What Causes an Outie Belly Button?

Whether or not your baby has an innie or an outie belly button is due to chance. You won't know right away which way your baby's belly button will go, but both innies and outies are healthy. In the majority of cases, an outie is perfectly normal and not of medical concern.

If your baby formed some scar tissue underneath the belly button, this could cause it to protrude and become an outie. If your baby has an umbilical hernia, this could have contributed to creating an outie belly button, too. Occasionally, an outie may be a sign of an umbilical granuloma (inflamed tissue), which is more likely to require treatment. Additionally, particularly if the area is painful, there could be an infection present.

What Is an Outie Belly Button?

The belly button, which is also called the umbilicus or navel, is really just a scar from where the umbilical cord detached from the baby. The way the umbilical cord is cut and clamped does not determine whether your child has an innie or an outie. The belly button forms in an inward or outward direction during the normal healing process.

However, as noted above, there are some (usually benign) medical issues, such as the formation of a hernia, inflammation, or scar tissue under the belly button, that can contribute to the development of an outie.

Causes of Outie Belly Buttons

An outie belly button often just forms naturally and is not a cause for concern. However, there are two main types of structural irregularities that can form underneath your child's belly button and push the tissue outward.

Umbilical Hernia

An umbilical hernia is a bulging of tissue under the site of the umbilicus. The umbilical cord, which delivered nutrients from the mother to the fetus in utero, goes through the abdominal muscles, creating an area where a hernia can easily form. The issue occurs before the baby is born and is most common among preemies, Black babies, and babies born with low birthweight. 

Typically, for an innie, the umbilical ring (the circle that makes the "button") will fully close in healing, but if an opening persists at the site, then abdominal tissue from underneath can protrude outward, forming an outie. Umbilical hernias are usually present at birth and sometimes seem to appear and disappear. This is often called a "reducible" hernia.

Umbilical Granuloma

An umbilical granuloma is a small, inflamed growth of tissue, which is essentially scar tissue, that forms at the belly button during the first few weeks of life. It often appears red, wet, and swollen. Sometimes, it becomes infected, oozes pus, and/or will bleed. This condition is usually not painful for the baby unless it becomes infected.

Your baby's umbilical granuloma is often treated either because it's infected or to prevent infection. Sometimes, home remedies work to alleviate the condition (always consult with your child's doctor) or it may be treated by the doctor.

Home treatments include placing salt on the granuloma (kept in place by gauze) for about 15 minutes twice daily for several days. This home remedy will often shrink and dry out the granuloma. If not, your doctor can treat it with the application of silver nitrate, which will painlessly burn off the excess tissue. Other methods of treatment include liquid nitrogen, tying off the lump with a suture until it dies off, or in more extreme cases, surgery.

Signs to Watch For

In addition to proper hygiene, watch for these signs of complications if your child has an outie belly button.

Umbilical Hernia

Monitor if your child has any pain or discomfort at the navel. An umbilical hernia is usually painless; in fact, the only symptom is that the belly button looks swollen or "herniated" outward. If an umbilical hernia becomes strangulated (tissue gets trapped or constricted within the hernia), it can become painful. This is rare, however.

As noted above, umbilical hernias typically don't need treatment. The issue usually goes away by the baby's first or second birthday. Surgery may be needed to repair it if an umbilical hernia is very big (larger than 2 cm, for example), a hernia is getting bigger, or it has not gone away by the age of four or five.

Umbilical Granuloma

This condition requires proper cleaning to stave off infection. Signs of an infected umbilical granuloma include discomfort, fever, swelling, oozing pus, and pain.

How to Care for Your Newborn's Belly Button

Despite common folklore, you can't flatten an outie by strapping something across your baby's belly or by taping a quarter over it. In fact, there's nothing you can (or should) do to change an outie. Instead, as your child grows, help them understand that it's just another way a body can look.

While an outie belly button is less common, it's just a normal feature of your child's appearance. Follow these steps to care for your newborn's belly button area:

• Aim to keep the area clean and dry by drying it completely once it's been cleaned, particularly if covering it either with a bandage or clothing.
• Ask your newborn’s pediatrician about wiping the belly button with alcohol swabs. Some doctors recommend it while others don't.
• Clean the area using mild soap and water, but don't scrub. Ask your pediatrician to recommend safe soaps.
• Fold the top edge of the diaper to ensure that it does not cover the belly button area. This will help keep it dry and heal faster.
• Keep the area dry by giving sponge baths in the first few weeks after birth rather than submerging the belly button in a bath.

A Word From Verywell

An outie belly button is generally not a medical issue. Unless there is a medical problem present, such as a large hernia or granuloma, there is no cause for concern. That said, contact your baby's pediatrician if you suspect that your child has an umbilical hernia or granuloma or any signs of infection or discomfort at the belly button to ensure you get a correct diagnosis and any needed treatment.