Dr Andy Raffles
Is my child’s stomach ache really appendicitis?
A stomach ache is a very common occurrence, especially in children. While abdominal tummy pain accounts for about 1 in 10 of childhood visits to a Paediatrician or GP, the abdominal pain your child experiences is usually the result of something much less concerning then appendicitis such as:
Swallowing lots of air
A mild food allergy – such as milk, wheat or egg , and gluten sensitivity
A stomach or intestinal infection
Enlarged glands in the abdomen – called Mesenteric Adenitis
Recurrent abdominal pain of childhood
If your child's stomach ache intensifies or lasts for more than a day, it could be a sign of something a bit more concerning. But again, there's a long list of diseases that could cause this including:
A stomach ulcer
Inflammatory bowel diseases, such as Crohns Disease, Ulcerative Colitis, or Irritable Bowel Disease
Complications that twist, block, or obstruct the bowels, such as a hernia
But if your child's pain begins in the belly-button area and spreads to the lower right abdominal area, it may be the result of appendicitis, a medical condition in which the appendix — a small, finger-shaped pouch attached to the large intestine usually (but not always!) in the lower right belly area — becomes inflamed. Where children are seen for acute (sudden onset) of abdominal pain, about 10 to 30 percent have had appendicitis or another condition requiring surgical intervention.
Appendicitis most often affects early teens and those in their twenties, but it can occur in younger children as well. It is very rare in the under 5’ s but can occur and can be difficult to diagnose. It's usually caused by an abdominal infection that has spread to the appendix, or by a blockage in the appendix. Interestingly a family history of appendicitis is quite a good predictor of a child’s symptoms being due to appendicitis.
If your child's abdominal pain worsens with movement, deep breaths, coughing, or sneezing, the possibility that he or she has appendicitis should be seriously considered. Still, it's important to look for other signs of appendicitis.
The Signs and Symptoms of Appendicitis in Children often include:
Loss of appetite
Inability to pass wind or stool
Constipation or diarrhoea
Importantly, although some children and young people with appendicitis do experience other symptoms of the condition, including nausea, vomiting, and lack of appetite, these signs are not predictive of appendicitis in children.
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. This symptom or sign is not affected by pain relievers, so do give pain relief whilst awaiting a diagnosis.
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.
More on Symptoms of Appendicitis Appendicitis may also cause different sets of symptoms with very young children. Some studies suggest that kids between ages 2 and 5 most often experience stomach aches and vomiting if they have appendicitis; fever and loss of appetite also frequently occur. For infants younger than 2 years old, appendicitis usually causes vomiting, a bloated or swollen abdomen and fever, though diarrhoea is also not uncommon.
To confirm a diagnosis of appendicitis, doctors often use imaging procedures. For children an ultrasound first, followed by a CT scan only if the ultrasound is inconclusive. This is due to caution concerning radiation exposure in kids.
Treating Complicated and Uncomplicated Appendicitis in Children An operation, under an anaesthetic, called appendicectomy, which involves the surgical removal of the appendix, is the standard treatment for appendicitis in children as well as adults. If appendicitis isn't caught in its early stages, the appendix can rupture and cause an infection of the peritoneum, the membrane that lines the abdominal cavity. This infection, called peritonitis can quickly spread, potentially causing death.
Because appendicitis is more difficult to diagnose in children than adults — especially in children younger than 5 — some 30 percent of kids with the condition will suffer from a perforated (ruptured) appendix before being treated.
For kids with acute, non-perforated appendicitis (meaning the appendix hasn’t ruptured), an urgent appendicectomy is the accepted, optimal treatment. In many centres this is done through laparoscopic surgery, keyhole surgery. When the appendix has ruptured, though, there are two surgical courses of action: early appendicectomy (performed within 24 hours of admission) or interval appendicectomy (performed several weeks later) after antibiotics are used to treat infection.
Currently there hasn’t been a clear agreement on which is the best way to manage ruptured appendix in children — with conservative treatment (antibiotics followed by interval appendicectomy) or early appendicectomy.
When acute appendicitis is uncomplicated and the appendix hasn’t ruptured, there’s increasing evidence supporting antibiotics as an alternative to surgery in adults, and recent studies have also examined if this holds true in paediatric cases.
Recent information from research studies suggests non-operative treatment, i.e. use antibiotics given into a vein or high oral doses, is safe and effective in children with acute uncomplicated appendicitis.
Most children make a complete recovery, although sometimes the bowel takes a while to fully recover.