Paediatricians have warned parents and caregivers against forcing the umbilical cord stump of newborn babies to fall off, stressing that delayed separation beyond three weeks could signal an underlying medical problem requiring prompt hospital evaluation.
The child health specialists said the umbilical cord stump of a full-term baby would ordinarily separate between five and 15 days after birth, although the process could take longer in premature babies and those born with low birth weight.
They cautioned that while variations in the time of separation were possible, persistent attachment beyond three weeks should not be ignored, as it could be associated with infection, inadequate cord care or, in rare cases, problems with the baby's immune system.
The experts, who spoke in exclusive interviews with PUNCH Healthwise, also warned against cultural practices and home remedies intended to hasten cord separation, noting that such interventions could cause bleeding, introduce harmful organisms and expose newborns to potentially life-threatening infections.
They urged parents to seek immediate medical attention if they noticed redness, swelling, pus, a foul smell or persistent bleeding around the stump, particularly when accompanied by fever, poor feeding, vomiting or abdominal swelling.
Delayed separation may indicate an underlying problem
A Professor of Paediatrics at Usmanu Danfodiyo University, Sokoto, Ben Onankpa, explained that the time required for the umbilical cord to separate depended partly on the baby's gestational age and the biological processes involved in healing.
According to him, the stump of a full-term baby would typically fall off within four to 15 days, while premature babies and those with low birth weight might take up to three weeks.
He explained that the inflammatory process necessary for the cord to separate from the base could be slower in premature babies, contributing to delayed separation.
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| Prof Ben Onankpa |
He added that when a full-term baby's cord remained attached longer than expected, infection and poor cord care were among the possible explanations that required attention.
“Most times, if it is delayed, there could be infection or poor cord care. In our culture, there are different approaches to cord care. Some people apply cow dung, some women have used toothpaste, some have used detergent, salt. But these are manipulations that are not good care. It can get the cord infected. And remember, it is still connected to the baby,” he said.
The paediatrician noted that some parents and caregivers were under pressure to make the stump fall off quickly because of cultural beliefs about the baby's completeness and social restrictions imposed on mothers while the cord remained attached.
However, he warned that such concerns should never lead to practices that interfere with the natural healing process.
According to him, manipulating the stump before it is ready to separate could cause bleeding and create an entry point for infection.
He likened the practice to plucking an unripe fruit, explaining that the stump should be allowed to dry and detach naturally rather than being pulled, pressed or subjected to other forms of manipulation.
Warning signs parents should never ignore
Onankpa identified redness of the skin surrounding the stump, continuous bleeding and pus as important warning signs that should prompt urgent medical assessment.
He said the situation became particularly concerning when a baby developed systemic symptoms such as fever, poor feeding, vomiting or abdominal distension.
The don said, “Once the skin around the cord becomes reddish, if you see continuous bleeding, it’s not a good sign. Also, if you see pus, or the baby becomes feverish and feeding poorly, vomits, or the abdomen becomes distended, the baby needs immediate medical evaluation because it (the cord) becomes a portal of entry for other infections. The infection can spread to the bloodstream.”
The warning highlights the vulnerability of newborns to infections and the importance of recognising changes around the umbilical stump before complications develop.
An infection that begins around the cord can become serious if it spreads beyond the surrounding tissue. Parents, therefore, should not wait for several symptoms to appear before seeking medical attention when a newborn shows signs of possible infection.
Onankpa stressed that the cord should not be forced to fall off, regardless of concerns about how long it had remained attached.
“There is no reason why the cord should remain there after the third week, all things being equal. If it drops before the third or fourth day, please seek medical care so that they can take proper care of the cord,” he said.
He also advised parents to seek professional assessment when the stump separates unusually early, particularly if there is bleeding or an open wound.
Paediatricians condemn harmful traditional practices
The specialists expressed concern over the application of substances such as toothpaste, salt, detergent, cow dung and breast milk to newborns' umbilical cords.
They also warned against hot fomentation, pressing, pulling and other local manipulations intended to accelerate separation.
According to the experts, these practices could irritate or injure the delicate tissue, cause bleeding and introduce germs that may lead to infection.
The risk is particularly serious in newborns, whose developing immune systems make them vulnerable to infections that can deteriorate rapidly.
Onankpa recommended chlorhexidine gel for cord care, advising caregivers to apply it to the base and stump as directed by a qualified health professional.
“The recommended cord care is chlorhexidine gel. Apply generously to the base of the cord, upwards to the stump. Most times, even if they apply it once, it’s still enough. But you can apply for the first three to four days. Avoid all local practices, including hot fomentation, pressing and manoeuvring, to make sure it drops quickly. If it drops naturally, it will get dried and then drop on its own,” he said.
He described chlorhexidine as an effective and accessible option for newborn cord care.
However, parents should follow the guidance of their healthcare providers on the appropriate cord-care method, as recommendations may depend on local clinical protocols and the baby's circumstances.
Keep the stump dry and monitor the baby
Also speaking, a Professor of Paediatrics, Omotayo Adesiyun, said the normal period for umbilical cord separation was between five and 15 days, with the process typically taking an average of six to seven days.
She explained that delayed separation became a significant concern when the stump remained attached beyond three weeks.
According to her, possible causes include keeping the cord wet, infection and, in rare cases, immune system abnormalities.
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| Prof Omotayo Adesiyun |
She advised caregivers whose babies' cords had not separated after two weeks to check for warning signs and ensure the baby was feeding well and did not have a fever.
Where no warning signs were present, she recommended keeping the stump dry and following appropriate cord-care guidance while monitoring the baby.
“If the cord has not fallen off after two weeks, the parents should check for the warning signs. Also check that the baby does not have a fever and is sucking well. If there are none, then the cord should be kept dry by cleaning with methylated spirit. If the cord has not dropped by 3weeks, the baby should be taken to the hospital for evaluation,” the child health specialist noted.
Her advice reinforces the importance of distinguishing between delayed separation without other symptoms and delayed separation accompanied by signs that could indicate infection or another underlying condition.
Parents should not, however, wait until the three-week mark if the baby develops fever, redness, pus, persistent bleeding, poor feeding or other concerning symptoms.
Newborn cord care and Nigeria's infant mortality burden
The specialists' warning comes amid continuing concerns about newborn and child survival in Nigeria, where preventable infections remain an important public health concern.
PUNCH Healthwise had earlier reported that improper handling of the umbilical cord could expose newborns to infection and contribute to infant morbidity and mortality.
Figures from the 2024 Nigeria Demographic and Health Survey put the country's infant mortality rate at 63 deaths per 1,000 live births, neonatal mortality at 41 deaths per 1,000 live births and under-five mortality at 110 deaths per 1,000 live births.
The figures underscore the importance of safe newborn care practices, timely recognition of danger signs and access to appropriate medical services during the early weeks of life.
Although not every case of delayed cord separation indicates an infection, the experts stressed that parents should avoid self-treatment and seek professional advice when the stump remains attached beyond the expected period or when concerning symptoms appear.
They also emphasised that the natural separation process should not be rushed to satisfy cultural expectations or personal concerns about the baby's appearance.
For parents and caregivers, the key message is that the umbilical stump should be allowed to separate naturally, kept under appropriate hygienic care and monitored for signs of infection.
When the cord remains attached beyond three weeks, the baby should be taken to a healthcare facility for evaluation. If warning signs develop at any time, medical attention should be sought immediately rather than waiting for the stump to fall off.