Appendicitis can strike at any age, though it is more likely to affect a child. It happens when your child’s appendix becomes inflamed and infected. The most common symptom is severe pain in the child’s lower right abdomen.

Treating acute appendicitis typically calls for removing your child’s appendix through surgery. Timely treatment is critical. The longer the infected appendix goes without treatment the more likely it is to rupture and cause a life-threatening condition.

Is Appendicitis Common In Children?

Every year an average of 70,000 children in the United States are diagnosed with appendicitis. This condition is most often seen in children between the ages of 10 and 19 years. It is a common reason for a child to visit the Emergency Room.

What Causes Appendicitis?

The appendix is a small tube shaped pouch attached to the large intestine and usually located in the lower right side of the abdomen. While its function is not entirely known, many believe its role is to store “good” bacteria, so that when we are ill with a gastrointestinal infection or treated with antibiotics we can more easily repopulate the colon. While the cause of appendicitis isn’t always clear, most often it is due to obstruction at the mouth of the appendix, sometimes by a stony mass of feces called a fecalith. The obstructed appendix then becomes inflamed and infected, causing pain. Appendicitis might also be associated with:

  • A recent abdominal infection
  • A digestive tract infection
  • Recurring problems with inflammatory bowel disease
  • An unknown intestinal parasite

What Are Common Symptoms of Appendicitis in Children?

The most common symptom of appendicitis in children manifests as abdominal pain localized in the lower right area of the child’s abdomen where the appendix is located. Many times the pain starts near the child’s belly button and moves to the lower right side as inflammation increases. Other symptoms of childhood appendicitis might include:

  • Sudden loss of appetite
  • Nausea & vomiting
  • Fever (commonly occurring 24-48 hours after onset of symptoms)
  • Pain with movement (including walking or shifting position in bed)

Appendicitis usually progresses in severity and pain over the course of several hours leading to the old adage “the sun never sets on appendicitis.”

How Is Appendicitis Diagnosed?

Appendicitis is first and foremost a clinical diagnosis based on history and physical exam. Therefore, your child’s primary physician will first perform a detailed medical history and physical. Your pediatrician might then order blood and urine tests to check for signs of an infection or inflammation.

Imaging studies of the abdomen may support the diagnosis. This might include an ultrasound or a CT scan to get a better understanding of the severity of the problem, and to help to assess the imminent risk of the appendix rupturing.

How Is Appendicitis Treated?

Most cases of acute appendicitis are treated by removing your child’s appendix. The surgery to remove the appendix is called an appendectomy. In a small number of cases of appendicitis where the symptoms and infection are mild and the problem is diagnosed early, treatment might involve antibiotics and observation only.

How Is An Appendectomy Performed?

There are different techniques that a pediatric surgeon might employ to treat acute appendicitis in a child including laparoscopic surgery and open appendectomy.

Laparoscopic Appendectomy

With a laparoscopic appendectomy, your child’s surgeon makes a series of small incisions in your child’s abdomen. They will then carefully insert a video camera laparoscope through one of the incisions. The surgeon uses the images to guide them through removing the inflamed appendix using special pediatric surgical tools. This type of appendectomy has a shorter recovery time as well as a lower infection rate.

Laparotomy Appendectomy

Also known as an “Open Appendectomy”, this procedure involves 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 each surgery, your child’s physician will administer a dose of antibiotics. During each procedure, a pediatric anesthesiologist will give your child anesthesia to induce a deep sleep and provide analgesia.

What Happens If My Child’s Appendicitis Isn’t Treated?

Acute appendicitis is a very serious condition. If it isn’t treated as soon as possible, your child’s appendix could rupture. When this happens bacteria rapidly spreads throughout your child’s abdomen. These bacteria can cause a serious infection called peritonitis. In some cases, a ruptured appendix might allow bacteria to infect the bloodstream, causing a life-threatening condition known as sepsis.

How Long Does It Take A Child To Recover After An Appendectomy?

The duration of stay in the hospital will largely depend on the severity of your child’s appendicitis. If it was caught early, most children only stay overnight and go home the day after surgery. Some can go home the same day.

In a severe or advanced case of appendicitis, a perforation of the appendix may occur. Because in this case the appendix has already ruptured, your child might need to stay in the hospital for up to five days to receive more antibiotics and observation.

Your child will be able to leave the hospital when they can eat a regular diet and have no fever or any lingering signs of drainage from the incision. They will need to demonstrate normal bowel function before they can be released.

What Are the Potential Complications After Appendectomy Surgery?

It is rare to have surgical complications following a laparoscopic procedure to treat an early and/or uncomplicated appendicitis. Complications are more common with advanced cases of ruptured appendicitis and can include:

  • Chronic pain
  • Infections near the incision site
  • An abscess, or pockets of pus
  • Small bowel obstructions that block the small intestine

How Long Does It Take for A Child To Feel Better After An Appendectomy?

The majority of children recover rapidly after appendectomy surgery without needing any significant changes in diet or lifestyle. Some children who need laparoscopic surgery will need to limit their physical activity for three to five days after being released from the hospital. A child who has a laparotomy should rest for 10 to 14 days before engaging in physical activity.

Your child will need to see their pediatrician for a follow-up visit in 2 to 4 weeks after appendectomy surgery. Your child’s healthcare provider will examine the wound and evaluate his or her recovery.

You should contact your child’s physician if they develop any problems with:

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