Appendicitis in Kids

Appendicitis happens to about 7% of people in the United States and is most common in kids and teens ages 5 to 20. It is very rare in infants. 

Appendicitis in kids should be treated as a medical emergency. Knowing the signs to seek help as soon as possible is important. The earlier appendicitis is diagnosed and treated, the better the recovery period. 

This article describes the symptoms, causes, and treatment for appendicitis in kids.

How Serious Is Appendicitis in Kids?

Appendicitis is considered a medical emergency. A blockage in the appendix causes bacteria to grow, leading to an infection. Possible blockage causes include hard stool (poop), swollen lymph nodes in the intestines, parasites, or other conditions. Appendicitis is not contagious. 

When the appendix is infected, it begins to swell. After 48 to 72 hours of infection, the appendix can burst, spreading bacteria throughout the body. This is a severe complication. A burst appendix may lead to a collection of pus (abscess) forming in the abdomen. 

Appendicitis requires immediate treatment to avoid a burst appendix. 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 challenging, especially in young children. It is helpful to know what to look for. 

Early Signs of Appendicitis in Kids

The early signs of appendicitis in kids usually include:

• Mild fever
• Pain around the belly button
• Pain in the lower right area of the abdomen

As the infection progresses, other symptoms may include:

• Severe pain in the abdomen
• Loss of appetite 
• Nausea and vomiting
• Diarrhea
• Swelling 

Often, the pain seems to get worse with any movement, like walking, jumping, or coughing. Riding in the car may be uncomfortable too. 

Signs of a Ruptured Appendix

The pain from appendicitis is usually located around the belly button and the right lower area of the belly. If your child suddenly describes the pain spreading across their stomach, they may have a ruptured appendix. When the appendix bursts, it often causes severe abdominal pain and a high fever of up to 104 F. 

Appendicitis in Young Children

While appendicitis is not common in babies and toddlers, it is possible. Infants and young children may experience different symptoms than older kids. It may also be more challenging for them to communicate their feelings. 

About 33% of children with appendicitis do not present with the classic signs and symptoms we expect, such as right lower belly pain. Appendicitis in toddlers and preschoolers may present with the following signs:

• Vomiting
• Fever
• Refusal to eat
• Diarrhea 

Appendicitis in infants and young toddlers may present with the following signs:

• Irritability
• Lethargy (fatigue)
• Swollen belly
• Vomiting 

Appendicitis in infants and young children is often confused with other infections like gastroenteritis or a urinary tract infection (UTI). Young children are at higher risk of a burst appendix (perforation) than older kids. Their symptoms may also be delayed. 

To determine if your young child has appendicitis, observe how they eat, move, play, sleep, and poop. Call your child’s healthcare provider if you are concerned that they may have appendicitis. 

When to Seek Care

It is important to seek medical care for appendicitis as soon as possible. If your child develops the classic signs of appendicitis (fever and right lower belly pain), call your healthcare provider or go to the emergency department right away. 

How Is Appendicitis in Children Diagnosed?

Appendicitis in children is diagnosed with a physical exam, medical history, blood tests, and imaging studies. Your healthcare provider will ask your child to describe their pain, how it feels, where it is located, when it started, and if it is worsening. 

Your child’s healthcare team will run tests to rule out other possible causes of their symptoms. Other possible reasons could include kidney stones, pneumonia, UTI, gastroenteritis, or other infections. 

Diagnostic tests to expect include:

• Blood tests: Complete blood count (CBC) and C-reactive protein (CRP) to test for infection and inflammation
• Urine test: Urinalysis to test for a bladder infection
• Imaging study: X-ray, ultrasound, or computed tomography (CT) of the abdomen to look for a swollen appendix.

How to Check at Home

It is not possible to diagnose appendicitis without medical tests. To determine if your child may be experiencing appendicitis at home, ask them to point to their pain. If they point at their belly button or right lower abdomen, appendicitis is possible. Other signs to look for include a mild fever and nausea. 

As soon as you suspect appendicitis, seek medical care right away.

How is Appendicitis in Kids Treated?

As soon as your child is diagnosed, their healthcare team will start treatment for appendicitis immediately. First, your child will receive an intravenous (IV) line for fluids and antibiotics.

Most children with appendicitis require surgery to remove the appendix (appendectomy). An appendectomy is usually performed laparoscopically. Most kids stay in the hospital for about one 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 a ruptured appendix. If your child experiences a burst appendix, their hospital stay will be extended for a longer course of IV antibiotics. 

What Happens After Surgery?

Most children stay in the hospital for one day following an appendectomy. Your child will still have an IV to receive antibiotics and fluids. Your child’s healthcare team will monitor their pain and prescribe medication as needed. 

Most children recover from surgery quickly without any issues. However, there are possible complications with any surgery. Once your child is discharged from the hospital, your healthcare team will instruct you to monitor for signs of infection. Call your child’s surgeon if you notice any of the following symptoms:

• Fever over 101.5 F
• Uncontrolled vomit
• Worsening pain
• Redness or swelling at the incision
• Pus or drainage from the incision

Don’t hesitate to contact your child’s healthcare provider with questions or concerns.

Helping Your Child Understand What’s Happening

Because of the seriousness of the diagnosis, your healthcare team will have to act fast. To help your child understand what is happening, reassure them that you will be with them as much as possible. Explain what is happening each step of the way, and if you do not know what is coming next, ask the healthcare providers. 

Summary

Appendicitis in kids occurs when the appendix becomes infected or inflamed. Appendicitis is a medical emergency and requires immediate treatment. Signs of appendicitis in kids include a mild fever, pain at the belly button, pain in the right lower area of the belly, nausea, and vomiting. Your healthcare team will perform blood tests, urinalysis, and imaging studies to diagnose this condition. The treatment for appendicitis includes IV fluids and antibiotics, surgery, and pain medication.