Appendicitis in Children

What is appendicitis?

Appendicitis is an infection or inflammation in the appendix. The appendix is a small, tube-shaped organ attached to the large intestine. It is located in the lower right side of the abdomen. If your child’s appendix gets infected, it needs treatment right away.

What happens if appendicitis isn’t treated?

Appendicitis is a very serious condition. If appendicitis isn’t treated, your child’s appendix can burst open (rupture). A ruptured appendix can spread bacteria throughout your child’s abdomen. These bacteria can cause a serious infection called peritonitis. A ruptured appendix also may allow bacteria to infect the bloodstream — a life-threatening condition called sepsis.

How common is appendicitis in children?

Appendicitis affects 70,000 children per year in the United States. It is most common in kids between the ages of 10 and 19 years. Appendicitis is the most frequent cause for emergency abdominal surgery in childhood.

What causes appendicitis in children?

The cause of appendicitis in kids is not always known. Most often, it is caused by an obstruction (blockage) at the opening of your child’s appendix. It also can be caused by:

• Abdominal infection.
• Digestive tract infection.
• Inflammatory bowel disease.
• Stool, parasites or growths inside your child’s appendix.

What are the symptoms of appendicitis in children?

Abdominal pain in the lower right area of your child’s abdomen is a key sign of appendicitis. The pain often starts around your child’s belly button and moves to the lower right side later. Other symptoms may include:

• Nausea and vomiting.
• Loss of appetite.
• Low-grade fever.

How is appendicitis in children diagnosed?

Your child’s healthcare provider will do a physical exam. They will ask you about your child’s symptoms and medical history. Your child’s healthcare provider may order blood and urine tests to check for infection. In addition, your child may have images of his or her abdomen taken.

What types of images will my child’s healthcare provider use?

Imaging tests to diagnose appendicitis in kids may include:

• Abdominal X-ray.
• An abdominal ultrasound uses high-frequency sound waves to show images of your child’s organs.
• Computed tomography (CT) scan shows cross-sections of your child’s body. It uses a combination of X-rays and computer technology.

How is appendicitis in children treated?

Sometimes appendicitis in kids may be treated with antibiotics alone. But most often, appendicitis is treated by removing your child’s appendix. The surgery to remove the appendix is called an appendectomy. Appendectomies may be performed in one of two ways:

• Laparoscopic: A surgeon makes several small incisions (cuts) in your child’s lower right abdomen. Your surgeon will then place a video camera through one of the incisions. They will then use small tools to remove your child’s appendix through the incisions. This type of appendectomy has a shorter recovery time and a lower infection rate.
• Laparotomy (open): A surgeon makes one larger incision in your child’s lower right abdomen. This type of appendectomy often is used in more complicated cases of appendicitis. It has a longer recovery time.

Before surgery, your child will receive antibiotics. A physician who specializes in pain relief and sedation in children (pediatric anesthesiologist) will give your child anesthesia. Anesthesia brings on sleep. The surgery will take about an hour to perform.

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 (acute 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 (perforated appendicitis), where the appendix has ruptured or burst, they will need to be in the hospital for about five days to receive more intravenous (IV) antibiotics. This will help treat the more severe infection and prevent it from coming back.

Your child will receive intravenous (in the vein) 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.

What complications may arise after surgery for appendicitis?

Complications sometimes occur after an appendectomy. These complications are more common with more advanced cases of ruptured appendicitis and can include:

• Infections: Infections may be treated with antibiotics. Sometimes, the wound may need to be opened to clean out the infection.
• Abscesses (pockets of pus): Abscesses can sometimes be treated with antibiotics. Bigger abscesses may need to be drained.
• Small bowel obstructions: Partial or complete blockage of the small intestine can occur. Surgery may be needed.

How soon after treatment will my child feel better?

Most children recover quickly after surgery. No diet or lifestyle changes are necessary. Kids who had laparoscopic surgery should limit their physical activity for the first three to five days of recovery. Children who had open (laparotomy) surgery should rest for 10 to 14 days before engaging in physical activity.

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 child’s incision site is normal. However, call your child’s healthcare provider if they develop any of the following:

• Fever.
• Increasing pain.
• Vomiting.
• Excessive swelling, redness or drainage from the incision.

What questions should I ask my child’s healthcare provider?

If your child has appendicitis, you may want to ask their healthcare provider:

• What kind of appendectomy surgery does my child need?
• When can my child go back to school?
• How can I tell the difference between appendicitis and other stomach problems?

A note from Cleveland Clinic

Appendicitis is a very serious condition. If you think your child may have appendicitis, contact his or her healthcare provider right away. It may be difficult to explain appendicitis to your child, but it's important to be honest. Tell your child they have a problem that needs to be fixed at the hospital. Explain that surgery can fix the problem and they won’t feel any pain because they’ll be asleep. A doctor will wake them up when the surgery is over. Remind your child that you’ll be there waiting for them and they’ll feel better soon.