Hernias are a common medical condition, even in children, and while they may sound alarming, they are often treatable with routine surgical procedures. As a parent, it is natural to worry when your child is diagnosed with a paediatric hernia, but with the right information, you can navigate the journey from diagnosis to recovery with confidence.

Understanding Paediatric Hernia

A hernia occurs when an internal part of the body pushes through a weak spot in the surrounding muscle or tissue. In children, hernias typically occur in the groin or belly button area and are often present from birth due to incomplete development of the abdominal wall.

Paediatric hernias are classified into different types based on their location and cause. The most common types include:

1. Inguinal Hernia

An inguinal hernia occurs when a part of the intestine or abdominal tissue pushes through the inguinal canal in the groin area. This type is more common in boys than girls and often appears as a bulge near the groin or scrotum.

Surgical repair is recommended as early as possible after diagnosis, typically within the first few months of life. However, older children, including a hernia in a 10-year-old boy, may also require repair if they develop symptoms.

2. Umbilical Hernia

An umbilical hernia occurs when the intestine pushes through the abdominal wall near the belly button. This is more common in newborns and premature infants and often closes on its own by age 4 or 5.

3. Epigastric Hernia

An epigastric hernia appears in the upper part of the abdomen, between the belly button and the chest. These are usually small but may require surgical intervention if they cause discomfort.

4. Incisional Hernia

This type of hernia develops at the site of a previous surgical incision. Although rare in children, it can occur after abdominal surgery.

What Are the Symptoms of a Hernia in a Child?

Recognising the symptoms of a hernia in a child enables early diagnosis and treatment. The symptoms vary depending on the type of hernia but generally include:

• A soft, noticeable lump or swelling in the groin (inguinal hernia) or belly button (umbilical hernia).
• The bulge becomes more prominent when the child cries, coughs, or strains during a bowel movement.
• The lump may disappear when the child is lying down or relaxed.
• Mild discomfort or pain around the affected area, especially after physical activity.
• Infants may be fussy, irritable, or cry excessively due to discomfort.
• The hernia may increase in size over time.
• The bulge may come and go, depending on the child’s position and activity level.
• In some cases, a hernia can cause digestive discomfort, bloating, or constipation.
• If the hernia becomes trapped (incarcerated) or strangulated (cutting off blood supply), symptoms can include – severe pain, vomiting, swelling and redness around the hernia & a firm, tender lump that does not go back in.

Causes of Hernia in Children

Let us now explore the reasons why a kid may develop a hernia.

• A hernia in a child happens when an organ or tissue protrudes through a weakened muscle or tissue. They can be present at birth or develop due to abdominal pressure.
• Many paediatric hernias result from incomplete closure of the abdominal wall during foetal development.
• Inguinal hernias occur when the inguinal canal (a passage in the lower abdomen) fails to close properly, allowing the intestine or other tissue to push through.
• Umbilical hernias develop when the muscles around the belly button do not close completely after birth.
• Premature babies are at a higher risk of developing hernias because their muscles and tissues are underdeveloped.
• Inguinal and umbilical hernias are more common in preterm infants.
• If a parent or close family member had a hernia as a child, the risk of the child developing one increases.
• Certain genetic conditions, such as connective tissue disorders, can make a child more prone to hernias.
• An injury to the abdominal wall can also contribute to hernia formation.
• Certain conditions or activities can increase pressure inside the abdomen, leading to a hernia such as – Chronic coughing (due to respiratory conditions like asthma or infections), constipation (straining during bowel movements can weaken the abdominal muscles) and heavy lifting or excessive physical activity in older children.

Treatment of Hernia in Children: What Are the Options?

Surgical repair is usually necessary for paediatric hernias, depending on factors such as type, size, and severity. While some umbilical hernias may resolve on their own, treatment varies based on individual circumstances.

1. Watchful Waiting (Non-Surgical Approach)

For certain types of hernias, doctors may recommend monitoring the condition instead of immediate surgery:

• Umbilical Hernia: Many umbilical hernias will naturally close by the time a child reaches 4 to 5 years of age. If the hernia is small and not causing any discomfort, doctors typically recommend a watchful waiting approach. However, surgery may be necessary if the hernia is larger than 1.5 cm, persists beyond the age of 5, or if it causes pain or complications.
• Lifestyle Modifications: To reduce abdominal pressure, it is important to prevent straining during bowel movements. Avoiding heavy lifting is also crucial for older children, as activities that strain the abdominal muscles should be avoided. Additionally, treating chronic coughing is essential in managing respiratory conditions such as asthma, as this can help prevent hernias from worsening.

