CLINICAL QUESTION

By what age are umbilical hernias in children likely to spontaneously close?

BOTTOM LINE

Most umbilical hernias in children, regardless of size, will spontaneously close by 5 years of age. (Level of Evidence = 2b)

SYNOPSIS

The authors evaluated the electronic health records of 68 pediatric primary care practices affiliated with Boston Children's Hospital in Massachusetts to determine the natural history of umbilical hernias in children. They determined that a hernia had spontaneously closed if they saw direct mention of the absence of a hernia or if no hernia was mentioned on two consecutive well-child visits. These imperfect criteria, although reasonable, can overestimate the actual spontaneous closure rate. The authors confirmed hernia repairs with hospital surgical records. They stratified spontaneous closure rates by hernia size: small (described in the record as small or measured 1 cm or less) or large (described in the record as large or measured greater than 1 cm). Umbilical hernias were diagnosed in 4,486 of 167,557 children (2.7%). This is lower than the 10% to 30% range reported in the literature. The distribution by sex was nearly even. Most records (76.3%) documented hernia size: 84.8% were small and 15.2% were large. Most hernias (88.6%) spontaneously closed by 5 years of age, including large hernias (80.1%). The authors also reported that 64% of all hernias closed by 1 year of age, 76.9% by 2 years, 82.4% by 3 years, and 86% by 4 years.