Appendicitis in Children
What is appendicitis in children?
Appendicitis is a painful swelling and infection of the appendix. It is a medical
emergency. The appendix can burst or rupture. This is serious and can lead to more
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 is not a vital organ. Removing it is not
Surgery to remove the appendix is called an appendectomy. It is 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 nose or mouth fluid, called mucus. It
can also occur because of 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 is 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 is
more detailed than a general X-ray.
Other tests may include:
- Blood tests. These tests check the infection. 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 is 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.
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 may first have IV antibiotics. These are
given through an IV tube called a PICC line, or a peripherally inserted central catheter.
This is done for about 10 to 14 days. In addition, the provider may 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 will be given
by IV into the bloodstream. Your child will also have antibiotics and medicines to
ease pain through the IV.
At some point, your child will be able to drink clear liquids such as water, sports
drinks, or apple juice. He or she will slowly move on to solid foods.
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. 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 is removed.
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 the 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 situation and could
be fatal. If you think your child has appendicitis, call your child’s provider or
go to the emergency room right away.
Key points about appendicitis in children
- Appendicitis is a painful swelling and infection of the appendix. It is a medical
- 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.