It begins with a simple complaint: "Mom, my belly hurts." Kids come to parents with all sorts of minor tummy troubles, so the parent decides to wait and see. Within just a few hours, the child seems to be hurting even more, so much so that he doesn’t want to play videogames on the phone or do much of anything other than lounge on the sofa. He is not hungry, and he’s not going to the bathroom much, either. So Mom begins to wonder, "Could this be appendicitis?"
It’s a question that just about every parent faces, and the answer is rarely an easy one. When is abdominal pain something serious, and when is it something that will work itself out? Parents can start their own assessment with a few basic questions: Did the consistent pain show up before any other symptoms – including diarrhea, vomiting or a fever? The first sign of appendicitis is pain. Did the discomfort start in the middle of the abdomen before moving mainly to the lower right side? Appendicitis pain is always present in the right lower portion of the belly. Is the pain constant? Cramping or pulsing isn’t usually a symptom of appendicitis. Is the child acting differently? Refusing fun activities and an overall change in disposition is a cause for concern with any health issue in children.
If the answers to these questions point toward appendicitis, it’s time to head to your local emergency care provider. You’ll have an even better idea about whether the child has appendicitis if the complaints intensify during the drive. Some patients with appendicitis say they hurt more every time the car crosses a bump in the road!
Once you arrive at an emergency room or physician’s office, your child will undergo a physical exam to determine the source of the pain, and they’ll likely ask you questions similar to those above. We can’t tell if someone has appendicitis using blood or urine tests, so the best way to diagnose it is with physical examination along with imaging technology.
Ultrasound is recommended as the initial imaging study because it doesn’t expose kids to radiation, but it can be hard to always identify an inflamed appendix this way. If it isn’t obvious on ultrasound, a child will most likely have a CT scan, which nine times out of 10 will show whether the appendix needs to come out.
Lots of families worry about the child’s appendix "bursting" or "rupturing." It happens when the pain has been going on for a couple of days, which indicates the infection is growing worse. If a child is assessed and treated quickly, this risk declines significantly – all the more reason to seek medical attention early!
In Arkansas, we do see perforation – or that "bursting" – in more than half of appendicitis cases. We believe this is because so much of the state is rural and many people have less access to urgent care than in urban areas. The bottom line: When abdominal pain is consistent and lower right-sided, don’t wait!
Treatment of appendicitis in kids is pretty straightforward. School-age kids will have surgery using a scope to take out the appendix. This usually results in three fairly small pencil-sized incisions. In preschool kids a single cut about two fingers wide will be made directly over the appendix. By the way, there is no age range for appendicitis, though we rarely see it in kids under 3. It’s much more common in school-age children all the way through young adults.
It’s always scary when a child needs to have surgery, but removing the appendix is one of the most common surgical procedures we perform at Arkansas Children’s Hospital. We average over 100 of these surgeries each year. Luckily, most go home within 24 hours. The kids that have experienced the perforated or "burst" appendix stay with us a little longer to get back to eating while receiving IV antibiotics. A child usually will be back to running and playing within a week of having his appendix removed, too.
When we talk with parents whose child has faced appendicitis, they always want to know what they could have done differently. Honestly? Probably not a thing! We’re not certain what causes the appendix to become inflamed, but we do know it’s not the stuff of old wives’ tales. Swallowed chewing gum, fingernail clippings, eating too many biscuits – none of these things cause appendicitis.
It’s possible that constipation may factor in, though. We do see more appendicitis cases in the spring and summer, when kids are more likely to be less hydrated and more constipated. And when we remove the appendix, we typically find a little bit of hardened stool blocking its opening to the large intestine.
One other piece of advice for parents heading to the hospital with a child in abdominal pain: Don’t let them eat or drink anything if you are bringing them to the hospital. If your child does need an appendectomy, having just had food or liquids will mean you may have to wait longer to go into surgery.
In general, the best way to prevent any kind of health issue is to hydrate well and proceed with good health habits. Though even then, families may face a serious concern like appendicitis.
Just remember, it can be hard for anyone to judge a child’s abdominal pain on their own at home. Always take a child with consistent, right-sided lower abdominal pain in for an exam. Even if the next few hours are overwhelming, a child with appendicitis will likely be diving back into video games and rowdy playground fun in just a few days.
Sam Smith, MD, is surgeon in chief at Arkansas Children’s Hospital and a professor of Surgery at the University of Arkansas for Medical Sciences. He writes a column each week covering a variety of kids’ medical concerns. If you have a topic you’d like him to consider addressing, email firstname.lastname@example.org.