I got a call from some friends the other day regarding their new daughter’s umbilical cord. This is a common problem that many new parents encounter and also a common problem that I see in the ER. The issue relates to infection. Infection of the umbilical cord is a serious problem and ALWAYS requires medical intervention. However, in the normal process of the umbilical cord falling off it often looks pretty horrible sometimes resembling infection. So how to tell? Hopefully this post will help some parents with that very question.
The Good, the Bad, & the Ugly
First the good
Even though it may look bad at some stages, this is a diagram of the normal umbilical cord detachment and healing process. Under normal circumstances the umbilical cord falls off on its own accord around 2-3 weeks of life. Sometime it is sooner and sometimes it is later.
The bad (but not that bad)
Sometimes when the umbilical cord has fallen off there is still some healing tissue in the new belly button. This tissue is called granulation tissue (or an umbilical granuloma) and often looks pretty horrible. Under the normal process of healing, this granulation tissue oozes fluid and has a slight yellow-green discharge. Let me assure you that in the absence of other more concerning signs this is nothing to worry about. Most times you can just leave it alone or clean the belly button several times per day with alcohol and it will heal up just fine. Sometimes your doctor might put a medicine on the umbilical cord to try and dry it up to allow it to heal faster. This medicine is called silver nitrate and is generally applied with a Q-tip.
This is a nice example of an umbilical cord granuloma. The granuloma is the beefy red area in the middle of the belly button and the area responsible for the discharge. Notice that the skin around the umbilicus looks pretty normal.
The ugly – infection of the umbilical cord
Infection of the umbilical cord has some overlap with an umbilical granuloma in that there may be a yellow-green discharge from the belly button. However, with infection you also see redness and swelling of the skin surrounding the umbilicus. Generally the skin is also tender to the touch and may express pus when you push on it. More importantly though, most kids will have generalized symptoms when they get infection of the umbilical cord – fever, fussiness, vomiting, lethargy, not feeding, not making urine, etc. If your baby has discharge from the umbilicus and some of these more worrisome symptoms you should seek medical care as soon as possible.
Here is a great example of an infected umbilicus (the medical word is omphalitis). The child with this umbilicus is likely running a fever, very irritable and fussy, and cries when the area is touched. An untreated umbilical cord infection is serious. From the umbilical cord, the infection can spread along the skin of the abdomen, down into the abdomen, and eventually into the blood. If your baby is having some of the “ugly” symptoms get it checked out as soon as possible.
Umbilical Cord Granuloma
The best home treatment is to leave it alone and try to keep it dry. I would try this for a few days to a week if you think that you child has an umbilical granuloma. Many will spontaneously resolve on their own. If that does not work, alcohol wipes are probably the treatment of choice. Simply use an alcohol wipe to clean the umbilicus with each diaper change. In a study looking at the effectiveness of this home treatment, 2 out of 3 granulomas resolved at home without any additional treatment. One last home therapy involves applying a topic antibiotic (like triple antibioic ointment) to the umbilicus several times per day.
The classic medical treatment is silver nitrate. Below is a picture of silver nitrate, which comes attached to the end of a Q-tip. The silver nitrate is a chemical, that when combined with moisture, reacts to form heat. This in effect “burns” the granuloma tissue. Care must be taken to avoid contacting normal skin, because if there is moisture present, it can react with the normal skin as well. Some people have expressed concerns about the silver nitrate causing burns to the skin surrounding the umbilicus. However most reviews suggest that this a very rare event and not serious when it does occur. Probably the most significant complication of this relatively safe procedure is secondary infection.
Some people advocate using a string to “tie” the granuloma off. This basically cuts off the blood supply to the granuloma at the point past the string causing the granuloma tissue to die. This overall appears to be safe, although it may be associated with slight pain and carries the risk of a secondary infection.
My Experience… As a Parent
For the first baby, we did nothing for the umbilical cord. Doing this allowed the cord to do what billions of cords before it did – fall off naturally. Of course, this takes time though. It was our experience that the cord took about 3-4 weeks to completely fall off and it fell off in 3 or 4 different segments. All along, there was a small amount of drainage but never any redness, swelling, fever, or other worrisome signs of infection.
Now with baby #2, the hospital convinced us that we needed to use the “triple dye,” pictured below. This is basically a purple drying agent which helps the cord fall off faster. True, the cord did fall off in about 6-7 days. However, the dye really only dries out the external part of the cord. The part further down still goes through the natural course of falling off. So this means the same oozing that we experienced before. In the grand scheme of things not sure the purple dye made much difference. Probably just one more unnecessary thing the hospitals can tack on your bill.
We have now been blessed with our third son. Decided to go back to the tried-and-true method of doing nothing for the cord… no alcohol, no triple dye, nothing but good ol’ mother nature. The first picture is a picture of the cord on day 2. The cord fell off all by itself on about day 8.
Check out this article regarding the use of silver nitrite versus conservative management with alcohol. It basically shows that 2 out of 3 kids can effectively be managed with just alcohol to the umbilicus with each diaper change(nappy in the UK). Silver nitrate can be used for those who fail conservative home therapy.
Here is another article describing some common home remedies and over-the-counter medications that you can use for simple umbilical granulomas before going to the doctor for silver nitrate.
Some people have expressed concerns about the silver nitrate causing some burns to the skin surrounding the umbilicus. This article notes that this is very rare and even if it does happen it does not cause any significant problems.