The diaphragm does more than help you breathe. This muscle separates the chest from the abdomen, keeping the lungs and heart apart from organs such as the stomach and intestines. When an opening forms in the diaphragm, abdominal organs can move into the chest. This is called a diaphragmatic hernia, and its effects vary from person to person. Some cases are detected before birth, while others appear after an injury or are found during imaging for another reason. Here, learn about the different types, symptoms, diagnosis, treatment, recovery, and ongoing care.

Key Takeaways

A diaphragmatic hernia can be present at birth or develop later: Its type, size, and location influence which organs may move into the chest and how the condition affects health.
Recognize symptoms that need urgent care: Get immediate medical help for severe breathing difficulty, sudden chest or abdominal pain, or repeated vomiting, especially after an injury.
Treatment and follow-up depend on individual needs: Ask the care team about testing, surgery or other support, recovery expectations, and any ongoing checks for breathing, feeding, growth, or development.

What Is a Diaphragmatic Hernia?

How the diaphragm separates the chest and abdomen

The diaphragm is a large, dome-shaped muscle beneath the lungs. It separates the chest, which contains the heart and lungs, from the abdomen, where organs such as the stomach and intestines sit. It also helps you breathe. When the diaphragm contracts, it moves downward and helps draw air into the lungs. When it relaxes, it moves upward as air leaves.

A diaphragmatic hernia is an opening or weak area in the diaphragm. The opening may be present from birth or develop later, such as after an injury. Its effects depend on its size and location, which organs are involved, and whether nearby structures are affected. The CDC explains the diaphragm’s role and how a diaphragmatic hernia forms.

How abdominal organs move into the chest through an opening

When there is an opening in the diaphragm, organs from the abdomen can move through it into the chest. These may include the stomach, intestines, spleen, or liver. The organs involved depend partly on where the opening is and how large it is.

In congenital cases, the opening forms as a baby develops before birth. An acquired hernia may occur later, for example, when an injury damages the diaphragm. Some hernias are found during imaging before birth, while others are identified after symptoms appear or during tests for another reason. Clinicians use imaging to locate the opening and see which organs have moved into the chest.

How displaced organs affect breathing and lung development

When abdominal organs move into the chest before birth, they can limit the space available for the lungs to grow. In some babies, this results in underdeveloped lungs, a condition called pulmonary hypoplasia. The blood vessels in the lungs may also be affected, sometimes leading to pulmonary hypertension, or high blood pressure in the lung arteries.

These changes can make it difficult for a newborn to breathe. Breathing problems may continue after surgery repairs the opening, because surgery cannot immediately reverse changes in lung development. The degree of lung involvement varies among babies, so the care team assesses each baby’s breathing and overall health when planning treatment. Children’s Mercy describes how congenital diaphragmatic hernia can affect lung growth.

What Types of Diaphragmatic Hernia Are There?

Diaphragmatic hernias are classified by when they develop and where the opening is located. Some form before birth, while others result from an injury or, less commonly, a surgical complication. Hiatal hernias also involve the diaphragm, but they occur through its natural opening for the esophagus and are usually considered separately.

The type, size, and location of a hernia help clinicians determine which organs may have moved into the chest and what care is appropriate.

Congenital hernias: Bochdalek and Morgagni types

Congenital diaphragmatic hernias (CDH) develop before birth. The two main types are Bochdalek and Morgagni hernias. A Bochdalek hernia occurs toward the back and side of the diaphragm. It is the more common type and usually appears on the left. A Morgagni hernia forms toward the front and is more often found on the right.

The opening’s size and location affect which abdominal organs can move into the chest. In some babies, this can limit lung development and cause breathing problems after birth. Other hernias may cause fewer symptoms and be found later. The Medscape overview of diaphragmatic hernias explains the key differences between Bochdalek and Morgagni hernias.

Acquired hernias from injury or surgery

An acquired diaphragmatic hernia develops after birth, often when an injury tears the diaphragm and allows abdominal organs to move into the chest. Causes include blunt trauma, such as an impact during a vehicle collision or fall, and penetrating injuries from sharp objects. In some cases, damage during chest or abdominal surgery can also lead to a hernia.

