Umbilical Granuloma

Have you ever heard of such a thing?  I haven't.  And I'm a nurse.  And I work with babies.  Apparently, this happens to 1 in 500 babies.  Way to go James!  Way to be 1 in 500! :)

When he was borned, his belly looked like this:

Four long weeks later, his cord finally fell off.  I was so excited to finally get to put him in a bathtub instead of doing counter-top sponge baths.  After the cord fell off, the tissue underneath was yellow looking and moist (for lack of a better word).  I didn't feel comfortable putting him in a bathtub yet, so I waited.  And waited.  And waited.  Two weeks later, it was just not looking right to me.  Every onesie he wore was stained yellow-ish by the end of the day.  His belly button area actually looked BIGGER than when the cord fell off.  Off to the pediatrician we went.  When I made the call, I was expecting to have to "defend" my reasoning for needing an appointment.  I guess I thought it was like I was at work, calling a doctor or nurse practitioner.  It's best to have all your facts straight prior to making a call.  Not that I always have my facts straight when I call an MD or NP, but it would be best if I would.  I thought the call would go like this:

Pediatrician office-lady-person:  "And what is the reason for this appointment?"

Nurse-mom-me:  "My son has something wrong with his umbilicus.  His cord fell off two weeks ago.  It's like a wound that won't heal.  It oozes a serous fluid on his clothing.  He is afebrile.  (no fever)  He's eating and voiding/stooling normally.  He doesn't appear to be bothered by this umbilical issue.  Do you think we could get an appointment for this?"

How the conversation actually went:

Pediatrician office-lady-person:  "And what is the reason for this appointment?"

Nurse-mom-me:  "My son has something going on with his belly button.  His cord..."

Pediatrician office-lady-person:  <interrupting me, in a good way>  "Alright!  We'll see you at 3pm."

Wait...that's it?  They didn't make me explain anything at all!  That was AWESOME.  When we got to the pediatrician (visit #1), they weighed him.  He was several ounces heavier than his two week check up.  If we learned nothing else at that appointment, I felt reassured about how the breastfeeding was going!  I explained to Dr. Monroe that I wanted someone who was medically trained and way more well-rested than I was to take a look at his belly button.  It looked like this:  (Sorry for the blurry pictures.  I am not a fan of my new point and shoot Fuji camera.)

(It looks like a small brain!!)

She immediately said "Oh, that's a granuloma.  We'll put some silver nitrate on it."  She silver nitrated the mess out of that thing.  It was quickly obvious to me that there were no nerve endings in this granuloma-thing because James didn't hit the ceiling when she applied it.  We think James has a crush on his pediatrician, Dr. Monroe, so maybe he was just trying to be brave.  After learning that silver nitrate can stain clothing, we changed him into another onesie we had in his diaper bag.  An "ugly" onesie that we didn't mind getting stained. We left the office with an appointment the next week for follow up.  

The next week we went back.  The appointment (visit #2) went exactly as the first.  Weight check, silver nitrate, change into ugly onesie, leave with appointment for the next week for follow up.  

The next week's appointment (visit #3) was shaping up to be the same as the previous ones.  No noticeable change observed in the granuloma.  Silver nitrate was not winning this battle, so they referred us to a pediatric surgeon.  Before we left the office they had already made us an appointment for that Friday.  

At the surgeon's office, the beginning part of the appointment (visit #4) was much the same with the weighing-in part.  The doctor decided to apply some lidocaine (topical anesthetic) for 15 minutes and then tied two really tight sutures around the base of the granuloma, cutting off the blood supply.  In theory, this would cause it to fall off within a week, according to the surgeon.  James was fine with the whole process, right up until those two sutures were cinched down nice and tight.  Apparently there were some nerve endings SOMEwhere in there!  My heart hurt to watch him hurt!  It was very brief, but still.  It hurt both of us. :(  We left there with instructions to come back in a week if it hadn't fallen off.

That very night during one of his diaper changes, it fell off!  There was MUCH rejoicing!  Okay, it was just me rejoicing, but I was happy.  Once again I had visions of putting James in a bathtub, hopefully prior to high school.  

The Monday after our Friday surgeon appointment, James had his two month well visit.  Back to the pediatrician.  Again (visit #5).  At this point Dr. Monroe was probably thinking we LIVE in her office!  She said that his belly button should heal up within a week or so.   Well, that was August 8th.  Now it's the 23rd and it still hasn't healed.  Yes, I should've taken him back to the doctor by now, but I keep hoping against hope that it will heal on it's own!  I got some silver nitrate sticks and had a nurse practitioner friend treat his belly button again.  That was two days ago.  Folks, if this doesn't heal it up, I don't know what will!

I guess I should post a picture of what it looks like now, but he is sleeping.  To be SURE I'm not waking a sleeping baby for a blog post. :)  Because of the silver nitrate, it sort of looks like we lit a firecracker in his belly button.  It's all dark gray/blackish around his belly button.  Scott says we could try the firecracker-route if this doesn't work.  

I can no longer football-hold James for his counter-top baths.  He's way too big for that.  One day he'll get a real bath...

disclaimer:  I know there are a million worse health problems my kid could have.  If this is the worst health-thing we go through with him, I'll be grateful.  It's a nuisance, but that's it.


Aug. 24th update:  Here's a picture of his firecracker belly button:

This picture also portrays his pot-belliedness quite well. :)