Appendicitis in Children: Symptoms, Diagnosis, and Treatment

What Is Appendicitis?

Appendicitis is the inflammation or infection of the appendix, a small, finger-shaped pouch attached to the large intestine. While its exact function remains unclear, a blocked or infected appendix can become a medical emergency—especially in children.

Why Is Appendicitis Dangerous in Kids?

1. Higher rupture risk: A child’s appendix wall is thinner, making it more likely to burst.
2. Atypical symptoms: Young children may not describe pain accurately, delaying diagnosis.
3. Rapid progression: Appendicitis can worsen within 24–48 hours, leading to severe infection if untreated.
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Symptoms of Appendicitis in Children

Unlike adults, children—especially those under 10—often show non-classic symptoms, making diagnosis tricky.

Early Signs (First 12–24 Hours)

1. Belly button pain that migrates to the lower right abdomen
2. Loss of appetite (a key indicator—kids who refuse favorite foods should raise concern)
3. Nausea and vomiting (usually after pain starts, unlike stomach flu)
4. Low-grade fever (around 100–101°F / 37.7–38.3°C)
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Advanced Symptoms (24+ Hours, Possible Rupture)

1. Sharp, constant pain in the lower right abdomen
2. High fever (above 102°F / 38.9°C)
3. Swollen or rigid belly
4. Limping or right leg pain (due to irritation of nearby nerves)
5. Extreme fatigue or confusion (signs of sepsis if the appendix bursts)

Symptoms in Infants & Toddlers

1. Excessive crying when moving or touching the belly
2. Refusal to eat or drink
3. Unusual sleepiness or irritability
4. Diarrhea or constipation
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Why Is Appendicitis Hard to Diagnose in Kids?

1. Vague complaints: Young children may simply say, “My tummy hurts,” without pinpointing the pain.
2. Mimics other illnesses: Symptoms can resemble stomach flu, UTIs, or constipation.
3. Atypical appendix location: In some kids, the appendix sits behind the colon, causing back or pelvic pain instead of classic right-side discomfort.
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How Is Pediatric Appendicitis Diagnosed?

Doctors use a combination of physical exams, scoring systems, and imaging to confirm appendicitis.

1. Physical Examination

1. McBurney’s point tenderness: Pain when pressing the lower right abdomen.
2. Rebound tenderness: Increased pain when pressure is released.
3. Psoas sign: Pain when extending the right leg (indicates an irritated appendix).
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2. Pediatric Appendicitis Score (PAS)

A points-based system assessing:

1. Pain migration (1 point)
2. Anorexia (loss of appetite) (1 point)
3. Nausea/vomiting (1 point)
4. Fever (1 point)
5. Right lower quadrant tenderness (2 points)
6. High white blood cell count (WBC) (1 point)

Score ≥6 suggests appendicitis and warrants further testing.

Treatment Options for Pediatric Appendicitis

1. Surgery (Appendectomy)

The gold standard for treating appendicitis. Two main approaches:

A. Laparoscopic Appendectomy

1. 3–4 small incisions
2. Faster recovery (1–3 days in hospital)
3. Less pain, lower infection risk

B. Open Surgery

1. Used for ruptured appendix
2. Longer recovery (5–7 days in hospital)
3. IV antibiotics needed to treat infection
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2. Antibiotics Alone (Non-Surgical Treatment)

1. May work for early, mild cases
2. High recurrence risk (up to 40%)
3. Not recommended for ruptured appendix

Post-Surgery Recovery

1. First 24 hours: Clear liquids only
2. Days 2–3: Soft foods (applesauce, yogurt)
3. Activity restrictions:
4. Laparoscopic: No sports for 1–2 weeks
5. Open surgery: No heavy lifting for 2–4 weeks
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Complications of Untreated Appendicitis

If ignored, an infected appendix can:

✅ Rupture, spreading bacteria into the abdomen (peritonitis)

✅ Form an abscess (pus pocket) requiring drainage

✅ Cause sepsis (life-threatening infection)

Survival rate with treatment: Over 99%

Mortality if ruptured and untreated: Up to 50%

When to Go to the ER

Seek immediate medical help if your child has:

🔴 Severe, worsening belly pain

🔴 Fever + vomiting + refusal to eat

🔴 Abdominal swelling or extreme fatigue

Final Thoughts

Appendicitis in children can escalate quickly, but early detection saves lives. Trust your instincts—if your child’s stomach pain seems unusual, seek medical attention immediately. With prompt treatment, most kids recover fully and return to normal activities within weeks.

FAQs: What Parents Need to Know

1. Can a 3-year-old get appendicitis?

Yes! While rare in infants, cases have been reported in children as young as 6 months.

2. How can I comfort my child before the hospital?

1. Do NOT give food/water (surgery may be needed).
2. Apply a cool cloth to the forehead for fever.
3. Avoid pain meds (they can mask symptoms).

3. Can appendicitis be prevented?

No, but high-fiber diets may reduce blockage risks.

4. How long does recovery take?

1. Unruptured appendix: 1–2 weeks
2. Ruptured appendix: 2–4 weeks (with antibiotics)