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Appendicitis in Children
Overview
Appendicitis is inflammation or infection of the appendix. The appendix is a small finger-shaped tube attached to the end of the large intestine in the lower right belly (abdomen). It’s usually caused by a blockage inside the appendix.
If your child has appendicitis, they need medical care right away. An infected appendix must be surgically removed.
If an infected appendix isn’t removed, it can rupture (burst). Infection from a ruptured appendix can spread in the abdomen and cause serious problems.
Children over age 6 are most likely to have appendicitis. Symptoms include:
- Worsening pain in the lower right abdomen
- Fever
- Loss of appetite
The appendix has no known purpose, so removing it doesn’t have long-term effects.
Causes
Appendicitis occurs when there’s a blockage in the appendix. It becomes inflamed and overgrown with bacteria (infected).
The blockage can be due to:
- A hard rocklike piece of stool (poop), called a fecalith
- Swollen lymph nodes in the intestine (caused by infection)
- Viral illness that causes the appendix to swell
- Parasites
- Mucus
Symptoms
The most common symptoms of appendicitis are:
- Belly (abdominal) pain. Often this is the first symptom. The pain usually starts near the belly button, and then moves to the lower right abdomen. It usually worsens over time or when your child takes deep breaths or coughs.
- Loss of appetite. This may or may not happen.
- Nausea and vomiting. This may occur several hours after abdominal pain starts.
- Low-grade fever.
- Pain throughout the entire abdomen
- Very high fever, up to 104°F
- Diarrhea
- Distended (swollen) abdomen
Diagnosis
We diagnose appendicitis with an exam of your child’s abdomen for signs of pain and tenderness. We may also use several tests.
Ultrasound
This is the most used test for diagnosing appendicitis in children. We place a handheld wand against your child’s abdomen. It uses sound waves to create images of your child’s appendix and surrounding structures. If the ultrasound is unclear, we may use computed tomography (CT).
Blood tests
We use these to check for infection.
Urine tests
These check for a bladder or kidney infection. These conditions can have symptoms similar to appendicitis.
Surgery
If we diagnose appendicitis, your child will need surgery to remove the infected appendix. It’s important not to give your child anything to eat or drink before surgery.
We’ll start intravenous antibiotics right away and the surgery is usually done within 12 to 24 hours after diagnosis.
The surgery (appendectomy) typically takes about an hour and is done using laparoscopy (a camera and small instruments). If your child has acute appendicitis, they can go home soon after the surgery. If your child’s appendix has already ruptured, they need to stay in the hospital after surgery to get treated with intravenous antibiotics.
If we find a perforated appendix with an abscess, we might not be able to operate right away. We may need to place a small drainage tube in the belly to drain the pus from the area. We also use intravenous antibiotics during draining.
When the infection improves a few days later, we’ll then remove the tube. After that, we might need to wait 2 or 3 months to do the appendectomy.
Recovery
If your child has acute appendicitis, they’ll stay in the recovery room for a short time after surgery until they’re awake and able to drink fluids. Then they’ll go home.
If your child’s appendix did burst, they’ll:
- Receive IV antibiotics and fluids until they can take fluids by mouth.
- Stay in the hospital 2 to 5 days or longer if needed.
The day after surgery, we help your child get out of bed and begin to walk around. This helps the healing process. We start your child on clear liquids, and then gradually reintroduce food. This gives the intestine time to heal.
We’ll also watch for signs that their infection is improving. When it’s improved, we’ll make a follow-up care plan and your child can go home.
Home Treatment
Follow these recommendations for caring for your child:
- Rest at home for a few days before returning to school. If your child’s appendix burst, they may need more days of rest. It’s important to have them get out of bed and move around every day.
- Return to normal eating gradually. Start with foods that are easy to digest, such as toast, soups, and baked chicken .
- Give prescribed pain medication as needed. Some can cause constipation. To help prevent this, once your child is eating solid foods, give them fiber-rich foods, such as fruits, vegetables, and whole-grain cereals.
- Wait 2 to 4 weeks before your child plays sports and takes physical education class. Your surgeon will give you specific instructions based on their needs.
If your child’s appendix burst, they may continue to take antibiotics at home and need special care for the incision. We’ll give you instructions on wound care. Minor swelling around the incision(s) is normal.
Call us at the Appointment and Advice Call Center at (866) 454-8855 if your child develops:
- Redness, drainage, or excessive swelling around the incision.
- Fever, vomiting, or increasing pain.
Follow-Up Care
Your child might need a follow-up appointment with the surgeon 2 to 4 weeks after surgery.
The doctor will make sure the incision is healing normally and your child is recovering well.