What Are The Symptoms
According to the NHS there are lots of signs to look out for in your child.
The main symptom is pain around the belly button which moves to the right hand side of the body after a few hours.
Coughing, pressing on the area and walking will make the pain worse.
Your child might also have a high temperature and they might be sick.
It can also hurt when they go for a wee and they may be constipated.
If your child has tummy pain which gets much worse very quickly call 999.
Key Points To Remember About Appendicitis
- the appendix is a small finger-like tube attached to the first part of the large intestine
- appendicitis is an inflammation of the appendix
- appendicitis is a potentially serious condition
- children with appendicitis can deteriorate quickly
- go to your family doctor or after-hours medical centre first if you think your child has symptoms of appendicitis – if you cannot get an appointment straightaway, go to your hospital’s accident and emergency department
When Should I Take My Child To See His Or Her Healthcare Provider
A follow-up outpatient visit will be scheduled 2 to 4 weeks after your child’s surgery. Your child’s healthcare provider will examine the wound and evaluate his or her recovery.
In the meantime, minor swelling around your childs incision site is normal. However, call your childs healthcare provider if they develop any of the following:
- Excessive swelling, redness or drainage from the incision.
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What Happens After Surgery
How long your child stays in the hospital depends mostly on how bad the appendicitis is. For an early case of appendicitis most patients stay overnight and go home the day after surgery. Some can go home the same day.
For an advanced case of appendicitis , where the appendix has ruptured or burst, they will need to be in the hospital for about five days to receive more intravenous antibiotics. This will help treat the more severe infection and prevent it from coming back.
Your child will receive intravenous pain medication and antibiotics during his or her hospital stay.
Your child can leave the hospital when they can eat a regular diet, has no fever or drainage from the incision and has normal bowel function.
Anatomical And Physiological Origins Of Appendicitis Signs And Symptoms
The pathophysiology of appendicitis in children differs from that of adults because of the changing anatomical location and susceptibility of the appendix throughout childhood. Neonates develop appendicitis infrequently because they have a less-susceptible, funnel-shaped appendix. In addition, the soft diet, recumbent posture, and infrequent gastrointestinal and upper respiratory tract infections of infants help lower their appendicitis incidence. When neonatal appendicitis occurs, the mortality rate historically has been quite high , although 1 recent report cites a lower mortality rate for neonatal appendicitis of 28%.
Around age 1 to 2 years, the appendix assumes the typical adult shape and becomes more susceptible to appendicitis. Lymphoid follicle hyperplasia and follicular size gradually increase throughout childhood and peak in the adolescent years, corresponding to the period of highest incidence of appendicitis., Adolescents tend to have a lower perforation rate than younger children, probably because they present earlier in the course of disease with more typical appendicitis symptoms.
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What Are The Early Signs And Symptoms Of Appendicitis
The most common symptom of appendicitis is lower right abdominal pain, starting near the navel. The pain may come and go at first, but if its caused by appendicitis, it will progressively get worse over a few hours.
Signs your abdominal pain is caused by appendicitis:
- Your pain begins suddenly, possibly waking you from sleep.
- Your pain gets worse when you move, cough or breathe deeply.
- Your pain is severe, different from any other abdominal pain you may have had before.
Pain is the first sign something is wrong, but other symptoms of appendicitis may appear later, including:
- Abdominal swelling
- Vomiting
Comparison With Adult Data
Comparing the current analysis in children with the previous Rational Clinical Examination article examining appendicitis in adults yields noteworthy similarities and differences. Right lower quadrant abdominal pain, typically identified as a classic symptom of appendicitis, was a much stronger predictor in adults than in children . Fever, anorexia, nausea, and vomiting were all poor independent predictors of appendicitis in both adults and children. Rebound tenderness and the psoas sign performed similarly in children and adults.
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What Happens After Appendicitis Surgery
Post-surgery, your child will not be allowed to eat or drink any fluids, as his intestines recover. His nutrition will be taken care of with intravenous fluids, through which medication will also be administered. If the appendix had ruptured, then he will have to stay longer in the hospital longer than if it hadnt. In either case, your child will have to continue taking antibiotics even after he is discharged for a certain period of time.
After discharge, your child must not play any contact sports or lift heavy objects. Some of the pain medications prescribed can cause constipation. Talk to your doctor about this and try to find a solution for the same. Light movements after the surgery instead of staying still will help reduce the occurrence of constipation. Once your child can eat solid foods again, she must have a fiber rich diet and drink plenty of water and soups.
The Signs And Symptoms Of Appendicitis In Children
In most adults, there is a very specific set of appendicitis symptoms that accompany abdominal pain. These often include:
- Loss of appetite
- Inability to pass gas or stool
- Abdominal swelling
- Constipation or diarrhea
But research suggests that appendicitis can affect children differently than adults. Along with abdominal pain, most kids with appendicitis often experience fever and a symptom known as “rebound tenderness,” a sharp pain that develops after pressure is placed on the lower right abdominal area and quickly released. Children may also have an elevated white blood cell count, which is a sign of an infection. Your doctor can check this with a blood test.
