According to a January 2004 article in "Pediatrics," appendicitis is the most common surgical emergency in children in the United States. Because many of the symptoms mimic symptoms of other, more common conditions, there is often a delay in diagnosis of appendicitis in children, particularly with younger children. Knowing the classic signs and symptoms, and being aware of symptoms that might easily be overlooked, can lead to an earlier diagnosis, which is important in preventing complications.
Abdominal Pain
Pain from appendicitis usually starts around the belly button. It worsens over a period of about 24 hours and then moves to the lower-right part of the belly. In addition to the pain, most children have "rebound tenderness." This is when someone presses down on the child's belly and as the pressure is released, the child has sharp, extreme pain on the lower-right side.
Fever
A 2007 study published in the "Journal of the American Medical Association" found that in children with abdominal pain, fever was the No. 1 predictor of appendicitis. The fever may be low-grade in the beginning. If appendicitis goes unrecognized, the appendix can rupture, which is a true medical emergency. With a ruptured appendix, a child's fever usually goes up abruptly, as high as 104 degrees F.
Vomiting
Because children with appendicitis have repeated vomiting, they are often wrongly thought to have a stomach bug early on. Children with a stomach bug usually begin to improve after about 24 hours and often develop diarrhea within the next day or two. Children with appendicitis have prolonged vomiting that worsens over time and rarely have diarrhea.
Loss of Appetite
Many children with appendicitis lose their appetite, although this is a much more reliable symptom in adolescents and young adults than in younger children.
Symptoms in Younger Children
The younger the child with appendicitis, the less likely they are to have the classic symptoms. Very young children with appendicitis may have mild abdominal pain that continues over the course of several days before getting severe. They may complain only of pain around the belly button instead of having pain that progresses to the lower-right part of the belly. This is worrisome, given the fact that the longer appendicitis goes unrecognized, the higher the likelihood for complications. In fact, 80 percent of appendicitis cases in children under the age of 4 result in a ruptured appendix. Because of this, any young child with abdominal pain should be watched closely for any other signs of illness. Appendicitis should always be considered in young children with abdominal pain, even if many of the "classic" symptoms aren't there. Abdominal pain in a young child that persists for more than a few days should be evaluated by a doctor.
References
- "Pediatrics"; The Diagnosis of Appendicitis in Children: Outcomes of a Strategy Based on Pediatric Surgical Evaluation; A. Kosloske et al; January 2004
- "Journal of American Medical Association"; Does This Child Have Appendicitis?; D.G. Bundy; July 2007
