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Should Your Child See a Doctor?

Umbilical Cord Symptoms

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Definition

  • This topic covers common questions asked about the umbilical cord or navel in newborns

Symptoms 

  • Umbilicus (navel) has a cloudy discharge or even some dried pus on the surface
  • Bleeding occurs from umbilical cord's point of separation
  • Separation of umbilical cord is delayed past 2 weeks

Omphalitis: Serious Complication 

  • Definition: Bacterial infection of the umbilical stump with spread to the surrounding tissues. It’s a medical emergency.
  • Incidence: 1 out of 200 newborns
  • Symptoms: Spreading redness around the navel. The area may be tender, swollen and have a foul odor.
  • Risk: Higher in those who receive “dry cord care”

Umbilical Granuloma: Minor Complication

  • Definition: Soft, pink round nubbin of tissue present in center of navel after the cord falls off. Usually covered with a clear discharge.
  • Incidence: 1 out of 500 newborns
  • Outcome: Usually grows in size if not treated. Can become an entry point for umbilical infections.
  • Treatment: Easily treated in your doctor’s office by applying silver nitrate chemical.

When to Call Your Doctor for Umbilical Cord Symptoms

Call Your Doctor Now (night or day) If

  • Newborn (under 1 month old) starts to look or act abnormal in any way
  • Bleeding won't stop after 10 minutes of direct pressure applied twice
  • Spot of blood over 2 inches (5 cm)
  • Red streak runs from the navel
  • Red area spreads beyond the navel
  • Fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen)
 

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen
  • Small recurrent bleeding continues over 3 days
  • Pimples, blisters or sores in area
  • Lots of drainage from navel (urine, mucus, pus, etc)
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • After following topic advice for 3 days, navel is not dry and clean
  • Nubbin of pink tissue inside the navel
  • Cord attached over 6 weeks
 

Parent Care at Home If

  • Normal cord or navel, questions about
  • Superficial infection of cord or navel and you don't think your child needs to be seen
  • Normal umbilical bleeding and you don't think your child needs to be seen
  • Normal early separation of the cord before 10 days
  • Normal delayed separation of the cord beyond 2 weeks
 

Home Care Advice for Umbilical Cord Symptoms

Treatment for Normal Umbilical Cord

  1. Alcohol:
    • Clean the navel with rubbing alcohol 4 times per day.
    • Use a cotton swab to clean away the dried pus or debris. Be vigorous about it. The umbilical area does not have any sensation, so the alcohol won't sting.
    • If the cord is still present, clean underneath it by lifting it and bending it to each side.
    • If the cord has fallen off, pour some alcohol into the depression and remove it after 2 or 3 minutes. (Reason: it takes that long to kill the bacteria.)
    • There is a minor controversy about using alcohol on the cord. Some hospitals recommend natural drying of the cord because using alcohol can delay separation of the cord by 1 or 2 days. However, alcohol prevents some cord infections and that is what's really important.
       
     
  2. Diapers: Keep the umbilical area dry to help healing. To provide air exposure, keep the diaper folded down below the cord area.
     
  3. Dryness: Avoid tub baths until the area is healed.
     
  4. Poop on Cord: Getting some poop on the cord or navel is not serious. If it occurs, clean the area with lots of water, followed by rubbing alcohol. That should prevent any infections.
     
  5. Call Your Doctor If:
    • Develops a red streak
    • Fever occurs
    • Your baby begins to look or act abnormal
     

Treatment for Superficial Infection of Cord or Navel

  1. Reassurance: A cloudy discharge from the navel is usually a mild infection from normal skin bacteria. Usually home treatment can clear it up quickly.
     
  2. Alcohol:
    • Clean the navel with rubbing alcohol 4 times per day.
    • Use a cotton swab to clean away the dried pus or debris. Be vigorous about it. The umbilical area does not have any sensation, so the alcohol won't sting.
    • If the cord is still present, clean underneath it by lifting it and bending it to each side.
    • If the cord has fallen off, pour some alcohol into the depression and remove it after 2 or 3 minutes. (Reason: it takes that long to kill the bacteria.)
       