Symptoms may appear soon after the injury or develop later. They vary depending on the tear and the organs involved, and some people may not notice symptoms right away. Because a diaphragmatic injury can be difficult to recognize, seek medical assessment after significant trauma, especially if breathing or abdominal symptoms develop. Columbia Surgery’s guide describes how trauma and surgical complications can cause acquired hernias.

Hiatal hernias and how they differ

A hiatal hernia occurs when part of the stomach moves through the hiatus, the natural opening in the diaphragm where the esophagus passes, and into the chest. This differs from Bochdalek and Morgagni hernias, which involve openings that formed during development. Acquired hernias usually involve a tear or other damage to the diaphragm.

Some hiatal hernias cause no symptoms. Others may contribute to heartburn, acid reflux, or difficulty swallowing. These symptoms can have other causes, so they do not confirm that a hernia is present. A clinician can assess persistent or concerning symptoms and recommend next steps. The UPMC overview describes how hiatal hernias differ from other diaphragmatic hernias.

What Causes Diaphragmatic Hernias, and Which Symptoms Need Urgent Care?

A diaphragmatic hernia occurs when an opening or tear in the diaphragm lets organs from the abdomen move into the chest. It may be present from birth or develop later, often after an injury. Symptoms range from breathing problems to chest or abdominal pain, and some people have few symptoms at first. The cause and symptoms can help clinicians decide how quickly to assess and treat the condition.

What clinicians know about congenital causes

A congenital diaphragmatic hernia (CDH) develops early in pregnancy, while the diaphragm is forming. If it does not fully close, organs such as the stomach or intestines may move into the chest. This can take up space needed for lung development. CDH often occurs on the left side, though it can also affect the right side or, rarely, both sides.

In many cases, the exact cause is unknown. Researchers have identified possible genetic and environmental influences, but a specific cause is not found for every baby. CDH is not caused by a parent’s everyday actions during pregnancy. The Centers for Disease Control and Prevention explains how diaphragmatic hernias develop, and some cases are detected during prenatal imaging.

How injuries, surgery, and other factors cause acquired hernias

An acquired diaphragmatic hernia develops after birth, usually when an injury tears the diaphragm. A forceful impact to the chest or abdomen, such as in a vehicle collision or fall, can cause this damage. Penetrating injuries can also tear the muscle. Symptoms may appear immediately, but a hernia is not always recognized at the time of injury.

Less commonly, damage during surgery or another medical procedure can lead to an acquired hernia. When abdominal organs move through the tear, they may affect breathing or become trapped. The University of Pittsburgh Medical Center describes acquired hernias and their causes. Anyone with breathing difficulty or chest or abdominal pain after a significant injury should be assessed promptly, even if the symptoms seem mild at first.

Symptoms in newborns, children, and adults

Newborns with CDH may develop severe breathing difficulty, rapid breathing, a fast heart rate, or bluish skin. Their abdomen may appear unusually sunken. These signs need immediate medical attention. In older children and adults, symptoms can include shortness of breath, chest or abdominal pain, a feeling of pressure, or difficulty swallowing. The symptoms depend partly on which organs have moved into the chest and whether they are affecting breathing or digestion.

If part of the bowel becomes trapped or blocked, symptoms may include worsening abdominal pain, vomiting, swelling, or difficulty passing stool or gas. Some people have mild or intermittent symptoms, so feeling relatively well does not rule out a hernia. The Columbia University Department of Surgery describes symptoms across age groups. A clinician can assess symptoms and determine whether urgent tests or treatment are needed.

When breathing trouble or sudden chest or abdominal pain needs urgent care

Call emergency services for a newborn who is struggling to breathe, has bluish skin, or is getting worse quickly. These symptoms can signal a serious condition that needs immediate medical care. For older children and adults, sudden chest or abdominal pain, especially when it occurs with shortness of breath, should also be assessed urgently. Do not wait to see whether severe or rapidly worsening symptoms improve on their own.

