The appearance of a newborn’s navel after the umbilical cord stump falls off is a common source of anxiety for new parents. When the navel protrudes outward instead of sinking inward, it is informally described as an “outie.” This outward appearance is usually a normal variation in how the umbilical scar heals, but it can sometimes indicate a medical condition. Understanding the visual differences between a typical healing navel and other causes of protrusion can offer peace of mind.
The Typical Appearance of a Healing Navel
The appearance of the navel is determined by how the skin and underlying tissue heal after the umbilical cord stump detaches, typically within one to three weeks after birth. The term “outie” refers to the final shape of the scar tissue that protrudes slightly rather than forming a concave “innie.” This shape is largely determined by chance and is not influenced by how the cord was clamped or cut.
The normal, healed navel may retain a small, soft, fleshy protrusion of skin and scar tissue. This is a common, harmless cosmetic variation, similar to the difference in shape of any scar on the body. This protruding scar may form a knot-like shape on the abdomen. The surrounding skin should appear healthy, dry, and free of discharge or odor.
Understanding the Causes of Navel Protrusion
Navel protrusion is generally due to one of three possibilities: a normal cosmetic variation, an umbilical granuloma, or an umbilical hernia. The latter two are medical conditions that result in a more pronounced or persistent “outie” look. Distinguishing between them involves observing the appearance, texture, and behavior of the protrusion.
An umbilical granuloma is an overgrowth of scar tissue that forms after the umbilical cord stump has fallen off. It appears as a small, soft, moist lump of pink or reddish tissue located in the center of the navel. This tissue may ooze a small amount of clear or yellowish fluid and is not painful to the baby. Granulomas represent an overproduction of healing tissue.
The other primary medical cause for a protruding navel is an umbilical hernia, which occurs in up to 20% of newborns. This condition is a bulge resulting from a small opening in the abdominal muscles—the umbilical ring—that did not completely close after birth. The bulge is soft to the touch and contains fat or a loop of intestine pushing through the opening.
A key characteristic of an umbilical hernia is that the bulge becomes more noticeable when the baby increases pressure in their abdomen, such as when crying or straining during a bowel movement. Conversely, the protrusion typically reduces in size or disappears entirely when the baby is relaxed or lying down. Unlike a granuloma, which is a localized tissue mass, a hernia is a structural issue beneath the skin.
When Medical Attention is Necessary
For most newborns, a protruding navel is a normal variation of the scar, requiring no intervention. If the protrusion is a small, asymptomatic umbilical hernia, the prognosis is excellent. Approximately 90% of these hernias close spontaneously without treatment by the time the child reaches four or five years of age, leading healthcare providers to often adopt a “watch and wait” approach.
Umbilical granulomas are generally harmless, but they require treatment if they do not resolve on their own within a week or two. The most common treatment involves the topical application of silver nitrate. This chemical cauterizes the excess tissue and is a simple, painless procedure performed by a healthcare professional.
Parents should seek immediate medical attention if they notice specific warning signs associated with any navel protrusion. These signs include the area becoming hard, firm, or tender to the touch, or if the bulge changes color to red, purple, or dark. Other urgent warning signs are a fever, increased swelling, or if the baby experiences pain, vomiting, or appears unusually ill or irritable. These symptoms can indicate a complication, such as an infection or, in the case of a hernia, an incarcerated or strangulated bowel.