What is appendicitis in children?

Appendicitis is a painful swelling, inflammation, and infection of the appendix.  It's a medical emergency because the appendix can burst or rupture. This is serious and can lead to more widespread infection. If not treated, it can be fatal.

The appendix is a thin, finger-shaped tube that is joined to the large intestine. It sits in the lower right part of the belly (abdomen). Experts don’t know for sure what role the appendix has in the body. It's not a vital organ. Removing it is not harmful.

Surgery to remove the appendix is called an appendectomy. It's the most common type of emergency surgery for children. Most children recover with no long-term problems.

What causes appendicitis in a child?

Appendicitis happens when the inside of the appendix is blocked by something, causing an infection. The blockage may be caused by mucus, stool, or parasites. Or the blockage may be caused by a bend or twist in the appendix itself.

The appendix then becomes sore and inflamed or swollen. This is because the germs (bacteria) in the appendix begin to increase quickly. As the swelling and soreness get worse, the blood supply to the appendix is cut off.

All parts of the body need the right amount of blood flow to stay healthy. When blood flow is reduced, the appendix starts to die. The appendix will burst or rupture as its walls start to get holes. These holes let stool, mucus, and other substances leak through and get inside the belly or abdomen. A serious infection called peritonitis may occur in the belly when the appendix bursts. If not treated, it can be fatal.

Which children are at risk for appendicitis?

Most cases of appendicitis happen between the ages of 10 and 30 years. Children with cystic fibrosis may have a greater risk. Having a family history of appendicitis may also increase a child’s risk for this condition.

What are the symptoms of appendicitis in a child?

Each child’s symptoms may vary. Below are some common symptoms of appendicitis.

Pain in the belly (abdomen) is the most common symptom. This pain:

• May start in the area around the bellybutton and move to the lower right-hand side of the belly. Or it may start in the lower right-hand side of the belly.

• Often gets worse as time passes

• May be worse when the child is moving, taking deep breaths, being touched, or coughing and sneezing

• May be felt all over the belly if the appendix bursts

Other common symptoms include:

• Upset stomach (nausea) and vomiting

• Loss of appetite

• Fever and chills

• Changes in behavior

• Trouble having a bowel movement (constipation)

• Loose stool (diarrhea)

• Swollen belly in younger children

How is appendicitis diagnosed in a child?

Your child’s healthcare provider will take a health history and do a physical exam. The provider may also order tests, including:

• Abdominal ultrasound. This imaging test uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. It's used to see internal organs as they work.

• CT scan. This imaging test uses both X-rays and computer technology to show detailed images of any part of the body. This includes the bones, muscles, fat, and organs. It's more detailed than a general X-ray.

Other tests may include:

• Blood tests. These tests check for infection and inflammation. They can also see if there are any problems with other abdominal organs, such as the liver or pancreas.

• Urine test. This test can tell if there is a bladder or kidney infection, which may have some of the same symptoms as appendicitis.

Symptoms of appendicitis may look like other health problems. Always see your child’s healthcare provider for a diagnosis.

How is appendicitis treated in a child?

Treatment will depend on your child’s symptoms, age, and general health. Appendicitis is a medical emergency. It's likely the appendix will burst and cause a serious, deadly infection. For this reason, your child’s healthcare provider will likely advise that your child have surgery to remove the appendix. Your child may be given antibiotics and fluids through an IV (intravenous) line before surgery starts.

Surgery is the most common treatment for appendicitis. But for some children, the healthcare provider may give antibiotics instead of surgery.

The appendix may be removed in two ways:

• Open or traditional surgery. Your child is given anesthesia. A cut or incision is made in the lower right-hand side of the belly. The surgeon finds the appendix and removes it. If the appendix has burst, a small tube or shunt may be placed to drain out pus and other fluids from the belly. The shunt will be taken out in a few days, when the surgeon feels the infection is gone.

• Laparoscopic surgery. Your child is given anesthesia. This method uses a few small incisions and a camera called a laparoscope to look inside the belly. The surgical tools are placed through 1 or more small incisions. The laparoscope is put in through another incision. This method is not usually done if the appendix has already burst.

What are possible complications of appendicitis in a child?

An irritated appendix can quickly turn into an infected and ruptured appendix. This can happen in a few hours. A ruptured appendix is an emergency situation. If not treated, it could be fatal. When the appendix ruptures, germs (bacteria) infect the organs inside the abdominal cavity. This causes a bacterial infection called peritonitis. The bacterial infection can spread very quickly. It may be hard to treat if diagnosis is delayed.

When should I call my child's healthcare provider?

An infected appendix can burst or rupture. This is an emergency and could be fatal. call your child’s provider and go to the emergency room right away If your child has the symptoms of appendicitis listed above, .

Key points about appendicitis in children

• Appendicitis is a painful swelling and infection of the appendix. It's a medical emergency.

• The appendix can burst or rupture, causing more infection. If not treated, it can be fatal.

• Healthcare providers will likely recommend that the child’s appendix be removed.

• An appendectomy is the most common type of emergency surgery for children.

• Most children recover with no long-term problems.

Next steps

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.

• Before your visit, write down questions you want answered.

• At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.

• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.

• Ask if your child’s condition can be treated in other ways.

• Know why a test or procedure is recommended and what the results could mean.

• Know what to expect if your child does not take the medicine or have the test or procedure.

• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.

• Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.