Seek urgent medical assessment after a significant chest or abdominal injury, even if symptoms are not severe at first. A tear in the diaphragm can be difficult to detect, and problems may develop later as organs move through the opening. Medscape’s clinical overview of diaphragmatic hernias notes that breathing difficulty and sudden pain may indicate a serious condition requiring urgent intervention. Only a medical evaluation can identify the cause and guide treatment.

How Do Clinicians Diagnose a Diaphragmatic Hernia?

Clinicians use imaging, physical examinations, and other tests to find a diaphragmatic hernia and understand how it affects breathing and nearby organs. The approach depends on a person’s age, symptoms, and medical history. Some hernias are detected during pregnancy; others are diagnosed after birth or in adulthood, sometimes during testing for another concern.

Diagnosis helps the care team plan appropriate treatment. For a newborn, clinicians assess breathing, lung development, and whether other conditions are present. For an adult, imaging can reveal the hernia’s location, which organs have moved, and whether nearby structures are affected. Test results are considered together, since a scan alone may not show the full effect of the hernia.

Use ultrasound and fetal imaging to diagnose before birth

A congenital diaphragmatic hernia may be found during a routine prenatal ultrasound, often around the middle of pregnancy. The scan can reveal abdominal organs in the chest and help clinicians assess the diaphragm and developing lungs. The Medscape overview of diaphragmatic hernias describes how fetal imaging can help identify these abnormalities.

If ultrasound findings suggest a hernia, clinicians may recommend additional imaging, such as fetal MRI, and closer monitoring during pregnancy. These assessments can provide more detail about the hernia and lung development, helping the care team plan delivery and newborn care. The results can inform discussions about potential needs after birth, though they cannot predict every detail of an individual baby’s condition.

Examine newborns and use imaging after birth

If a hernia was not detected before birth, clinicians may suspect one when a newborn has difficulty breathing. They assess the baby’s breathing and overall condition, then use imaging to look for abdominal organs in the chest. A chest X-ray can also show whether the lungs appear small or compressed. The CDC’s information on diaphragmatic hernia describes how X-rays can help identify the condition after birth.

The team may order further tests to assess the baby’s lungs and heart. Since breathing problems in newborns can have several causes, clinicians consider imaging alongside physical findings and other test results. If the baby needs urgent support, stabilizing their condition takes priority while the team continues its assessment.

Diagnose adults with X-rays, CT scans, and other tests

In adults, a diaphragmatic hernia may be suspected because of shortness of breath, chest discomfort, or digestive symptoms. Some people have no noticeable symptoms, and the hernia is found during imaging for another reason. A chest or abdominal X-ray may reveal organs in an unusual position. A CT scan can give clinicians a clearer view of the hernia’s location, contents, and effect on surrounding structures.

Depending on the symptoms and suspected cause, clinicians may also use ultrasound or MRI. Blood-gas tests do not show the hernia, but they can help assess how well the lungs are exchanging oxygen and carbon dioxide. The Columbia Surgery guide to diaphragmatic hernias outlines imaging tests used to evaluate the condition.

Assess severity, lung development, and related conditions

Identifying the hernia is only part of the assessment. Clinicians also consider how the lungs have developed, whether breathing or circulation is affected, and whether other conditions are present. For newborns, the team may check heart function and look for other congenital differences. These findings help guide decisions about respiratory support, monitoring, and the timing of surgery.

Before an operation, newborns may need careful breathing support and evaluation for associated conditions, particularly heart abnormalities. Medscape’s treatment guidance explains why these assessments matter in planning care. For adults, clinicians consider the hernia’s size, symptoms, and effect on nearby organs when discussing treatment options.

How Do Clinicians Treat a Diaphragmatic Hernia?

Treatment depends on the type and size of the hernia, which organs have moved through the diaphragm, and the patient’s overall health. A care team may include surgeons, respiratory specialists, and other clinicians. Newborns with congenital diaphragmatic hernias often need support for breathing and blood flow before surgery. Adults may have planned surgery or need urgent treatment, particularly if the hernia followed an injury or is affecting nearby organs.

Surgery usually involves moving the displaced organs back into the abdomen and closing the opening in the diaphragm. The timing and type of repair vary, so the care team will consider the patient’s needs and explain the recommended approach.

