Maybe you suspect your child has a hernia, or perhaps your child was recently just diagnosed with one. What now? Understanding hernias in children present differently than in adults.
Of course, I am not a licensed physician. However, I am a CST (Certified Surgical Technologist), and I have seen my share of hernias in pediatrics and adults.
There are various reasons that someone might develop a hernia in adults, and they’re most common in the groin and abdomen.
In adults, hernias can develop due to aging, abdominal surgery, muscle strain, digestive problems, and obesity. Smoking can also increase the risk of a hernia in adults.
To repair a hernia in the past, a surgeon would put the bulge back into place or stitch the muscles closed. Then, doctors introduced the use of mesh products to repair hernias in the 1980s.
Hernia mesh has since been associated with complications, and some products are now off the market.
All of these factors that play a role in hernias in adults are different from hernias in children.
The following are key things to know about hernias in children.
The Basics: Understanding Hernias in Children
We often think about hernias in the context of something an adult gets from lifting heavy items or the risk factors above. However, hernias can occur in babies, toddlers, and young children.
In most cases, when a child has a hernia, it’s congenital, meaning present at birth. It may not be something anyone notices until later in life, however.
Males are six times more likely than a female to have a hernia. Hernias occur when fatty tissue or an organ squeezes through a weak spot in the connective muscle or tissue surrounding it.
Symptoms of hernias in children can include:
- A lump in the groin, close to the thigh
- Ongoing crying in a baby
- A lump that seems more significant when a child is straining, such as when cough or crying, or standing, that then goes away when they’re relaxed or lying down
Types of Pediatric Hernias
The following are some of the more commonly seen types of hernias in children and babies.
- Inguinal hernia: This is the majority of hernias in children. These are in the lower part of the abdomen, near a child’s groin. In male children, the part of the intestine that’s protruding can enter the scrotum. In girls, the swelling is usually near the labia. These hernias can also appear in the belly button and abdomen. This type has two subcategories—a direct inguinal hernia, which occurs when a weak spot develops in the lower abdomen muscles, and an indirect inguinal hernia. This type occurs when the inguinal canal doesn’t close before birth. The inguinal canal is a passage that goes through the lower wall of the abdomen. This type is more common in babies born prematurely.
- Umbilical hernia: This type of hernia is most common in newborns and babies younger than six months old. A baby’s belly button might look swollen and enlarged, but this type will typically heal on its own by the time a baby is a year old.
- Epigastric: This type of hernia most commonly occurs in boys, and there’s a protrusion in the muscles of the abdomen somewhere between the belly button and chest, leading to a lump. Surgery is required to fix it.
- Hiatal: When the upper stomach bulges through a weak diaphragm opening, it can lead to a hiatal hernia.
- Sports hernias can develop in older children and teens, and repetitive turning and twisting usually cause them. Hockey, tennis, and soccer are the sports that most often lead to hernias.
In children, the most common hernias are inguinal hernias, making up around 80% of all hernia cases.
An inguinal hernia is usually a congenital abnormality in kids. They can also occur in adults, often because of progressive weakening of the abdominal wall.
During the development of the fetus, in boys, the testicle descends from this location into the scrotum. It can take part of the lining of the abdomen with it.
While girls don’t have a scrotum, a hernia can also develop because of an inguinal canal. It is usually the tube and ovary that will fall into the hernia sac.
A hydrocele is a fluid-filled sac in the scrotum or groin that can look like an inguinal hernia. The difference is that the hydrocele doesn’t contain bowel or tissue.
How Are Hernias Treated in Children?
Usually, hernias need to be repaired surgically in children to help avoid complications.
One of the primary complications your child’s doctor will likely want is to avoid strangulation. Strangulation is when part of the intestine gets trapped in the hernia, cutting off the blood supply to that intestinal area.
A child six months and younger have a higher risk of these complications with an inguinal hernia. Signs of strangulation include abdominal bloating, nausea and vomiting, and a bulge that’s tender and red.
A doctor might do a laparoscopic surgery to repair a hernia, where small cuts are made on the belly that lets the scope and instruments be inserted to fix it. If the bowel is trapped in the hernia, the child’s surgeon has first to make sure the blood supply to the bowel hasn’t been cut off too long. If so, a piece of the bowel may have to be removed.
Risk factors for children with a hernia include being born early, having a parent or sibling with one when an infant, or cystic fibrosis.
Having developmental dysplasia of the hip can mean an increased hernia risk, as can being a boy with undescended testes. Undescended testes mean the testicles didn’t move into the scrotum before the child was born.
If you or your child’s doctor suspects a hernia, a doctor can usually do a physical exam to diagnose it. The healthcare provider may first see if the healthcare provider can gently push the hernia back into the abdomen, which is a reducible hernia.
If the doctor can’t push the hernia back in, your child’s doctor might also order an ultrasound or X-rays to see the intestine closely.
The specific treatment approach will depend on your child’s symptoms, age, and overall health, as well as how severe their hernia condition is.
Understanding hernias in children present differently than in adults is important, and there are many treatment options, but usually, they are fixed with surgery.
It is important to remember the signs of a hernia, including a lump in the groin, constant crying in a baby, a lump that seems more significant when a child is straining, tenderness, and pain.