Pediatric Hernia Repair
Inguinal, umbilical, and epigastric hernias in infants and children — evaluated and repaired with laparoscopic precision in Calabasas.
- Typical age
- Newborn to 18
- Approach
- Open or laparoscopic
- Recovery
- Same-day discharge
A hernia occurs when an internal tissue, usually a loop of intestine or a bit of abdominal lining, pushes through a weak spot in the abdominal wall muscle. In children, this weak spot is almost always congenital: an opening that should have closed before or shortly after birth doesn’t fully seal. Hernias are common in infants and children and are almost always treatable with a straightforward outpatient procedure.
Most pediatric hernias fall into one of three categories: inguinal hernias (in the groin), umbilical hernias (at the belly button), and epigastric hernias (along the midline above the belly button). Each behaves differently, and only some resolve on their own without surgery.
Inguinal Hernias in Children
Inguinal hernias are the most common type of hernia in children and the most common reason for pediatric general surgery referrals. They occur when a small pouch near the groin, which is normally present during fetal development and closes before birth, fails to close completely. This leaves a passage through which intestine or, in girls, an ovary can slip.
Inguinal hernias are significantly more common in boys than in girls, roughly 8 to 10 times more frequent, because the passage in question is the same pathway the testicles travel through during development. Premature infants are also at higher risk. Unlike umbilical hernias, inguinal hernias do not close on their own and require surgical repair once diagnosed, both to relieve the bulge and to prevent incarceration, a complication discussed below.
Umbilical Hernias
Umbilical hernias appear as a soft bulge at or around the belly button and are caused by an incomplete closure of the muscle ring where the umbilical cord once passed through. They are extremely common in infants, particularly those born prematurely or at low birth weight, and are seen more often in Black infants for reasons that are not fully understood.
Most umbilical hernias close on their own by the time a child reaches 4 to 5 years of age, and watchful waiting is the standard recommendation for small, asymptomatic umbilical hernias in young children. Surgery is generally reserved for hernias that persist beyond age 4 to 5, that are unusually large, or that cause symptoms such as pain or incarceration.
Epigastric and Other Less Common Hernias
Epigastric hernias occur along the midline of the abdomen, between the belly button and the breastbone, where small gaps in the connective tissue allow a bit of fatty tissue to push through. They tend to be smaller than inguinal or umbilical hernias and are sometimes mistaken for a lump or cyst before diagnosis.
Less commonly, children can develop other variants, including incisional hernias at the site of a previous surgical incision, or, rarely, femoral hernias. Dr. Frykman evaluates each of these individually, since the recommended approach can differ from the more common inguinal and umbilical presentations.
Symptoms Parents Should Recognize
The hallmark sign of any hernia is a visible or palpable bulge, often more noticeable when a child is crying, coughing, straining, or standing, and less noticeable when they are relaxed or lying down. Many hernias cause no pain at all and are found incidentally during a well-child visit or bath time.
Parents should seek prompt medical attention if the bulge becomes firm, tender, discolored, or cannot be gently pushed back in, and especially if it is accompanied by vomiting, irritability, or refusal to eat. These can be signs of incarceration, meaning the protruding tissue has become trapped and its blood supply may be compromised. An incarcerated hernia is a surgical emergency and requires immediate evaluation, so any of these warning signs should prompt a same-day call to the surgical team or a visit to the emergency room rather than waiting for a scheduled appointment.
Diagnosis Pathway
Hernias are usually diagnosed through a physical exam alone. A pediatrician or pediatric surgeon will typically ask a parent to describe when the bulge appears and will examine the child both at rest and while the child is crying or straining, since this is often when a hernia becomes most visible.
Imaging is rarely necessary for a straightforward inguinal or umbilical hernia, but an ultrasound may be used if the diagnosis is unclear, if there is concern about an incarcerated hernia, or in girls where it’s important to confirm what tissue is involved. Once a hernia is confirmed, families are referred to a pediatric surgeon to discuss timing and the surgical approach.