Stabilize newborns before repair

A newborn with a congenital diaphragmatic hernia may need breathing support and close monitoring before surgery. The hernia can affect lung development and blood flow through the lungs, so clinicians work to support breathing and manage pulmonary hypertension. The team decides when to operate based on the baby’s condition, rather than following a fixed schedule.

Before repair, clinicians also check for other conditions that may affect care, especially heart abnormalities. An echocardiogram is commonly used to assess the heart, and the team aims to control pulmonary hypertension before surgery. This preparation helps clinicians understand the baby’s needs and plan the next steps. The preoperative care guidance for diaphragmatic hernias describes these priorities.

Repair newborn hernias with open or thoracoscopic surgery and a patch, if needed

During surgery, the surgeon returns the abdominal organs to their usual position and closes the opening in the diaphragm. An open repair uses a larger incision. In selected cases, surgeons may use thoracoscopy, which involves small incisions, a camera, and specialized instruments. The approach depends on the baby’s condition and the hernia’s size and severity.

If the opening can be closed without tension, the surgeon may use stitches. A larger defect may need a patch to cover it. The care team will explain which method is appropriate and why. MedlinePlus describes the steps involved in congenital diaphragmatic hernia repair.

Repair adult hernias with open, laparoscopic, or thoracoscopic surgery

Adults may need surgery to move displaced organs back into the abdomen and repair the diaphragm. Surgeons can operate through a larger incision or use minimally invasive techniques, such as laparoscopy or thoracoscopy. These approaches use smaller incisions and a camera, but they are not suitable for every hernia.

The right method depends on the hernia’s location and size, the organs involved, the patient’s health, and the surgeon’s assessment. An abdominal approach is often used because it gives the surgeon access to the hernia and its contents. The American Association for Thoracic Surgery’s overview of diaphragmatic hernias discusses repair options. Patients can ask their surgeon what to expect before and after the recommended procedure.

Repair traumatic and other urgent hernias

A forceful injury to the chest or abdomen can tear the diaphragm and allow organs to move into the chest. If organs become trapped or the hernia interferes with breathing or circulation, clinicians may recommend urgent surgery. The surgeon returns the organs to the abdomen and repairs the tear.

The timing and surgical approach depend on the patient’s stability, the extent of the injury, and whether other injuries need treatment. In some cases, the team may need to address immediate threats before completing the repair. Because these situations vary, clinicians weigh the risks and benefits of each approach for the individual patient. The Journal of Chest Surgery’s review of diaphragmatic hernia repair discusses the factors that can shape timing and surgical decisions.

Consider prenatal procedures for selected pregnancies and understand their limits

For some pregnancies affected by severe congenital diaphragmatic hernia, specialists may discuss a fetal procedure called fetoscopic endoluminal tracheal occlusion, or FETO. The procedure places a small balloon in the fetus’s windpipe for a period of time, with the aim of supporting lung growth before birth. It does not close the opening in the diaphragm, and it is not an option for every pregnancy.

FETO requires assessment by a specialist team, which can discuss potential benefits, risks, and alternatives with the family. The procedure can carry risks, including complications that may affect the pregnancy, so parents need a clear explanation of what it involves. Even after a prenatal procedure, the baby may need breathing support and surgery after birth. Longer-term care may also be important, as described in this review of advances in congenital diaphragmatic hernia management.

What Does Recovery After Hernia Repair Involve?

Recovery varies with the type of diaphragmatic hernia, the repair, and the patient’s overall health. Newborns with congenital diaphragmatic hernia often need intensive care after surgery. Adults may need a hospital stay and follow-up visits, with recovery guided by their surgeon.

Support newborn breathing and monitor pulmonary hypertension

Surgery repairs the opening in the diaphragm, but a newborn’s lungs may still need time and support to recover. Some babies need a ventilator or other breathing assistance after the operation. The care team also monitors pulmonary hypertension, which can make it harder for blood to flow through the lungs and for the heart to work effectively.

