When a child complains "my stomach hurts," one of the first fears
that a parent may have is that of appendicitis. Children's bellyaches are
often varied and numerous, and it important that parents recognize when a
particular stomachache might be cause for alarm.
The appendix is a finger-like piece of tissue shaped like a slender
pocket connected to the beginning of the large intestine. Most of the time,
it is located in the lower right side of the abdomen. The appendix contains
many lymph glands and may have something to do with fighting intestinal
infections, but its exact function is unknown. Whatever role the appendix
serves in the body, its removal has no negative effects on a child's
Appendicitis is inflammation of the appendix, produced when the lymph
tissue is overwhelmed by a large local infection. The appendix can also be
irritated if a piece of hardened stool, called a fecalith, becomes suck in
the appendix. None of these conditions are contagious to other children or
Most cases of appendicitis occur between 11 and 20 years of age, although
the problem can occur in any age group. Interestingly, and without a good
explanation, the majority occur in the winter months,
between October and March. Usually the first symptom of appendicitis
is abdominal pain, originating near the navel (belly button) and then moving
to the lower right portion of the abdomen. When the appendix is located in
its usual position, the most painful area is located halfway between the
hip bone and the navel. The child may be bent over with pain and prefer lying
down on the left side. After abdominal pain begins, a child with appendicitis
will usually develop a slight fever, accompanied by loss of appetite, nausea,
The pain is usually intense and unremitting, often waking the child
up at night. Abdominal pain that should concern parents gets progressively
worse over hours, without any signs of relief. The youngster is very sensitive
to sudden jarring motions, such as riding in a car and hitting a bump in
the road. Should a parent suspect their child has appendicitis, it is best
not to allow them to eat or drink as this will stimulate intestinal activity,
worsening the pain, and makes emergency surgery and anesthesia more dangerous.
Excessive sedative or pain medications are also best avoided until your child's
doctor or surgeon can perform a good physical exam on your youngster. The
physical exam is often a cornerstone in the diagnosis of appendicitis, and
pain medicine may mask the characteristic findings.
An accurate diagnosis of appendicitis can be challenging. This is
especially true if the youngster does not report the symptoms in the order
mentioned above or the child is very young. In children younger than two,
for example, the most common symptoms are a dramatic reduction in appetite,
vomiting and a distended abdomen. Toddlers with appendicitis may not even
tell their parents that their stomach hurts.
When the child is brought to their pediatrician, a complete exam will
be done, looking specifically for where the child is tender. The doctor will
also check for "rebound" tenderness This means that when pressure is applied
to the abdomen and then quickly released, the pain is more prominent than
the pain experienced with pressure alone. Often these children will double
up in pain and clutch their abdomen when they are asked to jump off the exam
table. In addition, a rectal exam will be done, either by the pediatrician
or the surgeon. A blood test is frequently performed checking for signs of
inflammation or infection. The urine is also checked looking for signs of
a bladder infection. Sometimes, x-rays will be taken. An abdominal often
shows an obstruction near the site of the appendix. An ultrasound examination
also may reveal abnormalities in the area
The decision to operate on a child suspected of having appendicitis
is often not easy as a clear-cut diagnosis is sometimes difficult to make.
Appendicitis can be confused with other conditions, such as a urinary tract
infection, kidney stones, pneumonia, intestinal flu (gastroenteritis) and
ovarian cysts. No laboratory test is specific for appendicitis. Frequently,
the child is admitted to the hospital for observation to watch the progression
of symptoms. Every once and a while, a child goes to surgery and a normal
appendix is found. Even the most experienced surgeon is not able to "call"
it correctly 100 percent of the time!
The best treatment for appendicitis is surgical removal of the appendix
(appendectomy). This operation is usually done through a small incision in
the lower abdomen. Children recover from surgery quickly and are usually
home on one to two days.
If the diseased appendix is not removed in time, the appendix may
break open or rupture. Perforation of the appendix can occur as early as
48 to 72 hours after symptoms begin. This leads to further complications,
such as an inflammation throughout the abdomen (peritonitis) and abscess
formation. In these cases, a larger abdominal incision is required to remove
the appendix. In addition, the child will be treated with antibiotics for
up to 10 days following surgery.
Remember, appendicitis is a medical emergency that will not go away
or its own or be treated at home. If you suspect that your child has
appendicitis, call your pediatrician immediately.