Importantly, although some kids with appendicitis do experience other hallmark symptoms of the condition, including nausea, vomiting, and lack of appetite, these signs are not predictive of appendicitis in children, according to a study published in July 2007 in the Journal of the American Medical Association.
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How To Elicit The Relevant Symptoms
Obtaining a history from children frequently challenges nurses and physicians. The evaluation of abdominal pain is dependent on the age of the child because young infants require an entirely different approach to elicit a relevant history than older adolescents. Parents, siblings, and other caregivers may be present in the examining room each may have a different perspective on the childs illness. Although most older children can give a history of their illness, toddlers and young school-aged children need a caregiver to communicate their history. In preverbal children, who may not be able to express how they feel or localize their pain, clinicians need to detect potential pathologic findings based on how children have been eating, playing, sleeping, and stooling. Although parents might be good judges of how their child feels, clinicians must draw appropriate conclusions from parents assumptions. Many children, especially younger ones, can be highly suggestible. Despite their contradictory meanings, questions such as Does it hurt here? and This feels fine, right? may yield the same yes response from many children.
What Are The Early Signs Of Appendicitis
Each child may feel the symptoms of appendicitis differently. For this reason, you must be vigilant about the collection of symptoms they present.
The pain of a ruptured or inflamed appendix usually manifests around the belly area. Afterward, it can move to the lower right or left side of the belly. If your childs pain doesnt subside or feels worse while moving or being touched, it could be a sign of an inflamed appendix.
Other symptoms of appendicitis include constipation, loose stool, or fever and chills. These are due to the compromised appendix and the spread of bacterial infection in the abdomen. If your child has these symptoms and more, its best to rush them to the nearest emergency clinic.
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Search Strategy And Quality Review
We searched MEDLINE via PubMed for articles published between January 1966 and March 2007. We crossed the parent search strategy for the Rational Clinical Examination with the terms appendicitis AND diagnosis, limited to articles in English involving children aged 0 to 18 years. The titles and abstracts of the final set of 2521 articles were independently reviewed by 3 authors . Articles selected by at least 2 authors were retrieved for full-text review those selected by only 1 author were reexamined by all 3 reviewers and selected by consensus. For our secondary search, we hand-searched the bibliographies of retrieved articles and reviews. We also consulted widely used medical history taking and physical examination textbooks for relevant signs, symptoms, and citations.- Sign- and symptom-focused MEDLINE searches and Cochrane Database searches further supplemented our secondary search. Our combined searches yielded 256 articles for full-text review.
Is Appendicitis Common In Children
Appendicitis is a common condition that affects a lot of children on a regular basis it is also something that can affect adults. Understanding who is most at risk can help you identify if a loved one may be affected and the breakdown of age groups most at risk are:
- Appendicitis is mostly common in children between the ages of 9-15. This is known as pediatric appendicitis.
- It has been known to manifest in adults up to the age of thirty but is not as common. The second most common age group for appendicitis is 16-30.
- This condition is highly unlikely to affect toddlers, infants and adults above 30 years. Although extremely rare, children from the age of 2 to 8 and adults beyond the age of 30 can theoretically be affected by this.
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How Long Will My Child Be In Hospital
A child with non-perforated appendicitis is generally in the hospital for 1-2 days following surgery.
A child with perforated appendicitis may require hospitalization for up to one week or longer. The child must stay in the hospital until they are:
- Eating
- No longer having high fevers for at least 24 hours
- Able to walk in the hallway
- Pain is managed with oral pain medications
- In selected cases, lab tests are used to guide the length of treatment
How Will Appendicitis Be Treated
Treatment is with surgery to remove the appendix, often performed using a laparoscope key-hole surgery or via a traditional incision. Your child will generally stay in hospital for 2-3 days.
One parent is usually allowed to go in with the child before theyre given the anaesthetic prior to the surgery. It can be daunting but the procedure is routine and generally goes ahead with no issues.
One thing to be aware of is that seeing your child after surgery can be distressing.
I thought my daughter would be calm and a bit hazy after the operation, says Tanya B. But she was crying in pain, was very disorientated and was begging for water of which she was only allowed a few small drops at a time but not too much in case she was sick.
She did get painkillers which kicked in quickly but I think its good to know beforehand that your child will probably be seriously out of sorts when they come round: its scary but it does pass and theyll be a different person in a couple of hours.
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The Road To A Diagnosis
The appendix is often referred to by doctors as “vestigial,” which means that it has no known function. We rarely think about it until it misbehaves. The problems begin when something in the intestines — typically a hard piece of stool — obstructs the opening to the appendix. Bacteria get trapped inside, and the irritated appendix swells. The intestine’s natural function is to squeeze, moving food and waste through the digestive tract. The obstruction prevents it from squeezing. That leads to nausea and, in some patients, vomiting and/or diarrhea. The pain usually moves from around the belly to the lower right side of the abdomen during the first 12 to 24 hours after the obstruction begins. During that time, the pain will worsen, but it’ll be easier for a doctor to recognize the problem.
