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Wednesday, March 12, 2014
Newborn and Infant Care
My 7 months old has an umbilical granuloma. My doctor has used silver nitrate 6 times. The lesion is still pink, soft, sometimes slightly moist, but it is no discharge or bleeding from it. These is no infection and she gain weight appropriately. My doctor suggested to have a surgery to remove it. I am afraid to let my a small baby to have surgery, especially under general anesthesia. Do you think she can wait when she is older, eg 3-5 years old? It is OK to leave the lesion like that? What is the chance to get infected? Thanks a lot!
Agreeing to surgery for one's child is never an easy situation for non-emergency health issues. Your baby's doctor has tried the recommended treatment a number of times without success. Sometimes umbilical granulomas just don't respond to silver nitrate. It is also possible that it is not a granuloma but another common condition of the umbilical area such as a cyst. Surgery to resolve the problem is the recommendation common for all of these problems including a persistent granuloma. The greatest downside to delaying the surgery is the possibility of infection. Being a wet site on the body in an area that can be expected to receive friction from clothing as well as crawling and will be in contact with floors, carpets, sand, dirt, etc. as she gets older all increase the likelihood of infection. None of the common umbilical problems tend to resolve on their own given more time. However, neither is an urgent or emergent problem.
If you decide to go forward with the surgery, it would be best to select a pediatric surgeon and to inquire about his or her experience in doing this procedure as well as his or her post-operative infection and complication rates. You should expect that the surgeon would know this information well and willingly share it. Having the surgery done at a Children's Medical Center with a pediatric anesthesiologist also minimizes risks to your child since pediatric hospitals are best prepared to provide health care tailored to the special needs of children and their families.
If you decide to wait a bit longer and see how much of a problem it is in terms of becoming infected or bothering your child as she becomes an active, exploring older infant and toddler, that is alright as well. If you take her to a park or playground for sandbox play or if she will be digging in the garden, it would be a good idea to cover the granuloma with a bandaid just for that play time to keep the area clean. It would not be good idea to keep it covered all of the time or to try and prevent her from playing on the floor or grass, or at a playground.
I hope this is helpful information.
Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University