Caring for baby’s umbilical cord

Unfortunately, many parents are still given the wrong information about how to care for their newborns belly button (or umbilical cord).

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Here’s what you need to know for babies born in resource-rich settings (note: the WHO recs for resource-poor settings are different). 

The umbilical cord’s job

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The umbilical cord is an essential lifeline while a fetus is in utero because it serves as the connection with mom’s circulation. But once a baby is born, the cord is clamped and cut.

It typically dries, shrivels and falls off within 1-3 weeks after birth.

How to care for it

Until the umbilical cord dries up and falls off, your job is to keep it infection-free. But best practices/recommendations have changed substantially over the years. These are the most up-to-date evidence based guidelines.

• Keep it outside of the diaper

  • Exposing the belly button to the air allows it to dry out more quickly. Many newborn diapers now have cut-outs for this purpose, but if yours does not, you can just fold the top of the diaper down. This avoids the cord catching on the diaper and being pulled off or irritated.

• Keep it dry but don’t panic if it accidentally gets wet

  • Most parents are told to sponge bath until the cord falls off. This is partly because if the skin remains moist, it can interfere with healing and create an environment where bacteria thrive.  

• Keep it clean.

  • Wash your hands before touching the cord/changing the diaper. You do not need to apply anything more to the area, but watch it for signs of infection.

The Pediatrician Mom Tip: In the past, families were told to clean the cord with alcohol. Some studies* have shown that this may actually delay healing and irritate the skin, so it is no longer recommended.

*PMID: 27057849; 31523534

• Don’t pull it off

  • Allow the cord to fall off on its own.

• Do not apply breastmilk, herbal poultices, or anything else that can increase the infection risk. Leave it alone!

Why this matters

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The cord can be a source of infection for the baby. This is called omphalitis, and it is VERY rare. But good umbilical cord care can facilitate healing and help prevent complications. 

What if it bleeds?

Its not unusual to have some minor bleeding or spotting as the cord falls off (think about what happens if a healing scab is pulled off too early). However, if you notice prolonged bleeding, call your pediatrician. 

What is a patent urachus?

Very rarely, the connection between the bladder and the belly button does not close off completely after birth. In this case, a baby might actually have urine coming from the umbilicus. If there is a large amount of leakage from the belly button, your pediatrician may order an ultrasound test to check for this. If your child has this, they may need minor surgery.

When to call the pediatrician

This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!

An infection of the umbilical cord (“omphalitis”) can be very serious, and requires immediate attention. Some indications you need to reach out include:

• Foul smelling or yellow drainage from the cord

• Redness of the skin around the cord (especially if its spreading)

• Fever or any sign of pain 

• Swelling of the skin in that area 

• If the cord has not fallen off by week 3-4. This can sometimes signal an underlying immune or anatomic issue. 

What is an umbilical granuloma?

Sometimes, instead of completely drying, the healing tissue forms scar tissue called a granuloma. This is usually pink in color and can have some light-yellow crust. It usually improves on its own within a week. However, if it does not, sometimes your pediatrician will cauterize it in the office (don’t worry: not a painful procedure).

Innie or outie?

Some babies develop an umbilical hernia as a result of a weakness in the muscle at the belly button.

These umbilical hernias are super common (they can occur in up to 20% of infants under 6 months of age). The vast majority improve on their own. If an umbilical hernias is not gone by about 4-5 years, or is very large, it may need to be surgically repaired.

If your baby has one, your pediatrician will evaluate it at each visit. You may notice that it is more obvious (and protrudes more) when baby bears down, such as when passing gas, pooping, crying. This is because bearing down increases intra-abdominal pressure - which then can push intestine through the weakness/hole. You should be able to push the hernia easily back through with gentle pressure - if this is not the case, or it is changing color or seems to be very painful/associated with fussiness, this can be an emergency.

Always call your pediatrician if you’re concerned!

Sources: healthychildren.org

PMID: 27573092

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Caring for a baby’s umbilical cord is often a source of stress for new parents. The truth is, as in many other things, more intervention is not necessarily better.

I hope this post provides some reassurance!

You are doing a great job, new mama (or dad)!