2. Surgical Treatment for Paediatric Hernias

Most paediatric hernias require surgical repair, especially inguinal hernias, as they do not close on their own and may lead to serious complications.

• Open Surgery (Traditional Approach): During the hernia repair procedure, a small incision is carefully made near the site of the hernia. The protruding tissue is gently pushed back into its proper position, and the weakened area is then strengthened using either stitches or a surgical mesh, particularly for older children. Finally, the incision is closed using dissolvable stitches or surgical glue to promote proper healing.
• Laparoscopic Surgery (Minimally Invasive Approach): During the procedure, three small incisions are made in the abdomen. A laparoscope, which is a small camera, is then inserted to assist in guiding the operation. Tiny instruments are used to repair the hernia, and the incisions are subsequently closed. This minimally invasive approach is particularly recommended for patients with bilateral hernias or recurrent hernias.

When Is Surgery Needed?

Surgery is typically recommended if the hernia does not close on its own, especially after the age of 5 for umbilical hernias. This is especially true if the hernia is causing pain, discomfort, or difficulty with digestion.

Additionally, if the hernia is growing larger over time or if there are signs of incarceration (trapped intestine) or strangulation (cut-off blood supply), emergency surgery may be necessary.

What to Expect After Hernia Surgery?

In most cases, children can return home on the same day after surgery. Normal activities can typically be resumed within a few days, although it is advisable to avoid strenuous activities for a few weeks.

Recovering from paediatric hernia surgery is usually quick and smooth, but proper post-operative care is essential to ensure a comfortable healing process. Here are some practical tips to help your child recover safely and effectively after hernia repair.

Follow Post-Surgery Care Instructions

After hernia surgery, follow the doctor’s specific guidelines for recovery based on the type of surgery. Keep the incision area clean and dry by avoiding bathing or swimming until approved by the doctor. Monitor for signs of infection such as redness, swelling, or fever. Ensure proper wound healing by not scratching or rubbing the incision area.

Manage Pain and Discomfort

After surgery, mild pain and swelling are normal but can be managed effectively. This can be done by giving prescribed pain medications, applying a cold compress for 10-15 minutes at a time, and encouraging gentle movements to prevent stiffness without overdoing it. Avoid aspirin to prevent increased risk of bleeding.

Activity and Movement: When Can a Child Resume Normal Activities?

After undergoing a procedure, most children can resume their daily routine within a few days. However, they should avoid heavy lifting and strenuous activities for 2-4 weeks. Gentle movements like short walks and deep breathing exercises are encouraged to prevent stiffness and discomfort. Children can usually return to school within 3-7 days, depending on how quickly they recover.

Nutrition and Hydration for Faster Healing

To recover well after surgery, it is important to eat a nutritious diet. This includes consuming protein-rich foods like eggs, lean meats, fish, and lentils for tissue repair, as well as fibre-rich foods such as fruits, vegetables, and whole grains to prevent constipation.

It is also essential to stay hydrated by drinking water, soups, or fresh juices. Foods to avoid during recovery include spicy or greasy foods that can cause discomfort, as well as carbonated drinks that may cause bloating.

Emotional Support: Helping Your Child Feel Comfortable

As surgery can be stressful for children, emotional support is crucial. Comfort your child by reassuring them the pain will pass, offering distractions such as books or TV, and letting them rest with their favourite toys or blankets.

Potential Complications and When to Seek Medical Help

Paediatric hernia repair is generally safe, but there are potential complications to watch out for, such as infection, hernia recurrence, tissue damage, bowel obstruction, and intestinal strangulation. Parents should be on the lookout for symptoms such as redness, swelling, pus, fever, pain, vomiting, bloating, and intense pain with a firm lump. Trusting their instincts and seeking medical attention promptly if any of these symptoms occur is crucial for a smooth recovery and preventing serious health issues.

Sources:

• https://drgursev.com/paediatric-hernia-surgery/
• https://www.omegapaediatrics.com/understanding-hernias-in-children/
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/hernia-in-children-and-babies/inguinal-hernia-in-children
• https://www.rupahealth.com/post/hernia-surgery-a-complete-guide-to-types-risks-recovery
• https://www.childrenscolorado.org/doctors-and-departments/departments/paediatric-surgery/tests-procedures-services/hernia-repair/