See a pediatrician promptly if a newborn’s belly button becomes red, swollen, painful, or unusually tender.
Foul-smelling discharge from the umbilical stump can be a sign of infection and should be evaluated as soon as possible.
Seek urgent medical care if the redness is spreading or the baby appears very unwell, as omphalitis can lead to serious complications such as sepsis or necrotizing fasciitis.

Omphalitis is an infection of the umbilical cord stump and the surrounding skin. It occurs when bacteria enter the area, causing symptoms such as redness, swelling, tenderness, and cloudy, foul-smelling discharge from the belly button.

Omphalitis mainly affects newborns during the first few weeks of life. Although it is rare, the infection can spread to deeper tissues or enter the bloodstream, especially in babies younger than 28 days.

Treatment typically involves antibiotics prescribed by a pediatrician, although surgery may be necessary in rare cases. It is important to seek immediate medical attention if a baby shows any signs of omphalitis, as early treatment can help prevent serious complications.

Main symptoms

The main symptoms of omphalitis include:

Redness around the belly button that spreads to the surrounding skin;
Swelling and warmth around the belly button;
Tenderness or pain when the area is touched, which may cause the baby to cry;
Pus or cloudy, foul-smelling discharge from the umbilical cord stump;
Increased fussiness or irritability.

Some babies may also develop a fever, feed poorly, or become unusually sleepy. These symptoms may indicate that the infection is becoming more serious.

Babies younger than 3 months who have a fever of 100.4°F (38°C) or higher, or any baby with rapidly spreading redness around the belly button, should be taken to the emergency room immediately.

Normal vs. infected umbilical cord

After birth, the umbilical cord stump gradually dries out, changes from yellowish to brown or black, and usually falls off on its own within 1 to 3 weeks. While some changes are part of the normal healing process, others may be signs of an infection.

Normal umbilical cord stump	Possible signs of an infected umbilical cord
Skin around the base looks normal or has a thin pink edge	Redness spreads to the surrounding skin
Stump is dry or slightly sticky	Pus or yellow-green discharge
Mild odor that improves with gentle cleaning	Strong, foul-smelling odor
A few drops of blood when the stump falls off	Bleeding that does not stop with gentle pressure
Baby feeds and sleeps normally	Fever, irritability, poor feeding, or unusual sleepiness

A small, moist, pink lump that appears after the umbilical cord stump falls off is usually an umbilical granuloma, rather than omphalitis.

Unlike an infection, an umbilical granuloma typically does not cause redness that spreads to the surrounding skin. However, it should still be evaluated by a pediatrician.

How it is diagnosed

Omphalitis is diagnosed by a pediatrician based on a physical examination of the belly button and an assessment of the baby's symptoms.

The doctor may collect a sample of any discharge using a swab to identify the bacteria causing the infection and determine the most appropriate antibiotic.

In babies who have a fever, appear unwell, or are 21 days old or younger, the doctor may also order blood and urine tests to check for signs of a more serious infection.

An abdominal ultrasound may be recommended to look for an abscess or a urachal remnant, which is an abnormal connection between the bladder and the belly button.

If omphalitis is suspected, the baby should be evaluated by a doctor immediately to ensure an accurate diagnosis and prompt treatment.

Causes of omphalitis

Omphalitis occurs when bacteria infect the umbilical cord stump and surrounding tissues. One of the most common bacteria responsible is Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus (MRSA).

Other bacteria that can cause omphalitis include Streptococcus pyogenes, Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.

The risk of developing omphalitis is higher in babies who:

Are born prematurely or have a low birth weight;
Are born after prolonged labor or when the mother has an infection during pregnancy or delivery;
Are delivered in conditions where proper hygiene and sterile practices are not followed;
Have homemade remedies or other nonrecommended substances applied to the umbilical cord stump;
Have a urachal remnant or another abnormality affecting the belly button.

Proper umbilical cord care, including keeping the stump clean and dry, can help reduce the risk of infection. Parents should also watch for signs of redness, swelling, or discharge and seek immediate medical attention if an infection is suspected.

How it is treated

Treatment for omphalitis should be guided by a pediatrician and aims to eliminate the infection and prevent serious complications.

Antibiotics are the main treatment for omphalitis. They are usually chosen to target Staphylococcus aureus and gram-negative bacteria. Depending on local antibiotic resistance patterns, the doctor may also prescribe antibiotics that are effective against MRSA.

Newborns with omphalitis generally require hospitalization and antibiotics given through a vein (IV), especially if they have a fever or appear unwell. In carefully selected babies with a mild, localized infection and a low risk of complications, the doctor may consider oral antibiotics with close follow-up.

Surgery is rarely necessary but may be recommended to drain an abscess, remove damaged or dead tissue in cases of necrotizing fasciitis, or remove a urachal remnant that causes repeated infections.

How to care for the umbilical cord stump

Keeping the umbilical cord stump clean and dry is recommended to help prevent omphalitis.

Proper umbilical cord care includes:

Washing your hands thoroughly before touching the baby's belly button;
Keeping the stump clean and dry, and folding the diaper below it to allow air to circulate;
Giving the baby sponge baths until the stump falls off;
Gently cleaning the stump with plain water if it becomes dirty with urine or stool, then patting it dry;
Allowing the stump to fall off naturally without pulling or picking at it.

Alcohol, chlorhexidine, powders, and home remedies should not be routinely applied to the umbilical cord stump unless recommended by a healthcare professional.

In settings with good access to healthcare and hygienic birth practices, routine antiseptic use is generally unnecessary, and alcohol may delay the stump from falling off.

Can adults get omphalitis?

Yes, adults can develop omphalitis, although it is rare. In adults, the infection may be associated with an infected urachal remnant or an umbilical pilonidal sinus, which occurs when hair becomes trapped in the belly button and causes inflammation or infection.

Symptoms are similar to those seen in newborns and may include redness, swelling, pain, and discharge from the belly button.

Treatment depends on the cause and severity of the infection and may include antibiotics or drainage of an abscess.

In some cases, surgery may be needed to remove an infected urachal remnant or pilonidal sinus.

Adults who develop these symptoms should see a doctor for an accurate diagnosis and appropriate treatment.

Possible complications

If omphalitis is not treated promptly, the infection can spread to surrounding tissues or enter the bloodstream, leading to serious complications.

Possible complications include:

Cellulitis: an infection that spreads to the skin and soft tissues of the abdominal wall;
Peritonitis: an infection or inflammation of the lining of the abdominal cavity;
Abscess: a collection of pus that forms beneath the skin or in deeper tissues;
Sepsis: a life-threatening response to an infection that can affect multiple organs;
Venous thrombosis: blood clots that can develop in the umbilical or portal veins;
Necrotizing fasciitis: a rare but severe infection that spreads rapidly and causes tissue death.

These complications are uncommon but can be particularly dangerous in newborns, especially those younger than 28 days.

Early medical evaluation and treatment are essential to prevent the infection from spreading and reduce the risk of serious complications.

Omphalitis (Infected Umbilical Cord): Symptoms, Causes & Treatment