Appendicitis in Children
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
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
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 intravenous line (IV) 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
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
one or more small incisions. The laparoscope is put in through another incision. This
method is not usually done if the appendix has already burst.
Sometimes the appendix bursts, and a collection of infected fluid or pus (abscess)
may form. If this happens and your child is stable, the provider may recommend not
removing the appendix right away. Instead, the provider may want to treat the infection
first and drain the infected fluid from the abscess. The appendix will be removed
later. This delayed surgery is called an interval appendectomy.
For an interval appendectomy, your child will be given IV antibiotics. These are given
through an IV tube called a PICC line, or a peripherally inserted central catheter.
This stays in place about 10 to 14 days. The provider may also use CT or ultrasound-guided
images to drain the abscess. Once the infection and inflammation are gone, your child
will have surgery to remove the appendix about 6 to 8 weeks later.
A child whose appendix ruptured will have to stay in the hospital longer than a child
whose appendix was removed before it burst. Some children will need to take antibiotics
by mouth for a certain period of time after they go home.
After surgery, your child will not be allowed to eat or drink anything for a certain
period of time. This lets the intestine heal. During this time, fluids, antibiotics
and pain medicine will be given by IV into the bloodstream.
As the healing progresses, your child will be able to drink clear liquids such as
water, sports drinks, or apple juice. and will gradually move on to soft then solid
After your child leaves the hospital, the healthcare provider will likely limit his
or her activities. Your child should not do any heavy lifting or play contact sports
for a few weeks after surgery or as instructed. If a drain is still in place when
your child goes home, he or she should not take a bath or go swimming until the drain
You will be given a prescription for pain medicine for your child to take at home.
Some pain medicines can make a child constipated, so ask your healthcare provider
or pharmacist about any side effects. Moving around after surgery rather than lying
in bed can help prevent constipation. Drinking fruit juices may also help. Once your
child can have solid foods again, eating fruits, whole grain cereals and breads, and
vegetables can also help stop constipation.
Most children who have their appendix removed will have no long-term problems.
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
When should I call my child's healthcare provider?
An infected appendix can burst or rupture. This is an emergency and could be fatal.
If you think your child may have appendicitis, call your child’s provider and go to
the emergency room right away.
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
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.
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.