September 8, 2017
A month ago, I had a little boy come into my office. He was hunched over, and telling me about his stomach pain. None of his symptoms were very specific. Mom said that he hadn’t felt well the past several days. He vomited once. He had a low-grade temperature a few days before that returned that morning. No diarrhea. Mom thought that he looked pale. That afternoon, he was sent home from school due to his worsening stomach pain. His mom told me, “I thought it might be appendicitis, so I wanted to bring him in.”
One of the biggest concerns in the back of parents’ minds when it comes to kids and stomach pain is appendicitis. Most of the time, a child’s stomach ache isn’t from appendicitis, but it is always a possibility.
Appendicitis happens when your appendix is inflamed, usually due to a blockage or obstruction. If an inflamed appendix is not treated, it can rupture, causing a life-threatening situation. The usual treatment for appendicitis is antibiotics and surgery to remove the appendix. It is very understandable why parents would be concerned about this diagnosis.
Perhaps the most frustrating element of appendicitis (for both parents and providers alike) is the fact that the presentation of this illness in childhood is not a cookie-cutter formula.
Appendicitis can manifest differently in different children. This review is meant to be a basic guide for parents on general symptoms to be watchful for when it comes to appendicitis. However, as I tell my own patients, go with your gut (no pun intended).
If your child seems to be abnormally ill, it is ALWAYS better to have your child evaluated by your pediatric provider. If you find out they don’t have appendicitis, peace of mind and education on how to keep your child comfortable at home is always worth going in for. Always.
Each year, appendicitis sends approximately 77,000 American children to the hospital.
Appendicitis is rare in children under the age of 4 years old and much more common in children between the ages of 10-19 (The incidence between birth and age 4 years is 1-2 cases per 10,000 children per year. That incidence drastically increases to 23.3 cases per 10,000 children per year between 10 and 19 years of age.). After 19, the incidence of appendicitis continues to decline, but appendicitis can still occur at any age.
Overall, 7% of people in the United States have their appendix removed during their lifetime.
Boys are twice as likely as girls to develop appendicitis. The cause for this isn’t fully understood.
Generally, children who are diagnosed with appendicitis have great outcomes.
Surgical removal of the appendix (called an appendectomy) and starting antibiotics as soon as possible is very important. About 10-20% of children 10-17 years will experience a ruptured appendix. The rate of perforation is much higher in children under the age of 3 (about 80-100%) because it is far more challenging to diagnosis. Children with ruptured appendixes usually need to stay in the hospital longer as they have a higher risk for abdominal infection and bowel obstructions.
For more information on pediatric appendectomies, read this great resource here.
The first question I ask when my patients are worried about appendicitis is, “Where is your stomach pain?”
The appendix is located in the lower right side of the abdomen.
Appendix pain is usually strongest in the lower right side of the abdomen, but sometimes it can extend over to the belly button (or even the left side of the abdomen in rare cases). Some children may also experience rebound tenderness with appendicitis. This is a clinical sign elicited during a physical examination when a provider presses on the abdomen. If your child experiences more pain after pressure is released from the abdomen (instead of when pressure is applied), we would consider your child to have rebound tenderness.
It is also very important to know that children who have appendicitis generally have pain with movement. Children with appendicitis usually don’t want to do regular activities, move around, or even walk because it increases their discomfort. Sometimes that pain will cause them to walk hunched over while holding their lower stomach. Children with appendicitis generally prefer to lie down. They will frequently lie on their sides with their legs curled up to try and alleviate stomach pain.
If you are concerned about appendicitis, ask your child to jump up and down. If their pain gets worse with jumping (or any regular movement), you should definitely have them evaluated by your pediatric provider immediately.
With some children, it can be hard to get them to pinpoint the exact location of stomach pain, so you need to also be on the lookout for some of the other common appendicitis symptoms.
Other Possible Appendicitis Symptoms In Children:
Gastroenteritis, commonly known as the “stomach flu,” is the most common cause of acute (rapid) onset abdominal pain in children. For this reason, parents regularly have a difficult time differentiating gastroenteritis from appendicitis.
There are some subtle differences between the two illnesses described in the below chart. Again, if you’re not sure, it’s always better to take your child to your pediatric provider for an evaluation.
It turned out that patient of mine nearly jumped off the table with right lower abdominal pain during his physical assessment. I sent him off to the ER to be evaluated immediately. When I called his mom back a few hours later to check on him, sure enough, he was headed into the OR for an appendectomy. That mom was so thankful she brought her son to see me at urgent care instead of waiting it out at home.
Appendicitis is no joke, so if you think there is a chance your child’s appendix is inflamed, seek immediate medical treatment. It’s not worth waiting.
Author: Dani Stringer, MSN, CPNP, PMHS – founder of KidNurse and MomNurse Academy