Umbilical cord stump care: cleaning, healing and infection signs

After birth, the umbilical cord is clamped and cut, leaving a short stump on your baby's tummy. It needs very little from you: keep it clean and dry, keep the nappy folded down below it, and let it fall off by itself. That usually happens somewhere between about 1 and 3 weeks. Most stumps heal without trouble, but it's worth knowing what normal healing looks like and which changes mean a doctor should take a look the same day.

How long does the umbilical cord take to fall off?

Sources give slightly different ranges, which shows how much normal healing varies:

The NHS guide to getting to know your newborn says the cord takes about a week to dry out and drop off. KidsHealth's newborn guide says about 10 days to 3 weeks. The AAP's HealthyChildren.org page on cord care says it should fall off by about 3 weeks, and to see a doctor if it is still attached after that.

How do I clean and care for the cord stump?

Current advice is simple: leave the stump alone as much as possible and keep it clean and dry.

1. Keep it dry and open to the air. Fold or roll the top of the nappy down below the stump so wee doesn't soak it and air can reach it. Make sure the nappy isn't pressing tightly on the cord, as the NHS Healthier Together cord care page advises.
2. Clean it only if it gets dirty. If wee or poo gets on it, or it gets sticky, clean around it with plain water and a fresh piece of cotton wool or a cotton bud. Victoria's Better Health Channel in Australia suggests cool, boiled water.
3. Dry it well. Pat the area gently dry after cleaning or after a wash.
4. Skip the alcohol and antiseptics. The AAP says not to use alcohol on the stump. The Royal Children's Hospital Melbourne skin care guideline in Australia says to keep the cord area clean with water and not to use alcohol wipes.
5. Let it come off by itself. Don't pull, cut or tamper with the stump, even when it is hanging by a thread. The plastic cord clamp may stay on until the stump separates.

Bathing while the stump is still on

The AAP suggests sponge baths until the stump has fallen off and the belly button has healed, and KidsHealth advises not soaking the area. A top-and-tail wash (face, hands, neck and nappy area) keeps your baby clean in the meantime. If the stump gets wet, pat it dry. Our guide to bathing a newborn walks through both.

What does normal healing look like?

• Colour change: the stump dries and darkens, from yellowish to brown or black. KidsHealth says this is normal.
• Shrinking: it dries out and shrivels before it drops off.
• A few drops of blood: the AAP says a few drops of blood on the nappy around the time the stump falls off are normal.
• No pain: the cord has no nerves, so your baby won't feel it come away, according to NHS Healthier Together.

What are the signs of an umbilical cord infection?

An infection around the cord (omphalitis) needs medical treatment. The AAP lists:

• red skin around the base of the cord
• a yellowish, foul-smelling discharge
• your baby crying when you touch the cord or the skin around it.

The NHS and Australia's Better Health Channel also list bleeding, swelling, oozing or weeping, and a strong, unpleasant smell as reasons to get the cord checked.

A guideline for doctors from Australia's Royal Children's Hospital Melbourne also lists redness spreading around the belly button as a reason for specialist review.

When should I get help for my baby's umbilical cord?

Call 999 or go to the nearest A&E now if:

• your baby is under 3 months old and has a temperature of 38°C (100.4°F) or more. The NHS urgent-help guide lists this among reasons to call an ambulance or go to A&E. The Royal Children's Hospital fever fact sheet in Australia says a baby under one month with a fever should go to hospital, and a baby under three months should see a doctor as soon as possible
• the stump area looks infected and your baby seems unwell, isn't feeding, or is much sleepier than usual

Call your doctor or NHS 111 straight away if:

• the stump is actively bleeding, beyond a few drops. The AAP says to call your doctor immediately.

See a GP the same day if:

• there is redness around the base of the stump, especially if it is spreading onto the tummy
• there is a bad smell, yellow or pus-like discharge, swelling or oozing
• your baby cries when the area is touched.

Mention it at your next check, or sooner if you are worried, if:

• the stump is still attached after about 3 weeks
• a small pink or red lump stays after the stump falls off
• there is a soft bulge at the belly button.

See also fever in babies and when to call the doctor.

What is an umbilical granuloma?

An umbilical granuloma is a small, soft, pink or red lump of extra healing tissue at the belly button. It appears soon after the stump falls off and may leak a little light-yellow fluid. The AAP says it usually goes away in about a week. If it doesn't, a doctor or nurse may treat it in the clinic, often by applying silver nitrate, as the Royal Children's Hospital Melbourne granuloma guideline in Australia describes. NHS Healthier Together suggests asking your health visitor if you think your baby has one. Don't try to treat it at home without advice.

Rarely, wee or poo leaks from the belly button. That points to a different, uncommon problem and needs a doctor promptly, according to the same guideline.

What is an umbilical hernia, and is it serious?

An umbilical hernia is a soft swelling at the belly button that often bulges more when your baby cries. It happens when a small opening in the tummy wall under the belly button hasn't closed yet. The NHS page on umbilical hernia says it is common in babies and young children and can range from pea-sized to around 2 cm across.

Most close on their own, although sources give different timeframes:

• the AAP says most heal within 12 to 18 months
• the Royal Children's Hospital Melbourne hernia guideline in Australia says more than 95% resolve by 2 to 3 years, and that some get bigger in the first 6 months before they shrink
• the NHS says it will usually disappear by the time a child is 5.

Show it to your GP or health visitor so they can check it and keep an eye on it. Don't tape a coin or band over it. The NHS says to call 999 if a hernia becomes more swollen than usual and the skin over it changes colour, or if there is severe tummy pain, vomiting, or no wind or poo passing.

What's worth noting while the cord heals?

A quick daily note of how the stump looks (dry, darkening, any redness, smell or discharge) and the date it falls off is useful if you need to describe a change to your midwife or GP. A dated photo of any redness helps show whether it is spreading.