Newborns usually receive care in a neonatal intensive care unit, where clinicians can closely track breathing, heart function, and lung recovery. The CDC’s guidance on congenital diaphragmatic hernia notes that babies may need breathing support after surgery. The type and duration of support depend on each baby’s condition, so the team adjusts care as the baby improves.

Check recovery, manage pain, and support feeding and nutrition

After surgery, clinicians monitor the incision, breathing, circulation, and signs of infection. They also provide pain relief suited to the patient’s age and needs. For newborns, feeding may resume gradually. Some babies need tube feeding or nutrition through a vein while they gain strength and develop the coordination needed to feed safely.

Recovery for a newborn may involve weeks or months of hospital care, depending on the baby’s health and progress. UCSF Benioff Children’s Hospitals describes the intensive support some babies need after repair. Families can ask the care team how it will track feeding and weight gain, what milestones to expect, and whom to contact with concerns.

Support adult recovery and follow-up

Adults may stay in the hospital after surgery so the team can monitor healing, manage pain, and help them move safely. The length of the stay and recovery at home depend on the operation, the patient’s health, and whether the hernia caused an emergency. Before leaving the hospital, ask how to care for the incision, when to resume usual activities, and which symptoms should prompt a call.

Follow-up appointments let the surgeon check healing and discuss any ongoing symptoms. People with a congenital diaphragmatic hernia may need longer-term monitoring, even after the initial repair. A review on lifelong follow-up explains that continued care can help clinicians identify concerns early and arrange appropriate support.

Watch for complications, including recurrence and reflux

After repair, clinicians may watch for recurrence, breathing problems, reflux, or intestinal obstruction. The possibility of complications varies with the hernia and the patient. Children born with congenital diaphragmatic hernia may need ongoing checks for breathing, digestion, feeding, and growth. A multicenter study of long-term outcomes reports complications seen in some patients, including recurrence and gastroesophageal reflux.

Follow the care team’s instructions and report new or worsening symptoms. Seek urgent medical care for severe trouble breathing, sudden or intense chest or abdominal pain, or repeated vomiting. These symptoms can have several causes, but they need prompt assessment.

What Is the Long-Term Outlook After a Diaphragmatic Hernia?

A child’s long-term outlook after a congenital diaphragmatic hernia (CDH) depends on the hernia’s severity, lung development, and any other health conditions. Some children do well after treatment and lead active lives. Others benefit from ongoing checks or support for breathing, feeding, growth, hearing, or development. Each child’s needs are different, so the care team can give families the clearest picture of what to expect.

How severity, lung development, and other conditions shape the outlook

The size and location of the opening, how much abdominal organs moved into the chest, and how the lungs developed can all affect a child’s care and recovery. Some infants respond well to treatment after birth and surgery. Although their lungs may be smaller than usual at birth, they can continue to grow and adapt over time, as UCSF Benioff Children’s Hospitals explains.

Other health concerns, including heart or lung conditions, can also shape the follow-up plan. Clinicians assess each child individually rather than relying on one factor to predict the future. Ask your child’s care team how the hernia’s severity and any related conditions affect their needs, and which changes to watch for at home.

Address long-term breathing, digestive, feeding, and growth concerns

Some children need ongoing care for breathing or digestive symptoms after CDH repair. Follow-up may include checks for asthma, gastroesophageal reflux, feeding difficulties, and weight gain. Reflux can make feeding uncomfortable, while breathing problems may affect everyday activity. Tell the care team if your child has persistent coughing, frequent vomiting, difficulty eating, or trouble gaining weight.

One study of long-term outcomes reported gastroesophageal reflux in 42% of children, hernia recurrence in 10.9%, asthma in 23.6%, and neurodevelopmental delay in 28.6%. These figures describe a study group, not an individual child’s likely outcome. The research on long-term CDH outcomes00473-5/abstract) illustrates why follow-up may include breathing, digestion, nutrition, and growth.

Monitor children’s hearing and neurodevelopment

Hearing and developmental checks can help identify concerns early. Hearing changes may not be obvious in infancy, but untreated hearing loss can affect speech, communication, and learning. Developmental assessments can show whether a child may benefit from support with movement, language, learning, or social skills.

