Hernias in Children: What Parents Should Know

CHOC_HerniasSpotting a lump or bump on a child’s body would be scary for any parent, but mom and dad can rest assured: Hernias are common and their repair is among the most common procedures performed on kids, a CHOC Children’s pediatric general surgeon says.

Just in time for national Hernia Awareness Month, Dr. Mustafa Kabeer offers detailed information on this common ailment.

Hernias occur when part of an organ or tissue pushes through an opening or a weak spot in the abdominal wall and creates a protrusion which is visually present. Children with hernias are often born with them, and when a hernia is first noticed depends on when enough pressure is generated to allow other tissues to protrude through the weakened area, Dr. Kabeer says.

“Families or kids might see big or little bumps, and, in most cases, near the belly button or groin,” he says. “Sometimes in premature babies, we see hernias right when they’re born, and sometimes we don’t see them until the child is older.”

Though there are many varieties of hernias, Dr. Kabeer recommends that parents of young children make themselves aware of three types.

Epigastric hernias

First, epigastric hernias occur when a tiny portion of fat protrudes through the abdominal wall in the midline between the belly button and chest, creating a tiny bump a few millimeters wide.

“They can cause some discomfort and they don’t go away on their own,” Dr. Kabeer says. “When we find them, we fix them.”

Inguinal hernias

Secondly,inguinal hernias occur when part of a child’s intestine protrudes between the abdominal muscles and is seen as a bulge in the groin. Girls born with this type of hernia are more likely to have a protrusion on both sides.

This type of hernia is very common, especially in premature babies. This type of hernia should be repaired in a timely manner because, if left unfixed, they can cause discomfort and, on rare occasions, lead to the intestine being stuck in the hernia. This could cause obstruction and require a more urgent operation, says Dr. Kabeer.

“We want to fix these soon,” he says.

CHOC_Hernias2Umbilical hernias

Finally,umbilical hernias appear in babies born with a weakness in the belly button. This type of hernia is very common, and not something that should concern parents, Dr. Kabeer says.
Present when a baby cries, strains or coughs, these hernias cause no discomfort and rarely prompt larger problems, he says.

Dr. Kabeer estimates that 85 percent of umbilical hernias go away with time. That said, if a child still has a protrusion by age 3 or 4, CHOC surgeons will repair the hernia, Dr. Kabeer adds.

Physician can advise treatment

Parents who notice a hernia on their child’s body – particularly those near the groin or between the belly button and chest – should make an appointment with their pediatrician to help determine the type and course of treatment.

Though often harmless, some hernias prompt concern because the protruding organ or tissue can get stuck in the opening, which can compromise blood flow, Dr. Kabeer says. This can damage the protruding part, such as the intestines or even an ovary in girls.

Aside from the obvious bulge, symptoms of hernias can include pain and swelling. Babies who have an obstruction often exhibit abdominal distention, vomiting, redness and pain. If this occurs, parents should seek emergency treatment immediately, Dr. Kabeer cautions.

Short surgery, recovery

Should surgery be required to repair a hernia, the short procedure is performed under general anesthesia and requires no hospital stay, he says.

Recovery is also relatively fast following hernia repair surgery, Dr. Kabeer says. School-aged children are back to normal after about a week, and younger children recover even faster.

Learn more about surgery at CHOC Children’s.

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Kids and Surgery

boy before surgeryWHAT TO TELL YOUR CHILD BEFORE SURGERY
Parents should understand and work through their concerns, because if the parents are scared, the child will be scared; if the parents are calm, the child will be calm too, says Dr. David Gibbs, a CHOC Children’s Pediatric
Surgeon. “I try and listen to what the family has to say. I need to know what the family is afraid of and what is bothering them,” Dr. Gibbs says. “I try to make the parents realize they are doing the right thing and we will help you through this.” CHOC allows parents to stay with their child in their hospital room during the entire surgery hospitalization period but are not allowed in the operating room.

TIPS FOR SURGERY DAY
Dr. Gibbs recommends that parents have their hospital bag packed the night before surgery so they will arrive at the hospital on time. Also, parents should not eat in front of their child because the child won’t be allowed to eat. “I recommend promising the child some kind of special treat or gift after the surgery. I think it’s fine to say, ‘After we go through this, we’re going to get you some toy or thing you wanted and celebrate you having gone through this.’ Have the child bring a favorite blanket, special outfit, stuffed animal or toy, something that reminds him of home. It makes the child feel a little more comfortable.”

GETTING YOUR CHILD ON BOARD
Preparing your child in advance and planning ahead for surgery will help make your child feel more comfortable about the surgery and recover better and faster, says Dr. Gibbs. “Don’t plan a trip to Disneyland a week after the surgery. Do whatever it takes to make your child calm, relaxed and pain-free. This will help him heal better and faster and he will be more compliant. This is not just about making him feel better. It’s about making him recover faster. If the child feels that he or she is a part of the experience with some degree of control, then they will get better faster.”

FAST FACTS

  • The number of children under the age of 18 admitted for surgery as inpatients in the U.S. annually: 450,000
  • Number of inpatient surgeries performed at CHOC in 2013 (Orange and Mission Campuses): 3,591
  • Number of outpatient surgeries performed at CHOC in 2013 (Orange and Mission Campuses): 4,990

View the full feature on Kids and Surgery

Dr. David L. Gibbs
Dr. David L. Gibbs
CHOC Children’s
Pediatric Surgeon

PHYSICIAN FOCUS: Dr. David L. Gibbs

Dr. Gibbs is a pediatric surgeon,
president of the medical staff at CHOC Children’s and the CHOC Children’s Specialists Division Chief of Pediatric Surgery.

Dr. Gibbs completed his internship and residency at Massachusetts General Hospital in Boston, followed by fellowships in pediatric surgery at the UCSF Fetal Treatment Center in San Francisco, the Long Island Jewish Medical Center, Schneider Children’s Hospital/Pediatric Surgery in New Hyde Park, New York, and the Hospital for Sick Children in Toronto, Canada. His clinical interests include pediatric laparoscopic surgery and neonatal surgery.

Dr. Gibbs’ philosophy of care: “When a child needs surgery, it can be just as scary for the parents as it is for the child. We treat the entire family with the greatest compassion and understanding.”

EDUCATION:
Ohio State University

BOARD CERTIFICATIONS:
Adult and Pediatric General Surgery

More about Dr. Gibbs | CHOC Children’s Pediatric Surgery

This article was featured in the Orange County Register on May 12, 2014, and was written by Amy Bentley.