Appendicitis: Children and Teens

Appendicitis is an inflammation that can lead to infection of the appendix. It affects 7 percent of Americans and is the most common reason for a child to need emergency abdominal surgery, according to the American Academy of Family Physicians. Young people between ages 11 and 20 are most often affected. A child, especially a boy, may have a greater risk for appendicitis if someone else in the family had it.

The appendix is a small, fingerlike structure attached to the large intestine in the lower right side of the abdomen. Appendicitis occurs when the appendix is blocked by a piece of stool, a foreign body that was swallowed, or swelling from an infection. Bacteria then invade the wall of the appendix. This causes more damage.

If the infected appendix isn't removed, the appendix may leak or burst. This can cause either a localized infection or a life-threatening condition called peritonitis.

There's no way to prevent appendicitis. It is rare in countries where people eat a high-fiber diet, but experts haven't yet shown such a diet definitely prevents it.

Signs and symptoms

The symptoms of appendicitis in older children and teens are abdominal pain, fever, and vomiting. The pain usually begins in the center of the abdomen, around the area of the navel. Later, it may move downward and to the right.

After abdominal pain begins, older children and teens with appendicitis usually develop a fever, lose their appetite, feel nauseous, and may vomit. Other symptoms include diarrhea; the need to urinate frequently; a strong urge to urinate; constipation; and, sometimes, respiratory symptoms.

In children younger than age 2, the most common symptoms are vomiting and a bloated and swollen abdomen.

Diagnosis

It can be difficult to diagnose appendicitis, especially in younger children. Even experienced health care providers aren't able to diagnose it 100 percent of the time. Lab testing, ultrasound, and CT scans, along with history and physical examination, are most frequently used to establish a diagnosis. 

Treatment

Appendicitis is a medical emergency that is most often treated surgically. If the appendix is removed surgically before it bursts, complications are rare. The hospital stay is usually 2 or 3 days. If the appendix breaks, a longer hospital stay is needed after it's removed. 

In some cases, appendicitis may be treated with antibiotics alone, or by drainage done through the skin and, at a later time, an appendectomy.  

When to call your health care provider

Call your health care provider immediately if you suspect your child has appendicitis. This will give your health care provider more time to confirm the diagnosis and remove the infected appendix before it leaks or bursts and spreads infection. If you are unable to contact your health care provider, don't wait, go directly to the emergency room.

If it appears your child may have appendicitis, don't give him or her pain medication or anything to eat or drink. Having an empty stomach speeds preparation for surgery, if needed.