Umbilical Cord Care
How to look after your baby's umbilical stump with simple dry-cord care, and when to worry.
- Last reviewed
- Sources cited
- 3 sources
- Author
- Dr Jubal John, FRACP
- Category
- medical guides
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Take-home
The current WHO + Royal Children’s Hospital Melbourne recommendation for term babies in clean, high-resource settings is dry cord care: keep it clean and dry, nappy folded below, and let it fall off on its own. No alcohol, no creams, no antiseptic. Most cords separate between 5 and 15 days. Call for infection signs: red spreading skin around the cord, pus, bad smell, fever, or an unwell baby.
The routine: three simple steps
1. Clean hands first
Wash with soap + water before you handle the cord, every time.
2. Keep it dry + open
Fold the nappy below the stump. No creams, alcohol, or cotton wool unless specifically advised. Bathing is fine.
3. Call if
- • Redness spreading on the tummy
- • Smelly or pus-y discharge
- • Bleeding that keeps starting
- • Baby unwell or feeding poorly
That’s it. Most families don’t need to do anything else.
Bathing is fine
A bath once the cord is in place is safe. The old advice to “keep the cord dry” meant don’t soak it for ages, not “don’t ever let it touch water”. A normal bath, gentle pat dry, air dry for a couple of minutes, and on with the nappy.
Nappy position matters
Most modern nappies have a pre-cut dip for the umbilicus. If yours don’t, fold the front edge down below the cord so the nappy doesn’t rub or trap wetness against it.
What about the small plastic clamp?
The small white or blue plastic clip near the belly button stays on through the hospital stay and home, you don’t need to remove it. It falls off naturally with the cord stump itself a few days after discharge.
When it falls off
- Usually between day 5 and day 15
- Can take up to 3 weeks and still be normal
- A small amount of yellowish ooze or dark crust in the first day or two after separation is normal
- A few drops of blood-stained discharge when it comes off is normal
- The plastic clamp comes away with the cord: you don’t have to do anything to it
- The belly button area is slightly moist for a few days, then dries
What NOT to do
Not recommended
- Alcohol wipes: not needed in clean settings; can irritate
- Antiseptics (betadine, chlorhexidine): only indicated in high-risk settings per WHO; not routine here
- Cotton wool or gauze dressings: trap moisture, delay separation
- Binders, “belly bands”: not recommended; can trap infection
- Pulling or twisting: never. Let it fall off.
- “Home remedies” (turmeric paste, breastmilk, salt, coin taped over): no evidence of benefit, real risk of infection
WHO reserves chlorhexidine cord care for home births in low-resource settings where infection risk is high. In hospital or home settings with clean conditions, dry care is safer and simpler.
Signs of cord infection (omphalitis)
Omphalitis is rare, but serious when it happens. Any of these, call the same day:
Red-flag features
- Redness of the skin around the cord, spreading onto the abdomen
- Foul-smelling discharge (not the mild normal smell at separation)
- Pus at the base
- Bleeding that keeps restarting or a large amount of blood
- Warmth or swelling at the base
- Fever in baby (> 38°C) or cold, mottled, unwell baby
- Poor feeding, unusual sleepiness, or floppiness
The reason to escalate quickly: a baby’s immature immune system can let omphalitis spread to the bloodstream fast (sepsis). Early review, early antibiotics, and most cases resolve cleanly.
Umbilical granuloma: after the cord falls off
A pink, moist, berry-like lump of tissue in the belly button 1–2 weeks after the cord comes off is a granuloma. It’s not an infection, just over-healing tissue. Features:
- Soft, pink, shiny, sometimes weeps clear or yellowish fluid
- Not red, not hot, no spreading redness, baby well
- Often discharges slightly into the nappy
Treatment
Most granulomas settle spontaneously. If persistent (> 4 weeks) or discharging enough to be a nuisance, we can treat it in-clinic with:
- Silver nitrate cautery (quick, a few seconds, done in clinic)
- Common salt application (home method for small ones, small dab of cooking salt covered with a cotton ball for 30 minutes 2x/day for 3–5 days)
Don’t attempt silver nitrate at home, it burns surrounding skin if not applied precisely.
Umbilical hernia: a normal bulge
A soft, round bulge around the belly button that gets bigger when baby cries is an umbilical hernia. Reassuringly:
- Very common, especially in premature or Black/African-heritage babies
- Not painful, not dangerous in the vast majority
- Most umbilical hernias close spontaneously by ages 4–5 years
- Surgery only considered if still present after age 4–5, very large, or rarely strangulated (sudden tender, red, firm, same-day review)
No taping, no coins, no binders: none of these speed healing and some cause skin problems.
When to seek help
Green — usually fine
Green: normal
- Dry, brown-black stump, still attached, baby well
- Small amount of dried crust or minor oozing after separation
- Normal belly button healing in the week after cord falls off
Amber — be alert
Amber: book a review within 24 hours
- Persistent moist granuloma-type lump weeks after separation
- Small amount of bleeding that settles with pressure
- Cord still attached at 3 weeks
Red — act now
Red: seek same-day / emergency review
- Red, spreading skin around the cord
- Pus or foul-smelling discharge
- Fever, lethargy, poor feeding, unwell baby
- Bleeding that keeps starting, or significant ongoing bleeding
- Sudden painful tender bulge at the belly button (possible strangulated hernia)
Common questions
“How often should I clean it?”
You don’t need to “clean” a healthy cord daily. Just keep it dry, and if it gets soiled (stool, urine) clean the area gently with warm water and pat dry.
“The cord looks ugly and smells a bit: is that OK?”
A mild smell as the cord dries and separates is normal. A foul smell (rotten, sweet-sickly) is not — seek medical review.
“Can I pull it off if it’s hanging on by a thread?”
No. Let it come off by itself. Pulling can cause bleeding or leave a bit of tissue behind.
“It bled a little when it came off: is that OK?”
A few drops, once, settling with a moment of gentle pressure, normal. Ongoing bleeding, blood on the vest, or blood on the nappy every time, not normal — seek medical review.
“Can I put breastmilk on it?”
There are small studies suggesting breastmilk is at least as good as dry care for cord separation time. It’s harmless if you want to. Dry care alone works equally well and is simpler.
Related reading
Worried about the cord?
Arrange a review quickly if you're worried, omphalitis moves fast and is worth catching early.