Umbilical hernia is due to a persistent opening of the umbilical ring, which normally spontaneously closes. After birth, this fascial opening (umbilical ring) closes spontaneously with continued growth of the rectus abdominis muscles toward one another. Although closure is complete in most children by five years of age, this is not true for all children, as in 5 % cases it closes between 8 to 11 years of age. Spontaneous closure is less likely to occur in patients who have a fascial opening that is greater than 1.5 cm. Umbilical hernias due to failure of spontaneous closure are frequently seen in patients with Ehlers-Danlos, Beckwith-Wiedemann syndrome, Down syndrome, hypothyroidism, or trisomy 18.
Management — Children with large, proboscoid (trunk-like) hernias without any decrease in the size of the umbilical ring defect over the first two years of life, generally require surgery, because their hernias are unlikely to close spontaneously.
Risk of umbilical hernia getting incarcerated is very less and so hernia can be safely observed, unlike an inguinal hernia, which requires a closure as soon as detected.
Danger signs of incarceration of an Umbilical Hernia (excess cry, redness, tense & irreducible swelling, vomiting) should be explained to the parents and surgery should be considered in child with any such past history of incarceration.