Umbilical hernias are a common surgical condition in both adult and pediatric patients. However, they are distinct pathologies with unique etiologies, management recommendations, and, thus, surgical referral indications. In adults, umbilical hernias are typically acquired, have a high risk of strangulation/incarceration, and can almost always be reasonably referred to a surgeon for evaluation (particularly for those >2 cm). In pediatric patients, these hernias are congenital, have a low risk of incarceration/strangulation, and can be safely delayed for surgical referral until age 4–5 years. In both populations, prompt identification of complications such as incarceration or strangulation warrants prompt emergency care and evaluation by a surgical specialist for possible intervention. This chapter aims to outline these distinct hernia types and surgical referral considerations.