Dear Doctor,

My baby is only 3 days old but his umbilical cord ​smells so bad. I try to keep the cord stump dry at all times though when I gave him  a bath it was hard. So now I only give him a sponge bath. But it always smells and it’s unbearable. What can I do to change that. The cord is yet to fall off. 

Rose

Dear Rose

When a baby is born, he is coated with secretions from the womb and birth canal and does not smell very pleasant. However, after a bath and being cleaned up, he smells okay, except for the umbilical cord.  The umbilical cord attaching him to his mother is cut off, when he is delivered. Because the blood supply  of cord is cut, it starts to dry up and wither. A purplish blue stump remains in place of the cord.  Ultimately it dries off and falls around a week or so. In some babies it may fall as early as third day. Since after the blood supply being cut off, it becomes "dead flesh”, it does smell like dead rotting flesh,  which is not pleasant.  

However, it is best to ignore it. Previously, pediatricians recommended cleaning of this stump with alcohol. However, alcohol causes dryness and irritation of the very delicate skin of the infant. This carries risk of skin being denuded and secondary infection occurring, hence, use of alcohol is no longer recommended. The residual cord is best left to dry and fall of naturally. 

Rarely, the residual umbilical cord may get infected. This may be manifested by redness, swelling, itching on and around the umbilical cord with or without discharge of dirt yellow, greenish pus.  There may be one or more of these symptoms. If infected, the cord is very painful to touch. The baby may develop high fever due to infection and become very irritable, listless and refuse feeds and even sleep. In this case, he will need local wound care and even antibiotics if infection is severe. About 10 to 20 per cent babies have umbilical hernia at birth. African-American children are more prone to it. Here, the abdominal muscles fail to close completely at birth. Thus, part of the bowels or abdominal contents can bulge through the opening and may get infected, emitting a bad odour. It is easily diagnosed by seeing a small soft swelling around the belly button which is mostly reduced by a finger. This usually subsides by three to four years of age. If not, then it is operated.  If the baby is eating and  sleeping well, does not cry unduly, does not cry when cord is touched, there is nothing to worry about.  Leave the cord as such, tolerate the bad smell for a few more days. Once the stump falls off, the bad smell will also disappear spontaneously. However, one should not attempt to remove it forcibly. That would be painful, can cause infection and is likely to cause a scar. 

 Dr Rachna is a specialist in internal medicine at Ruhengeri Hospital.

rachna212002@yahoo.co.uk