Belly buttons come in all shapes and sizes. There are innies and outies. Pregnant women often have their innie become an outie temporarily when their bellies grow. A few people don’t even have a belly button to speak of. The majority of belly buttons are innies. This doesn’t mean that having an outie is a cause for concern, though.

Almost immediately after birth, a baby’s umbilical cord is clamped and cut, leaving an umbilical stump. Within one to three weeks, the stump dries and shrivels up, eventually falling off. The baby is sometimes left with scar tissue, some more than others. The amount of space between the skin and abdominal wall may also have something to do with how much of the stump remains visible or tucks away. Contrary to popular belief, it has nothing to do with how the cord was cut or the competence of your doctor or midwife.

How a baby’s umbilical cord is clamped or cut has nothing to do with baby ending up with an outie. An outie is normal and not usually a medical concern, only a cosmetic one for some.

For some infants, the cause of an outie belly button may be an umbilical hernia or granuloma.

Umbilical hernia

Most umbilical hernias are harmless. They occur when part of the intestine bulges through the umbilical opening in the abdominal muscles. This creates a soft bulge or swelling near the navel that might become more noticeable when the baby cries or strains. They are more common in premature babies, low birth weight babies, and African-American infants.

Umbilical hernias usually close on their own without treatment before the age of 2. They’re usually painless and don’t produce any symptoms in babies and children. Hernias that don’t disappear by the age of 4 may need to be surgically repaired to prevent complications. Rarely, the abdominal tissue can become trapped, reducing blood supply. This can cause pain and increase the risk for tissue damage and infection.

If you believe your baby has an umbilical hernia, speak to a pediatrician. Get emergency medical care if:

  • the bulge becomes swollen or discolored
  • your baby is in pain
  • the bulge is painful to the touch
  • your baby begins to vomit

Umbilical granuloma

An umbilical granuloma is a small growth of tissue that forms in the belly button in the weeks after the umbilical cord is cut and the stump falls off. It appears as a small pink or red lump and may be covered in a clear or yellow discharge. It doesn’t usually bother the baby, but it can occasionally become infected and cause symptoms such as skin irritation and fever. It will often go away on its own within a week or two. If it doesn’t, treatment may be required to prevent infection.

Once your pediatrician has diagnosed an umbilical granuloma, if there are no signs of infection, it may be treated at home using table salt. To use this method:

  1. Expose the center of the umbilicus by gently pressing on the surrounding area.
  2. Apply a small pinch of table salt over the granuloma. Too much can damage the skin.
  3. Cover with a clean piece of gauze for 30 minutes.
  4. Clean the area using clean gauze soaked in warm water.
  5. Repeat twice a day for three days.

If this doesn’t work or if there are signs of infection, the granuloma can be treated in a doctor’s office using silver nitrate to cauterize the granuloma. Topical steroids have been suggested as another treatment.

An outie is harmless and there’s no need to see a doctor. If you’re concerned about a hernia, bring it up at your baby’s next checkup. A doctor can spot a hernia easily and will likely suggest a “watch and wait” approach. There’s no danger to your baby’s health and it will likely resolve on its own over time.

The only time an outie poses a risk is if the intestine becomes trapped.

Chances are you’ve heard the myth that you can prevent an outie by strapping something across a baby’s belly or taping a coin over it. This is pure folklore with no medical merit. Not only will this not change the shape or size of your baby’s belly button, but it could actually be harmful. The coin and tape could irritate your baby’s skin and cause an infection. It’s also a choking hazard should the coin come loose.

An outie belly button is a cosmetic issue and doesn’t require surgery. Granulomas need to be treated to avoid infection. Hernias usually disappear on their own and those that don’t can be treated with a simple surgical procedure after the age of 4 or 5.

If your child is bothered by their outie when they get older, speak to their doctor.

To avoid irritation or infection, you’ll need to keep the stump clean and dry until it falls off.

To do this:

  • give your baby sponge baths instead of submersing them in a tub
  • don’t cover the belly button with their diaper
  • use mild soap and water

Call your doctor if the stump hasn’t fallen off in two months or if you notice:

  • a foul-smelling discharge
  • redness
  • signs of tenderness when you touch it or the surrounding skin
  • bleeding

An outie belly button isn’t a medical issue. If you’re concerned about a hernia or granuloma, or if your baby appears to be in pain and is showing signs of infection, see your doctor. Otherwise, an outie belly button is just that — a belly button that sticks out — and shouldn’t be a cause for concern.