When you have a brand new baby at home, there will be a lot of things to take care of.
Fortunately, the umbilical cord stump doesn’t require you to do too much, but there are some things you’ll want to look out for.
There are a few different schools of thought, so I’ll cover all of them here.
Basic care instructions.
As with anything baby-related, ask your doctor about their recommendations for umbilical cord care. But the universal directions are:
- Keep it clean and dry. If it gets dirty, wash it (more on that below).
- Fold diaper down or use newborn diapers that are cut to avoid the navel area.
- Change diaper often to avoid leakage and possibility of the umbilical cord getting dirty.
- Dress baby in t-shirt and diapers if it’s warm weather, rather than onesies which may irritate it.
- Don’t submerge baby in a bath. Sponge baths are best until the cord falls off.
- No matter what, don’t pull or tug on it, even if it’s hanging by a thread. You can cause bleeding and make the healing process take longer.
- The best thing you can do is to leave it alone. There is no need to bandage it.
The umbilical cord stump is basically like a scab, so you can treat it that way. That means, if it accidentally gets torn off too soon, it will bleed. That shouldn’t be a problem, but you’ll want to treat it appropriately.
In clinical practice, the umbilical cord stump typically falls off by 2 weeks of age. Rarely, it may take up to 4 weeks old, especially if the area is kept too moist. For this reason, only sponge baths are recommended while the cord is still attached.
Although recommended in the past, there is no need to “clean” the area around the umbilical stump with alcohol or any other antiseptic. Doing so prolongs the amount of time it takes for it to fall off. Parents may also notice that the antiseptics hospitals previously applied to the umbilical stump at birth are no longer used. Clinical research has shown that there is benefit or need to do so in hospital settings. In select situations where birth conditions are less hygienic, an antiseptic may still be used.
Dr. Leah Alexander, MD, FAAP
Things to expect (what if it bleeds?)
Here are some of the things you might expect to happen as your baby’s umbilical cord dries out.
A variety of strange colors.
Your baby’s umbilical cord stump is going to turn all kinds of interesting colors as it dries up. It could start out bluish white and change to purple, green, yellow, brown, gray, or black–the colors of the rainbow and then some! Don’t worry about the color.
During the cord separation process, it is normal to see scant yellow or green discharge where it is loosening from the umbilicus. Dried blood may also be noticeable. As long as the surrounding skin is not red or tender, no infection is present.
It can take anywhere from 7 to 21 days for the stump to fall off, but it could even be longer or shorter than that. If your baby still has the umbilical cord attached after 4 weeks, call your doctor. Occasionally, it can take up to two months for it to fall off! That is unusual, and, if it’s taking over 2 months, then you should take your child to the doctor.
You can expect a small amount of bleeding where the cord separated from baby’s body. If the diaper rubs against it, you might see a few drops, or you might notice a clear, mucous-like secretion streaked with blood. You can clean around it and apply gentle pressure to stop bleeding, if necessary.
If the bleeding isn’t stopping or it’s more than a few drops, call your doctor. It’s possible there is an infection.
After the stump falls off, you might notice a small amount of fluid tinged with blood for up to two weeks. This is most often noticed during the first bath once the umbilical stump falls off. If it is not healed and dry after two weeks, call your doctor.
Signs of infection.
The following symptoms rarely occur, but, if you notice any of these signs, contact your doctor immediately. These signs of infection can lead to something called omphalitis, which can be life-threatening.
- Belly button is warmer than other skin;
- There is a cloudy, pus-like drainage with foul smell;
- Baby seems uncomfortable or in pain when area is touched;
- Surrounding skin is red or swollen;
- Lethargy, low appetite, irritability;
- Abdominal swelling
Again, if you notice any of these signs, call your doctor right away.
How to clean it.
This is where there are many different schools of thought, so you should probably follow your doctor’s advice, but I will list the options below.
It was recommended in the past to use alcohol to clean the stump, and to do it four times a day! However, the American Academy of Pediatrics recently changed their recommendations, as they found alcohol can irritate the skin, delay healing, and there was no evidence that it decreased the risk of infection.
Mayoclinic.org says that if the stump is dirty or sticky, you can clean it with plain water, and dry it by holding a clean absorbent cloth around it, or fan it with a piece of paper.
Some sites mention a treatment using Goldenseal root and Echinacea, but in my practice, I do not recommend applying any of such treatments. They are not necessary.Dr. Leah Alexander, MD, FAAP
Here’s a good video that shows you how to clean it:
WebMD informs us of a couple other things that could occur (but probably won’t):
After the stump falls off, if you notice a moist, red lump with yellow/green drainage that lasts more than two weeks, this could be extra tissue called “umbilical granuloma”. This is a moist,“fleshy” protrusion that forms on the umbilicus after the stump comes off.
Although a granuloma may dry out and heal on its own in a few days, it may need treatment by a doctor. A painless application of silver nitrate during an office visit usually solves this issue.
This is a minor problem that can be treated painlessly via cauterization by a doctor applying silver nitrate. There are no nerve endings in the umbilical stump, so your baby won’t feel a thing.
Or if you see bulging tissue after the cord falls off, this could be an “umbilical hernia”, which usually goes away on its own, but should be watched by a doctor.
An umbilical hernia is a small opening between an infant’s abdominal muscles near the umbilicus. It may not be apparent until 2 weeks after birth. Some are the size of a dime while others may be as large as a quarter. They are painless. Most small umbilical hernias self-resolve within a few years but larger ones may require surgical intervention.
It is also important to mention that strapping or applying a belt to an umbilical hernia is not recommended or safe.
Dr. Leah Alexander, MD, FAAP
Some people want to be able to control whether their baby will have an “innie” or an “outie”. Unfortunately, there is no way to determine this–it is all up to chance. But if you keep your baby’s tummy clean and dry, they should have a beautiful, healthy belly button.