Treatment Options: Laparoscopic vs. Open Repair
Surgical repair is recommended for all inguinal hernias, since they do not resolve without treatment, and for umbilical or epigastric hernias that persist past the age when they would typically close on their own or that cause symptoms.
Both laparoscopic and open techniques are used in pediatric hernia repair, and the right choice depends on the type of hernia, the child’s age, and whether both sides need to be addressed. Laparoscopic repair uses a small camera and fine instruments through tiny incisions, and offers the advantage of allowing the surgeon to check the opposite side for a second, not-yet-visible hernia in the same procedure, which is common with inguinal hernias in young children. Open repair, still the standard approach for many umbilical and epigastric hernias, uses a single small incision, often hidden within the belly button, and typically takes well under an hour.
Age is an important consideration in timing. Premature infants and very young babies with inguinal hernias are typically scheduled for repair promptly, given the higher risk of incarceration in this age group, while umbilical hernias in toddlers are often simply monitored. Dr. Frykman discusses the specific timing and technique recommended for each child during the surgical consultation.
Recovery Timeline and Activity Restrictions
Pediatric hernia repair is typically performed as same-day, outpatient surgery, meaning most children go home the same day. Recovery is generally quick: infants and toddlers are often back to their normal feeding and activity within a few days, while older children may need 1 to 2 weeks before returning to school, and 2 to 4 weeks before resuming sports, gym class, or other strenuous activity.
Mild discomfort at the incision site is normal for the first several days and is usually managed with over-the-counter pain relief as needed. Parents are given specific bathing, wound care, and activity guidance at discharge, along with a follow-up visit to confirm the repair is healing well.
Dr. Frykman's Expertise
Dr. Frykman is a fellowship-trained pediatric surgeon who focuses exclusively on surgical conditions in infants and children, including the full range of pediatric hernias: inguinal, umbilical, epigastric, and less common variants. This focused experience means incision placement, anesthesia planning, and post-operative care are all tailored specifically to a child’s smaller anatomy, rather than adapted from adult surgical protocols. Families throughout the Calabasas and greater Los Angeles area turn to Dr. Frykman for hernia evaluations and repair, from routine umbilical hernia consultations to urgent same-day evaluations for a suspected incarcerated hernia.
When to Call Us / What to Bring to Your Consultation
If you’ve noticed a bulge at your child’s belly button or in the groin area, or your pediatrician has raised a concern about a possible hernia, Pacific Coast Pediatric Surgery is here to help. Contact us to schedule a consultation with Dr. Frykman and get a clear plan for your child’s care. If your child’s bulge is firm, painful, or won’t go back in, please seek emergency care right away.
Frequently Asked Questions
At what age should a pediatric hernia be repaired?
Inguinal hernias are typically repaired soon after diagnosis, regardless of age, since they carry a risk of incarceration and do not resolve on their own. Umbilical hernias are usually monitored until at least age 4 to 5, since most close on their own by then.
Are pediatric hernias dangerous?
Most hernias are not dangerous and cause little more than a visible bulge. The main danger is incarceration, where the protruding tissue becomes trapped and loses blood supply. This is why any hernia that becomes firm, painful, or discolored needs urgent evaluation.
Is hernia surgery safe for infants?
Yes. Hernia repair is one of the most common and well-established procedures in pediatric surgery, including in premature infants, and is performed as outpatient, same-day surgery in the large majority of cases.
Will my child need surgery on both sides?
Not always. Many children only have a hernia on one side. During laparoscopic repair, Dr. Frykman can also check the opposite side for a hidden hernia in the same procedure, which is common with inguinal hernias, and address it if one is found.
How long is recovery after hernia surgery?
Most children resume normal daily activity within a few days and return to school within a week to two weeks. Strenuous activity and sports are typically restricted for 2 to 4 weeks to allow the incision to heal.
What if my child's umbilical hernia hasn't closed by school age?
Umbilical hernias that persist past age 4 to 5, or that are unusually large or symptomatic, are generally recommended for surgical repair. Dr. Frykman can evaluate whether continued monitoring or repair is the better option for your child.