Between 25 and 50 percent of children who develop appendicitis will have a rupture, which occurs when the appendix gets so inflamed its wall breaks down. The hole lets intestinal bacteria, stool, and mucus leak into the otherwise sterile abdominal cavity and cause a serious infection. Sometimes the rupture happens within the first 18 hours after the obstruction, but it can take several days — or not happen at all.
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Poor Neighborhoods Linked To Delayed Access To Appendicitis Care In Kids Study Finds
Feb. 16 — Children living in neighborhoods with lower-quality schools and housing, high crime, and limited economic opportunities are more likely to develop complicated appendicitis, a study published Wednesday by JAMA Network Open found.
People age 18 years and younger with appendicitis living in neighborhoods with lower scores on the Child Opportunity Index had a 28% higher risk for the more severe form of the common condition compared to children from wealthier areas, the data showed.
This indicates they may be experiencing delays in diagnosis and access to care, the researchers said.
“Timely access to pediatric surgical care may help reduce the need for emergency surgery, long hospital stays or admission to the intensive care unit,” study co-author Dr. Fizan Abdullah said in a press release.
“Our findings may help in developing policies and programs to increase community opportunity and ensure that all children, no matter where they live, gain equitable access to surgical care,” said Abdullah, head of pediatric surgery at Lurie Children’s Hospital in Chicago.
The findings are based on an analysis of nearly 67,500 children diagnosed with appendicitis nationally between Oct. 1, 2015, and Sept. 30, 2018.
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When To Contact Your Childs Doctor
Childhood appendicitis is extremely treatable but can be serious. You should rush your child to the doctor if none of the symptoms seem to be abating. If your child is in severe pain, then seek immediate medical assistance. A ruptured appendix causes more complications and is harder to recover from. Reaching your doctor early enough is a key to a quick recovery.
Appendicitis can be an exhausting and excruciating experience for everyone involved. Follow your doctors instructions, and treat the condition fully and at an early stage to help your child live a long, healthy life. Do not medicate your child without your doctors knowledge or prescription. For the treatment to be completely effective, ensure you fully disclose all information about your childs medical history to your doctors.
What Preparation Is Needed
Once a decision has been made that your child needs to have an appendectomy:
- Your child will not be permitted to have any drink or food by mouth
- Your child will have intravenous fluids to keep them hydrated
- Your child will receive antibiotics through the drip
- Your child will receive pain killers to keep them comfortable whilst waiting for the operation
- The person with parental responsibility will be asked to sign a consent form. The operation will be described to you in detail at this time and you are encouraged to ask any questions that you may have.
- Your child will be operated on as soon as possible. Unfortunately, due to other emergency patients your child may have to wait some hours for the operation to take place. You will be kept updated by your nurses and doctors.
- Where possible your child will be seen by one of our play specialists who will be able to help prepare your child with regard to what to expect and address any fears they may have.
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What Are The Complications Of Appendicitis
If doctors don’t remove an inflamed appendix, it can sometimes burst. If this happens, the infected contents of the appendix spill into the abdominal cavity. This is a more serious medical emergency. If left untreated, infection of the lining of the abdominal cavity can be life-threatening. This requires immediate emergency treatment, including an intravenous line and antibiotics.
The signs of a perforated appendix include:
- a severe worsening of symptoms – especially severe abdominal pain and swelling
- reluctance to move because it makes the pain worse
Could That Stomachache In Your Child Be Appendicitis
When children are stressed or anxious, their bodies release the hormone cortisol into the blood. This can trigger abdominal cramps and discomfort. Appendicitis is an inflammation of the appendix. It causes sudden pain that begins around the navel and then moves to the lower right abdomen.
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Let Weary Surgeons Sleep
Several generations of general surgeons have the indelible memory of a beeper going off just as they drift to sleep, alerting them to a patient in the emergency department with acute appendicitis, Dr. John Hunter of the department of surgery at Oregon Health & Science University in Portland said in a journal commentary accompanying the study.
The surgeons would then spend between four hours to the whole night examining, imaging and treating the patient, leading to yawns and struggles to pay attention the next day.
The main benefit of the latest findings is to validate the practice of treating acute appendicitis urgently rather than as an emergency, Hunter said.
“The ability of a surgeon to sleep through the night results in a day without the fatigue engendered by a sleepless night caring for a patient with acute appendicitis,” Hunter said.
“A secondary benefit is the savings to the hospital generated by minimizing staff and anesthesiologist presence late in the evening and during the wee hours of the morning.”
Pediatric researchers have also found similar results in smaller studies on children, Nathens said.
