Common early signs and what to do

Appendicitis affects about 7% of Americans and is most common in children and teens between the ages of 5 and 20. Very rare in infants.

Appendicitis in children should be treated as a medical emergency. It is important to know the signs to seek help as soon as possible. The sooner appendicitis is diagnosed and treated, the longer the recovery period will be.

This article describes the symptoms, causes, and treatment of appendicitis in children.

How serious is appendicitis in children?

Appendicitis is considered a medical emergency. When the appendix becomes blocked, bacteria can grow and cause an infection. Possible causes of blockage include hard stools (poop), swollen lymph nodes in the intestines, parasites, or other conditions. Appendicitis is not contagious.

When the appendix becomes infected, it begins to swell. The appendix may rupture 48 to 72 hours after infection, and bacteria can spread throughout the body. This is a serious complication. If the appendix ruptures, a lump of pus (abscess) may form in the abdomen.

Appendicitis must be treated immediately to avoid appendix rupture. This condition is the most common cause of emergency abdominal surgery in children.

How do I know if my child has appendicitis?

Recognizing the early signs of appendicitis can be difficult, especially in young children. It helps to know what to look for.

Early signs of appendicitis in children

Early signs of appendicitis in children usually include:

• slight fever
• pain around belly button
• pain in the lower right part of the abdomen

As the infection progresses, other symptoms may appear, including:

In many cases, the pain seems to worsen with any movement, such as walking, jumping, or coughing. Riding in a car may also become uncomfortable.

Signs of a ruptured appendix

Pain from appendicitis usually occurs around the belly button and lower right side of the abdomen. If your child suddenly complains of pain that radiates throughout the abdomen, the appendix may have ruptured. A ruptured appendix often causes severe abdominal pain and a high fever of up to 104°F.

Appendicitis in infants

Appendicitis is not common in infants and young children, but it can occur. Infants and young children may experience different symptoms than older children. It can also be even more difficult to communicate how you feel.

Approximately 33% of children with appendicitis do not have the typical signs and symptoms that we would expect, such as right lower quadrant pain. Symptoms of appendicitis in infants and preschoolers may include:

• vomiting
• heat
• refuse to eat
• diarrhea

Symptoms of appendicitis in infants and young children may include:

• irritation
• Lethargy (fatigue)
• swollen belly
• vomiting

Appendicitis in infants and young children is often confused with other infections, such as gastroenteritis or urinary tract infections (UTIs). Young children are at greater risk of appendix rupture (perforation) than older children. Symptoms may be delayed.

To determine whether your young child has appendicitis, observe how your child eats, moves, plays, sleeps, and defecates. If you are concerned about the possibility of appendicitis, contact your child’s health care provider.

When to seek care

It is important to see a doctor as soon as possible if you have appendicitis. If your child develops the classic signs of appendicitis (fever and pain in the lower right quadrant), call your health care provider or go to the emergency room right away.

How is appendicitis diagnosed in children?

Appendicitis in children is diagnosed by a physical exam, medical history, blood tests, and imaging tests. The health care provider will ask your child to describe the pain, how it feels, where the pain is, when it started, and whether the pain is getting worse.

Your child’s health care team will perform tests to rule out other possible causes of symptoms. Other possible causes include kidney stones, pneumonia, urinary tract infections, gastroenteritis, and other infections.

Expected diagnostic tests include:

How to check at home

Appendicitis cannot be diagnosed without medical tests. To determine if your child is experiencing appendicitis at home, ask them to point out the pain. If it points to your belly button or lower right abdomen, you may have appendicitis. Other signs to watch for include mild fever and nausea.

If you suspect you have appendicitis, see your doctor right away.

How is appendicitis in children treated?

As soon as your child is diagnosed, the medical team will begin treating appendicitis immediately. First, your child will receive an intravenous (IV) line to administer fluids and antibiotics.

Most children with appendicitis require surgery to remove the appendix (appendectomy). Appendectomy is usually performed laparoscopically. Most children stay in the hospital for about a day after surgery for monitoring, pain control, and IV antibiotics.

There is no way to prevent appendicitis, but early treatment can reduce the risk of complications such as appendix rupture. If your child experiences a ruptured appendix, the length of the hospital stay will be extended due to prolonged IV antibiotic treatment.

What happens after surgery?

After appendectomy, most children stay in the hospital for one day. Your child will need an IV to administer antibiotics and fluids. Your child’s medical team will monitor the pain and prescribe medication if necessary.

Most children recover quickly from surgery without any problems. However, complications can occur with any surgery. After your child is discharged from the hospital, your medical team will ask you to monitor your child for signs of infection. Contact your child’s surgeon if you notice any of the following symptoms:

• Fever above 101.5°F
• uncontrollable vomiting
• worsening of pain
• Redness or swelling at the incision site
• Pus or drainage from the incision

If you have any questions or concerns, please do not hesitate to contact your child’s health care provider.

Help your child understand what is happening

Because the diagnosis is serious, the medical team must act quickly. Reassure your child that you will be there as much as possible to help them understand what is going on. Explain what’s happening at each stage, and ask your health care provider if you’re not sure what happens next.

summary

Appendicitis in children occurs when the appendix becomes infected or inflamed. Appendicitis is a medical emergency and requires immediate treatment. Signs of appendicitis in children include a mild fever, pain in the belly button, pain in the lower right side of the abdomen, nausea, and vomiting. Your medical team will do blood tests, urine tests, and imaging tests to diagnose this condition. Treatment for appendicitis includes IV fluids and antibiotics, surgery, and pain medication.