Reported rates of hearing impairment vary widely across studies. In one multicenter study, 4.5% of children had been diagnosed with hearing loss by 1.5 years of age. This finding supports monitoring, but it does not predict what will happen for any one child. Ask your child’s clinicians when hearing tests and developmental assessments are recommended. The multicenter study in Japan highlights the value of monitoring these areas as children grow.

Provide follow-up and specialist support as children grow

Regular follow-up lets clinicians review a child’s health and adjust care as needs change. Depending on the child, the team may include a pediatric surgeon, respiratory specialist, dietitian, hearing specialist, or developmental professional. Not every child needs every type of specialist, so ask which appointments are right for your child.

At visits, share changes in breathing, feeding, sleep, growth, hearing, or development. You can also ask about physical activity, school, and symptoms that should prompt a call. Keeping copies of test results and treatment records can help when several clinics are involved. A review of long-term CDH follow-up describes how structured monitoring can connect children and families with appropriate care as they grow.

How Can Families Plan for Ongoing Care?

Care for a child with congenital diaphragmatic hernia (CDH) may continue after surgery and discharge. The follow-up plan depends on the child’s health, recovery, and development. A clear plan can help your family keep track of appointments, share information between clinicians, and know whom to contact with questions.

Coordinate pediatric, surgical, respiratory, and developmental care

Some children need follow-up from several specialists. Depending on a child’s needs, the care team may include a pediatrician, pediatric surgeon, pulmonologist, cardiologist, nutritionist, physical therapist, or child development specialist. A primary care clinician can help coordinate care, monitor growth, and bring recommendations together. The American Academy of Pediatrics’ follow-up guidance recommends a primary care medical home close to the family, with follow-up tailored to the child. Ask who will coordinate appointments, how clinicians will share records, and whom to contact if your child’s symptoms change.

Ask about treatment, recovery, and follow-up

Before discharge, ask for a written plan covering medications, feeding and nutrition, follow-up visits, and symptoms that need prompt medical attention. Find out which clinicians will check your child’s breathing, heart health, growth, hearing, and development, and when those assessments should happen. Keep a record of questions, symptoms, and visit summaries to refer to during appointments. If instructions are unclear, ask the care team to explain them in everyday language. Confirm whom to call with concerns during office hours and after hours. As your child grows, needs may change, so review the plan with the pediatrician and specialists.

Find emotional and practical support

A child’s diagnosis and recovery can bring emotional strain as well as new demands on daily life. Ask a hospital social worker or care coordinator about counseling, family support groups, financial assistance, transportation, and help arranging appointments. If your child needs support with feeding, breathing, or development, ask whether community services or early intervention may be helpful. Some children with CDH have ongoing concerns related to breathing, feeding, growth, hearing, or development, as UCSF Benioff Children’s Hospitals explains. Your care team can help you find resources that fit your child’s needs and your family’s circumstances.

Frequently Asked Questions

Can a diaphragmatic hernia be found before birth?\ Yes. A prenatal ultrasound may show abdominal organs in the chest or signs that the lungs are affected. The care team may recommend more imaging and monitoring to understand the hernia and plan for delivery and newborn care.

Does every diaphragmatic hernia cause symptoms?\ No. Some people have few or no symptoms, and a hernia may be discovered during imaging for another reason. Others develop breathing difficulty, chest or abdominal pain, or digestive problems. Symptoms depend on the hernia and the organs involved.

When should I seek emergency care?\ Call emergency services for severe or worsening difficulty breathing, bluish skin in a newborn, or sudden intense chest or abdominal pain. After a significant chest or abdominal injury, get medical assessment promptly, even if symptoms seem mild.

Does surgery always happen right away?\ No. The timing depends on the person’s condition and the hernia’s effects. Newborns with congenital hernias may need breathing and circulation support before repair. An injury-related hernia may need urgent surgery if organs are trapped or breathing is affected.

Can a diaphragmatic hernia return after repair?\ Recurrence is possible, though the risk varies. Follow-up visits help the care team check healing and watch for symptoms or other concerns. Ask your surgeon what follow-up schedule is right for you or your child.

Diaphragmatic Hernia: Causes, Symptoms, and Treatment