     
  3. Antibiotic Ointment: If a little pus is present, apply an antibiotic ointment such as Polysporin 4 times per day after each cleansing (no prescription needed).
     
  4. Diapers: Keep the umbilical area dry to help healing. To provide air exposure, keep the diaper folded down below the cord area.
     
  5. Dryness: Avoid tub baths until the area is healed.
     
  6. Call Your Doctor If:
    • Develops a red streak
    • Fever occurs
    • Navel is not completely dry and clean after 3 days using this treatment
    • Your baby begins to look or act abnormal
     

Treatment for Normal Umbilical Bleeding

  1. Reassurance: A few drops of blood is normal with cord separation. Friction against the diaper may make it recur.
     
  2. Bleeding: Apply direct pressure for 10 minutes with a sterile gauze to stop any bleeding. Clean the area beforehand, rather than afterwards. (Reason: to prevent rebleeding)
     
  3. Diaper: Prevent friction on the umbilical stump from the diaper by folding it down or cutting a wedge out of the diaper.
     
  4. Call Your Doctor If:
    • Bleeding becomes worse
    • Few drops of blood continues over 3 days
    • Your baby begins to look or act abnormal
     

Treatment for Normal Early Separation of the Cord Before 10 Days

  1. Reassurance: The cord can't fall off too early. The average cord falls off between 10 and 14 days.
     
  2. Alcohol:
    • Clean the navel with rubbing alcohol and a cotton swab 4 times per day.
    • Pour some alcohol into the depression and remove it after 2 or 3 minutes. (Reason: It takes that long to kill the bacteria.)
    • The umbilical area does not have any sensation, so the alcohol won't sting.
       
     
  3. Diapers: Keep the umbilical area dry to help healing. To provide air exposure, keep the diaper folded down below the navel.
     
  4. Dryness: Avoid tub baths until the area is healed.
     
  5. Call Your Doctor If:
    • Develops a red streak
    • Fever occurs
    • Your baby begins to look or act abnormal
     

Treatment for Normal Delayed Separation of the Cord Beyond 2 Weeks

  1. Reassurance: Most cords fall off between 10 and 14 days. All cords eventually fall off by themselves. Continue to be patient.
     
  2. Stop Alcohol: Stop applying rubbing alcohol to the cord. Rubbing alcohol sometimes also kills the good bacteria that help the cord dry up and fall off.
     
  3. Diaper: Help the cord dry up faster by keeping the diaper folded below it. Another approach is to cut out a wedge of the diaper (if disposable) with scissors so the cord is exposed to the air.
     
  4. Call Your Doctor If:
    • Cord begins to look infected
    • Fever occurs
    • Cord is still attached over 6 weeks
    • Your baby begins to look sick or act abnormal
     

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


References

  1. Anhalt H et al. Retained umbilical stumps. Am J Dis Child. 1992;146:1413.
  2. Dore S, Buchan D, Coulas S, Hamber L, Stewart M, Cowan D, Jamieson L. Alcohol versus natural drying for newborn cord care. J Obst Gynecol Neon Nursing. 1998;27:621-627.
  3. Edelsen M and McKenzie SE. Why is this newborn bleeding? Contemp Pediatr. 2000;17(7):60-68.
  4. Janssen PA, Selwood BL, Dobson SR et al. To dye or not to dye: a randomized, clinical trial of a triple dye/alcohol regime versus dry cord care. Pediatrics. 2003;111:15-20.
  5. O’Donnell KA, Glick PL, Caty MG. Pediatric umbilical problems. Pediatr Clin North Am. 1998; 45:791-800.
  6. Razvi S, Murphy R, Shlasko E, Cunningham-Rundles C. Delayed separation of the umbilical cord attributable to urachal anomalies. Pediatrics. 2001;108:493-495.
  7. Zupan J, Garner P. Topical umbilical cord care at birth. Cochrane Database System Review. (2):CD001057, 2000.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 8/1/2010

Last Revised: 10/1/2010 4:18:44 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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