Umbilical cord care and infection signs
Caring for your newborn's umbilical cord stump can feel daunting, especially when it does not look the way you expected. The good news is that the cord requires very little from you. Mostly it just needs to be kept dry. This guide walks you through what normal healing looks like, how to care for the stump correctly, and the signs that something is wrong and needs urgent attention.
What is the umbilical cord stump?
During pregnancy, the umbilical cord was the lifeline connecting your baby to the placenta, delivering oxygen and nutrients. After birth, the cord is clamped and cut, leaving a small stump attached to your baby's navel. This stump needs to dry out and separate on its own, which takes between 1 and 4 weeks in most babies, with the average being around 2 weeks.
The stump is initially soft and yellowish-green. Over the following days and weeks it dries out, shrinks, and changes colour from yellow-green to brown, and eventually to dark brown or black. This colour change is entirely normal and is simply the stump drying out. It is only when you see changes in the skin around the stump that you need to pay attention.
How to care for the stump correctly
Current guidance from the WHO and NHS is straightforward: keep it dry and let it air. Simple cord care, without antiseptic solutions, is recommended in most settings because it allows the cord to separate more quickly and reduces the chance of irritation.
Here is what the guidance recommends:
- Keep it dry. Avoid getting the cord wet during baths. Give your baby sponge baths (wiping with a damp cloth) rather than full immersion baths until the stump has fallen off and the navel has healed.
- Fold the nappy below the cord. Most newborn nappies have a notch cut out for this purpose. If yours do not, fold the front waistband down so it sits below the cord rather than rubbing against it. This keeps the area exposed to air and prevents urine from soaking into the stump.
- Let air reach it. Dress your baby in loose clothing that does not press directly on the stump.
- Clean only if needed. If the cord gets dirty, gently clean around the base with a cotton bud dampened in plain cooled boiled water, then let it air dry completely.
- Do not use antiseptic routinely. The WHO's 2014 guidelines note that routine antiseptic application in low-risk settings (clean home births or hospital births in high-income countries) does not improve outcomes compared to dry cord care and may delay cord separation. If your midwife or GP has given you specific instructions to use antiseptic, follow their guidance.
- Do not pull the cord. Even if it looks like it is only hanging on by a thread, let it fall off on its own. Pulling it before it is ready can cause bleeding and may create an entry point for bacteria.
What is normal during healing?
Knowing what to expect helps you feel less alarmed by normal changes.
Normal signs during cord healing include:
- The stump changing colour from yellowish-green to brown to dark brown or black
- The stump shrinking and becoming harder over time
- A very small amount of clear or slightly bloody discharge right at the point where the cord separates from the skin, which is normal in the last day or two before it falls off
- A mild smell as the cord dries (similar to a slight musty or earthy smell)
These are all expected parts of the process. You do not need to do anything extra in response to them.
Signs of infection to watch for
Umbilical cord infection is called omphalitis. It is uncommon but it can progress quickly in newborns, whose immune systems are still developing. This means it is important to act fast if you notice the warning signs.
Signs of omphalitis include:
- Redness spreading outward on the tummy skin. A small amount of pinkness right at the base of the stump can be normal, but redness that is spreading outward onto the surrounding tummy skin is not. This is the most important warning sign.
- Warmth or swelling in the skin around the cord base
- Pus or smelly discharge from the cord. A thick, yellow or green discharge with an unpleasant smell is different from the small amount of clear or lightly bloody fluid that can appear as the cord falls off.
- A baby who has a fever (temperature above 38 degrees C in a baby under 3 months always needs urgent assessment)
- A baby who is not feeding well or who seems unusually sleepy or limp
If you see the redness spreading on the tummy skin, or if your baby has a fever alongside any cord changes, contact your GP urgently or take your baby to urgent care. Do not wait to see if it improves on its own. Omphalitis in newborns can deteriorate quickly and needs antibiotic treatment.
Distinguishing infection from normal
It helps to have a clear mental picture of the difference.
Normal: The stump changes from green-yellow to dark brown or black over days to weeks. Right as it falls off, you may see a tiny amount of clear or lightly bloody fluid. The skin immediately around the base may look faintly pink for a day or two after separation.
Not normal: Redness spreading outward onto the tummy skin beyond the immediate base of the cord. Pus that is thick, yellow, green, or has a bad smell. Warmth or swelling in the surrounding skin. Any combination of cord changes plus a baby who has a fever or is unwell.
The key distinction is whether changes are happening in the stump itself (normal) or spreading into the surrounding skin (not normal and needs prompt attention).
When the cord will not fall off
Most cord stumps separate by 4 weeks. If your baby's cord stump is still present and otherwise healthy-looking at 4 to 6 weeks, mention it to your GP at your next appointment or contact your health visitor. A delayed cord separation can occasionally point to an underlying immune system condition, such as leukocyte adhesion deficiency, that benefits from early investigation. This is uncommon, but it is worth raising rather than waiting further.
Do not attempt to help the cord along by pulling, cutting, or wrapping it. Leave this entirely to your GP or midwife to assess.
What to do if you are worried
If you are ever unsure whether what you are seeing is normal, contact your midwife, health visitor, or GP and describe what you are seeing. It is always better to ask than to wait and wonder. For signs of spreading redness, fever in a newborn, pus, or a baby who seems unwell alongside cord changes, seek medical attention the same day and do not leave it until the next available routine appointment.
Frequently asked questions
When will my baby's umbilical cord fall off?
The cord stump usually falls off between 1 and 4 weeks after birth, with 2 weeks being roughly average. If it has not fallen off by 4 to 6 weeks, mention it to your GP or health visitor, as delayed separation can occasionally indicate an underlying issue that is worth checking.
How do I clean the umbilical cord stump?
Keep it dry as much as possible. If you need to clean it, gently wipe around the base with a cotton bud dampened in plain cooled boiled water, then let it air dry completely. Fold the nappy below the cord so it stays exposed to air. Give sponge baths rather than full immersion baths until the cord falls off.
Is it normal for the cord stump to smell?
A faint smell as the stump dries is normal. A distinctly bad or unpleasant smell, particularly alongside pus or redness spreading on the tummy skin, is not normal and needs an urgent GP visit. When you are unsure, have it checked.
What does an infected umbilical cord look like?
Look for redness that is spreading outward onto the skin of the tummy (not just at the very base of the stump), warmth or swelling in the surrounding skin, pus or smelly discharge, and a baby who has a fever or is not feeding well. These signs together suggest omphalitis, which progresses quickly in newborns and needs same-day medical assessment.
Should I use antiseptic on the cord stump?
Current WHO and NHS guidance does not recommend routine antiseptic use. Research shows that dry cord care, keeping the cord clean and dry without antiseptic, is as effective and may allow the cord to separate more quickly. If your midwife or GP has advised differently, follow their specific instructions for your baby.
What if the stump has not fallen off after 4 weeks?
Contact your GP or health visitor to have it assessed. Most stumps separate by 4 weeks, but a small number take longer. Occasionally, delayed separation points to an immune system condition that benefits from early diagnosis. Your GP can examine the cord and, if needed, arrange any relevant tests.
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