Umbilical Cord Care: What to Know Until It Falls Off

That little piece of cord on your baby's belly button is one of the things that worries new parents most in the first days. Will it hurt if I touch it? How do I clean it? When will it fall off? The good news: the umbilical cord asks very little of you. A bit of patience, a bit of attention and plenty of dry air.

When does the cord fall off? After the cord is cut at birth, a small stump is left behind. Over time this stump dries out and falls off on its own. According to the newborn care guide of Turkey's Ministry of Health, the cord normally falls off within 7-14 days. The American Academy of Pediatrics (AAP) also says the cord should have dried and fallen off by the time your baby is 3 weeks old, and that if it is still there after that, your baby should see a doctor. Guidance can differ slightly between countries, so check with your pediatrician.

Dry care: less is more. The World Health Organization (WHO) recommends clean, dry cord care to prevent infection in healthy newborns. The Turkish Ministry of Health guide likewise advises keeping the cord dry without wiping it with anything until it falls off, and not wrapping gauze around it. According to the AAP, there is no need to put alcohol on the cord either. WHO lists the traditional substances applied to the cord in some communities among harmful practices. So do not put anything on the belly button that your doctor has not recommended.

Fold the diaper below the belly button. Moisture makes it harder for the cord to dry. The AAP recommends folding the diaper down below the cord so pee does not touch it. The Turkish guide also says the cord should not be covered by the diaper and, if needed, the diaper should be folded over on itself to leave the belly button exposed.

How do you bathe your baby until the cord falls off? According to the Turkish Ministry of Health guide, getting the belly button wet can delay the cord falling off and make a belly button infection (omphalitis) more likely. That is why the first tub bath at home is recommended one day after the cord has dried and fallen off. Until then, you can wipe your baby down every day with lukewarm water and a soft cloth or towel, keeping the belly button protected.

Normal things you may see as it falls off: According to the AAP, seeing a few drops of blood in the diaper as the cord separates is normal. Do not let these small spots scare you. But if it is actively bleeding, that is different, and you need to see a doctor.

Signs of infection (omphalitis): The Turkish Ministry of Health reminds parents that drying cord tissue is a good place for bacteria to grow. So watch for these signs:

• Redness or swelling around the belly button
• Foul-smelling, yellowish discharge
• Your baby crying or seeming tender when you touch the belly button
• Bleeding that does not stop

Umbilical granuloma: Sometimes, instead of drying completely, a small reddish-brown piece of tissue is left where the cord was. This is called an umbilical granuloma. It may ooze a light yellowish fluid. According to the AAP, it usually goes away on its own within a week. If it does not, your doctor can treat it.

Umbilical hernia: You may notice a bulge at your baby's belly button when they cry. The AAP explains this as a small opening in the belly wall and says it usually heals on its own in the first 12-18 months. According to the NHS, umbilical hernias in babies can range from the size of a pea to about 2 cm (about 3/4 inch) and usually disappear by age 5. The AAP especially stresses not taping a coin or anything else over the belly button, because this does not help the hernia and can cause a skin rash. If the hernia has not closed by age 3-5, surgery may be needed.

When to see a doctor, when to call your local emergency number? Contact your pediatrician or family doctor if:

• The cord has not fallen off after 15 days (Turkish Ministry of Health) or after 3 weeks (AAP)
• There is redness, swelling, foul-smelling discharge or bleeding at the belly button
• A granuloma has not gone away within a week
• The hernia is getting bigger
• Your baby's underarm temperature is above 37.5°C (99.5°F): the Turkish Ministry of Health advises first removing a layer of clothing and measuring again after 15 minutes, and going to a doctor or hospital right away if it is still high.

If the hernia becomes hard and looks painful, if the swelling grows along with a change in color in the area, or if there is vomiting or trouble feeding, inability to pass gas or poop, or severe tummy pain that will not go away, call your local emergency number without delay. The NHS describes this as an emergency.

Dear mom, that little cord is the last keepsake of the nine-month bond between you and your baby. All you need to do is keep it dry and exposed without touching it too much. It will fall off in its own time, leaving behind a tiny belly button you will never tire of kissing.