The document provides a comprehensive overview of different types of hernias in children, including umbilical, inguinal, and their causes, symptoms, diagnosis, and treatment options. It highlights that many umbilical hernias resolve spontaneously by age 2, while inguinal hernias typically require surgical intervention. Risk factors for hernias and specific clinical features are also discussed, emphasizing the importance of proper management and care.

1. HERNIA
PRESENTED BY:
M.C.KNIRANDA
ASSISTANT PROFESSOR
SSNSR, SU.

2. DEFINITION
• A hernia is the abnormal exit of tissue or an organ, such as the
bowel, through the wall of the cavity in which it normally resides
• Hernia is a protrusion of intestine through a weakness in the
abdominal muscles.

3. TYPES OF HERNIA IN CHILDREN
• A hernia that occurs in the belly button area is called an umbilical hernia.
• A hernia that occurs between the belly button and the breast bone is called
an epigastric hernia.
• A hernia that occurs in the groin area is called an inguinal hernia.
• A hernia that occurs in the diaphragm area is called a diaphragmatic hernia.
• Occur when the upper part of the stomach bulges through a weak opening in
the diaphragm is called Hiatal hernia.
• An injury to the inguinal area caused by repetitive twisting and turning is
called Sports hernia.
• A protrusion of tissue that forms at the site of a healing surgical scar is called
Incisional hernia.

4. CAUSES
•A hernia can develop in the first few months after the
baby is born because of a weakness in the muscles of the
abdomen.

5. RISK FACTORS
• Prematurity
• A parent or sibling who had a hernia as an infant
• Cystic fibrosis(inherited disorder that causes severe damage to the lungs,
digestive system and other organs in the body.)
• Developmental dysplasia(presence of abnormal cells within a tissue or
organ) of the hip
• Undescended testes (occurs when one or both testicles fail to move into the
scrotum before birth)
• Abnormalities of the genitourinary system (e.g. Bladder exstrophy)

6. UMBILICAL HERNIA
• An umbilical hernia occurs when part of intestine bulges through
the opening in abdominal muscles near the bellybutton (navel).
• Umbilical hernias are common and typically harmless.

7. CAUSES
• During gestation, the umbilical cord passes
through a small opening in the baby's
abdominal muscles.
• The opening normally closes just after birth.
• If the muscles doesn't join together completely
in the midline of the abdominal wall, an
umbilical hernia may appear at birth or later in
life.

8. RISK FACTORS
• Umbilical hernias are most common in infants — especially premature
babies and those with low birth weights.
• In the United States, black infants appear to have a slightly increased risk of
umbilical hernias.
• The condition affects boys and girls equally.

9. CLINICAL FEATURES
• Soft swelling or bulge near the navel.
• The bulge may be visible only when they cry, cough
or strain.
• Umbilical hernias in children are usually painless.
Severe symptoms –
• Begins to vomit
• Has tenderness, swelling or discoloration at the site
of the hernia

10. DIAGNOSIS
• An umbilical hernia is diagnosed during a physical examination.
• Sometimes imaging studies — such as an abdominal ultrasound or
a CT scan — are used to screen for complications.

11. TREATMENT
• More than 90% of these hernias will naturally close on their own, typically by
the time the child reaches the age of 2 years.
• In cases where the patient becomes symptomatic or if the umbilical hernia has
not healed by the age of 5 years, a surgical repair can be considered a
treatment option.

12. SURGICAL MANAGEMENT
• The only treatment for an umbilical hernia is
hernia repair surgery.
• During the procedure, a surgeon makes
incisions (cuts) that allow them to access the
hernia and push the tissue back into place.
• Then, they strengthen the abdominal wall
muscle to hold the tissue in place.
• Sometimes, they use a material called
surgical mesh to strengthen the tissue
barrier.

13. What is a surgical mesh?
•Surgical mesh is a medical device that is used to provide
additional support to weakened or damaged tissue.

15. INGUINAL HERNIA
• An inguinal hernia in an infant is a hernia that occurs in the groin. Inguinal
means groin.
• An inguinal hernia occurs when part of intestine pushes through an opening
in their abdominal wall through the inguinal canal.
• The inguinal canal extends from baby’s abdomen to their genitals.

17. INCIDENCE
• Inguinal hernias occur in 1% to 5% of healthy, full-term baby boys.
• Up to 30% of premature babies are born with an inguinal hernia.

18. CAUSES
• All babies are born with a tunnel-like passage called the inguinal canal. The inguinal canal
extends from baby’s belly (abdomen) to their genitals.
• During fetal development, a baby boy’s testicles form inside his abdomen. Then his
testicles move through the inguinal canal into his scrotum.
• Normally, the inguinal canal closes before birth.
• But sometimes, it doesn’t close all the way. This leaves an opening from belly into the
inguinal canal. When this happens, the intestines can slide through the opening, causing a
hernia.
• Inguinal hernias are rare in female babies, but they can occur.

19. CLINICAL FEATURES
• The main symptom of an inguinal hernia is a bulge under the skin in their
groin or scrotum.
• Pain and discomfort that improves with rest.
• Heaviness or pressure in their groin.
• Swollen scrotum.
• Burning at the site of the bulge.
• Crankiness(grumpy, irritable) and
• Difficulty feeding in infants.

20. SEVERE SYMPTOMS
• Severe pain or tenderness.
• Redness and bruising around the site of the bulge.
• No appetite.
• Fever.
• Nausea and vomiting.
• Bloody stool

21. DIAGNOSIS
• An inguinal hernia is diagnosed during a physical exam.
• Sometimes imaging studies — such as an abdominal ultrasound or
a CT scan — are used to screen for complications.

22. TREATMENT
• Unlike some umbilical hernias, inguinal hernias will not
resolve on their own.
• Surgery is required to correct the defect and prevent any
harm to the hernia contents.

23. • The surgery to repair an inguinal hernia is usually a day surgery,
the child will go home the same day as the procedure.
• Premature babies who are less than 60 weeks post-conception
age may require an overnight stay.
• The procedure will be done under general anesthesia.

24. The surgical approach for repair of an inguinal hernia
depends on the clinical situation:
Open repair:
• A tiny incision is made in the groin and the
hernia is closed using sutures.
• The overlying skin is sealed with
DERMABOND, a sterile, liquid adhesive that
will hold the edges of child’s wound together
and act as a waterproof dressing.

25. Open repair with laparoscopic evaluation of the other side:
• The procedure is done in the same manner as the open repair; however, prior to closing the
hernia, a small camera (laparoscope) is used to check for the presence of a hernia on the
opposite side of the groin or scrotum.
• If a second hernia is present, another tiny incision is made on the opposite side of the groin
and the other hernia is repaired.
• Using a laparoscope to evaluate the opposite side for a hernia is done in certain situations
depending upon the patient’s age, since hernias on both sides are more common in babies and
small children.
• The overlying skin is sealed with DERMABOND.

26. NURSING MANAGEMENT
• Encourage parents to hold infants when crying and during feeding
• Instruct the child to avoid pushing, lifting, or engaging in vigorous activity.
• Prevents strain on the incision and possible hernia recurrence.
• Instruct in doing sponge baths till the incision heals.
• Maintains integrity of the incision.