue to die off.

“Incarcerated and strangulated hernias usually affect the intestinal tract, as a section of the intestine is pushed through the muscle. This causes serious problems because it can block the digestion and in more severe cases — such as with strangulated hernias — it can require intestinal resection,” Scheidler said.

Surgery

Pediatric hernia surgery is a simple outpatient procedure and is one of the most commonly performed surgeries on children. “The procedure itself takes about 30 minutes, and the infant is usually discharged within an hour afterward,” Scheidler said.

Unlike adult hernia surgery, which can be more complicated and require mesh support to be inserted in the muscle, hernia surgery for children simply requires a small incision to stitch the muscle tissue together.

The child is put under general anesthesia or laughing gas during the procedure, and will be fully recovered within five to seven days with minimal discomfort during the healing period.

While hernia repair is a routine surgery with a very low complication rate, it can quickly become more serious if the hernia becomes incarcerated or strangulated.

“Many parents put off the surgery because they’re nervous about it, but waiting for the situation to escalate is the worst thing you can do. Incarcerated hernias are far more damaging, and treating them can be a much more serious procedure,” Scheidler said.