Umbilical cord care: cleaning the stump step by step, and when to see a doctor

Your job with umbilical cord care is small: keep the stump clean and dry, and let it drop off by itself. KKH has you wipe the base with cotton wool and cooled boiled water, then fold the nappy below it. HealthHub says the stump falls off in one to two weeks. Below are the steps and where Singapore hospitals differ. The signs that need a doctor come near the end.

How to care for the umbilical cord, step by step

1. Wash your hands before and after you touch the stump, which NHG's navel care leaflet says helps prevent infection.
2. Fold the top of the nappy down below the stump. HealthHub says this keeps it exposed to air, not urine.
3. Dress your baby in a loose shirt rather than a bodysuit until the cord drops off, so air can circulate and dry it, as KKH advises. Our newborn clothes guide lists tops that work.
4. Wipe the base with cotton wool dipped in cooled boiled water after each bath and whenever the cord gets wet. KKH says to clean from the base upwards.
5. Use a fresh piece of cotton for each wipe, as NUH advises, then dab the stump dry with a clean towel the way HealthHub suggests.
6. Keep medicated oil and cord spirit off it. HealthHub says no oil on the stump or in the belly button, and NUH no longer recommends cord spirit because it delays the cord coming off.
7. Let it fall off on its own. NUH warns that pulling on it early may cause bleeding.
8. Keep cleaning the base after it falls off until the skin heals over, as NUH advises.
9. Check the skin around it at every nappy change. If it turns red or there's a foul-smelling discharge, KKH says to see a polyclinic or GP.

What KKH, NUH and HealthHub each tell parents

Every Singapore source we read agrees on the basics: keep the stump clean and dry with air around it. Where they part ways is how much cleaning to do and how long the stump should last.

So a stump that's still on at day 12 is within what NUH and HealthHub expect, even if a relative says it should be gone by now. Past 3 weeks, the AAP wants a doctor to see it.

Cord spirit and alcohol swabs are where the advice has moved most. NUH says it no longer recommends cord spirit, because it delays the cord separating. The AAP says there's no need to use alcohol on the stump at all. We couldn't find a Singapore hospital page that still tells parents to use either. If your own doctor gave you different instructions, ask them at your first polyclinic or clinic check.

Confinement customs and the cord: what doctors say

If someone else is helping, such as a confinement nanny or a grandparent, show them these steps on the first day home. A few traditional habits touch the cord directly:

• Medicated oil on the navel. HealthHub says not to put any on the stump or in the belly button. NUH's guide for new parents says no medicated oil or powder on your baby's abdomen.
• Cord spirit. NUH no longer recommends it, as it slows the cord coming off.
• A coin or tape pressed over a belly button that sticks out. The AAP says it won't help a hernia and may cause a skin rash.
• Binding the belly or bundling the baby in thick layers. This covers the stump, while KKH, NUH and HealthHub all want it open to the air so it can dry.

Our confinement guide covers the rest of the month's customs. For where cord care fits in the first weeks at home, see newborn care basics.

After the cord falls off: bleeding and granuloma

HealthHub says there may be a little blood or yellow discharge for a few days after the stump drops off. KKH says a little blood on the stump is normal. Keep cleaning and drying the base until the skin heals.

Sometimes a small, wet lump stays in the navel. NHG calls this an umbilical granuloma: a moist, red stalk of tissue that forms after the cord has dried up and fallen off. Left untreated, NHG says it can ooze and make the skin around it red and sore. The AAP says it usually goes away in about a week.

If it doesn't, have your polyclinic or GP look at it. NHG says it can be treated with silver nitrate, which dries the granuloma without pain, and it often takes more than one treatment. Keep the nappy folded below the navel until it heals, and go to every follow-up.

Umbilical hernia or a normal belly button?

Some babies have a belly button that pushes out when they cry. The AAP says this may be an umbilical hernia: a small hole in the tummy muscle that lets tissue bulge out under pressure, such as crying. It isn't serious, the AAP says, and it usually closes by itself in the first 12 to 18 months. If it hasn't closed by 3 to 5 years, it may need surgery.

Don't tape it flat or press a coin on it. Point it out at your baby's next check so the doctor can keep an eye on it.

When to see a doctor

Take your baby to a polyclinic or GP if you notice any of these:

• Red skin around the navel. KKH's going-home leaflet sends you to a polyclinic or GP for this, and for foul-smelling discharge or bleeding.
• Watery discharge from the navel. KKH's newborn care page lists this with redness.
• Urine coming from the cord. NUH asks you to seek medical attention.
• A lot of foul-smelling discharge, or skin that turns red and swollen. NUH says these may be signs of infection.
• Crying when you touch the cord or the skin next to it, which the AAP lists as a sign of infection.
• Discoloured skin around the navel, or a baby who seems unwell. NHG lists both.
• A stump that's still on after 3 weeks. The AAP says that needs a doctor's visit.
• Active bleeding from the cord. Call your baby's doctor right away, the AAP says.

An infected stump is called omphalitis, and the AAP says it needs medical treatment.

Some signs mean Children's Emergency at KKH or NUH, not a GP:

• Any fever in a baby under 3 months. KKH lists fever or illness at this age as a Children's Emergency case.
• A temperature above 37.5 degrees C under the arm. KKH's newborn care page treats that as a fever.
• 38 degrees C or more under 3 months. NUH says your baby should be seen in hospital, however well they look.
• Poor feeding or vomiting that keeps coming back. KKH lists both.
• A baby who is drowsy or won't stop crying, which KKH also lists.

Call 995 for an emergency, as KKH advises. Our baby fever guide covers fever in more detail.

Frequently asked questions

When does the umbilical cord fall off?

KKH's two pages say within a week, and 7 to 10 days. NUH says within 2 weeks, and HealthHub says 1 to 2 weeks. The AAP says a stump still there after 3 weeks needs a doctor's visit. Let it come off by itself.

How do I clean my newborn's umbilical cord?

Wash your hands, then wipe the base with cotton wool and cooled boiled water, from the base upwards. KKH says to do this after each bath and whenever the cord gets wet. Our newborn bath steps cover the bath itself. Dab it dry and fold the nappy below it.

Can I use cord spirit or alcohol swabs on my baby's cord?

NUH no longer recommends cord spirit, because it delays the cord coming off. The AAP says there's no need to use alcohol on the stump. KKH advises cotton wool and cooled boiled water. If your doctor told you otherwise, check with them.

Is it normal for the belly button to bleed after the cord falls off?

A little, yes. KKH says a little blood on the stump is normal, and HealthHub says some blood or yellow discharge can last a few days. If the cord bleeds actively, the AAP says to call your baby's doctor right away.

What does an infected umbilical cord look like?

The AAP lists red skin around the base and a foul-smelling yellowish discharge. Your baby may also cry when you touch the cord, and NUH adds swollen skin. See a polyclinic or GP, or go to Children's Emergency if your baby has a fever.

Can I bathe my baby before the cord falls off?

Yes. HealthHub says to bathe your baby as you normally do, then lightly dab the stump dry with a clean towel. Fold the nappy below the stump afterwards so it stays in the air.