Dear Dr. Soukup,
Our 2 year old daughter has a lump on her belly, just above her belly button. Her pediatrician has been watching it, because it doesn’t bother her, but we notice it gets much bigger when she is running around. Is it time to have it checked out? Thank you, Peter and Jen Z.
Dear Peter & Jen,
Your description sounds a lot like an epigastric hernia, which is a common type of hernia seen in infancy and childhood. Epigastric hernias are found in the midline of the upper abdomen, somewhere between the belly button and the chest. The lump that you have noticed is caused by a small amount of fat that protrudes through an opening in the strength layer of the abdominal wall. Parents notice the lump most obviously when the child is standing or straining, because abdominal pressure pushes the fat out. It typically falls back inside and flattens out when laying down or relaxed. Although we don’t exactly know what causes epigastric hernias, the area of weakness is more likely present at birth rather than caused by injury or straining.
The hernia opening starts out very small (typically just a few millimeters across), although the fatty lump can feel and look much larger. Because the opening is so small, epigastric hernias are very unlikely to develop emergency complications, such as “incarceration” (when the intestine gets stuck) and are therefore safe for “watchful waiting” at first. Epigastric hernias are usually asymptomatic in babies and young children; In older children, however, they are more likely to cause symptoms because the opening can enlarge over time, and the fat can get stuck in the hernia opening leading to pain or discomfort. Because epigastric hernias do not close by themselves, I typically recommend surgical repair once a child is 2-3 years of age or older. At this age, anesthesia is very brief and safe, and the abdominal wall is still thin enough to allow for repair through a tiny incision over the lump.
The procedure is very well tolerated in children, and most are running around by the next day, back to their usual selves. For your daughter, since your pediatrician has been following this closely, there is no urgency for evaluation by a pediatric surgeon, but it is certainly a reasonable time to start the discussion if you wish. Hope that helps.
Thanks for your question!
Thanks for your question! Dr. Soukup
Elizabeth S. Soukup, M.D., M.M.Sc.
Dr. Soukup is a Pediatric Surgeon at the Elliot Hospital and has an interest in educating families about pediatric health and wellness. Her mission is to provide expert specialty care for children of all ages in New Hampshire – newborns through teenagers – striving to keep them close to their families and communities. If you would like more information, call 603-663-8393 for an appointment, or visit our website at http://elliothospital.org/website/pediatric-surgery.php. Check out her previous articles at #askthepediatricsurgeon.
Dr. Soukup earned her Bachelor of Science from the Massachusetts Institute of Technology and her Doctor of Medicine from the University of Chicago Pritzker School of Medicine, where she received the Outstanding Achievement Award in Medicine, graduating first in her class. She completed her General Surgery training at the Massachusetts General Hospital and her fellowship in Pediatric Surgery at Children’s Hospital Boston. During her time in Boston, she also completed a Masters of Medical Sciences degree in clinical investigation from Harvard Medical School. She was awarded Elliot Hospital’s “Physician of the year” for 2018. She is board-certified in both Pediatric Surgery and General Surgery. She has specialized training and experience in minimally invasive surgical treatment for babies, children and teenagers. Her practice includes all areas of general pediatric surgery, including common pediatric surgical problems as well as neonatal surgery, congenital anomalies, minimally invasive surgery, and complex thoracic surgical problems.