Appendicitis Symptoms in Children

Appendicitis is an inflammation of the appendix, a finger-shaped pouch that projects from your colon on the lower right side of your abdomen. The appendix doesn't seem to have a specific purpose.

As the inflammation worsens, appendicitis pain typically increases and eventually becomes severe.

Doctor examining boy's abdomen
Science Photo Library - IAN HOOTON . /Brand X Pictures / Getty Images

Although anyone can develop appendicitis, most often it occurs in people between the ages of 10 and 30. Standard treatment is surgical removal of the appendix.


Abdominal pain is the hallmark symptom of appendicitis. What can confuse people, though, is how the pain starts and can change. Most people associate appendicitis with right lower quadrant pain (the right lower side of the belly) but overlook the fact that the pain often starts as a more generalized pain or pain that is just around the belly button (periumbilical pain).

With classic appendicitis, the pain then moves to the right lower quadrant over the area of the appendix. The pain is worse with movement, and the child may have a hard time getting comfortable.

Other common appendicitis symptoms can include:

  • Vomiting, although it is usually not repeated vomiting as you might have with a stomach virus
  • Loss of appetite
  • Nausea
  • Abdominal swelling
  • Low-grade fever

Other appendicitis symptoms can sometimes include constipation, diarrhea, and inability to pass gas.

Appendicitis symptoms usually worsen over 24 to 36 hours, afterward, without treatment, the child's appendix may perforate. Symptoms will likely then get worse, with an increase in abdominal pain and development of a high fever.


A blockage in the lining of the appendix that results in infection is the likely cause of appendicitis. The bacteria multiply rapidly, causing the appendix to become inflamed, swollen, and filled with pus. If not treated promptly, the appendix can rupture.

Atypical Symptoms

Unfortunately, there can be delayed diagnosis in acute appendicitis in children. Fever and diarrhea were the most common missed symptoms in delayed diagnosis.

That makes it important to seek medical attention whenever your child has right lower quadrant pain or you suspect that he may have appendicitis. Your pediatrician or emergency room doctors can then perform a physical exam and perhaps do tests to try to figure out if your child does indeed have appendicitis, even when he doesn't have classic appendicitis symptoms.

What Else You Need to Know

  • Abdominal pain followed by vomiting is commonly seen with appendicitis, while in most other causes of abdominal pain and vomiting—such as a stomach virus—the child will start vomiting first and then complain of abdominal pain.
  • Other tests that can be helpful in diagnosing a child with appendicitis can include an ultrasound or CT scan, although they are not always necessary when a child has classic appendicitis symptoms.
  • The treatment for appendicitis is an appendectomy, which is the surgical removal of the inflamed appendix.
  • Although appendicitis is more common in older children, peaking in occurrence between the ages of 12 and 18 years, it can occur in young children, too. The diagnosis is more difficult, though, as kids this age often don't complain of specific right lower quadrant pain and may just be irritable.
6 Sources
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  2. Johns Hopkins Medicine. Appendicitis.

  3. Shogilev DJ, Duus N, Odom SR, Shapiro NI. Diagnosing appendicitis: evidence-based review of the diagnostic approach in 2014. West J Emerg Med. 2014;15(7):859-71. doi:10.5811/westjem.2014.9.21568

  4. National Institute of Diabetes and Digestive and Kidney Diseases. Symptoms and Causes of Appendicitis.

  5. Choi JY, Ryoo E, Jo JH, Hann T, Kim SM. Risk factors of delayed diagnosis of acute appendicitis in children: for early detection of acute appendicitis. Korean J Pediatr. 2016;59(9):368-373. doi:10.3345/kjp.2016.59.9.368

  6. National Institute of Diabetes and Digestive and Kidney Diseases. Treatment for Appendicitis.

By Vincent Iannelli, MD
 Vincent Iannelli, MD, is a board-certified pediatrician and fellow of the American Academy of Pediatrics. Dr. Iannelli has cared for children for more than 20 years.