At what age should I consider surgical intervention for an umbilical hernia in a child, and what are the referral criteria?

Surgical intervention for an umbilical hernia in a child is generally considered if the hernia persists beyond the age of 3 to 5 years, if it is large, symptomatic, or complicated (e.g., incarceration or strangulation).

Referral criteria include:

• Hernias that do not close spontaneously by age 3 to 5 years.
• Presence of symptoms such as pain, tenderness, or signs of incarceration (e.g., irreducibility, redness, or swelling).
• Large defects that are unlikely to close on their own.
• Any suspicion of complications requiring urgent surgical assessment.

Children with these features should be referred to paediatric surgery for specialist assessment and management.