APPENDICITIS IN CHILDREN
Appendicitis is an inflammation (infection) of the appendix. The appendix is a hollow tube about the size of your little finger that forms a blind pouch where the small intestine joins the large intestine. In 99 percent of all children, the appendix lies in the lower right quarter of the child’s abdomen.
Appendicitis can occur at any age. If the appendix is not surgically removed, the infection worsens until the appendix bursts. Then the infection spreads throughout the abdomen. An infected appendix may perforate (rupture) within hours of the initial pain or may not rupture for a day or two. A ruptured appendix can lead to death.
Signs and symptoms
Persistent abdominal pain in your child should be considered a symptom of appendicitis until proven otherwise. Typically, the pain of appendicitis is constant; it does not come and go as does the pain from cramps. Once it starts, it grows continually worse. The pain may start in the pit of the stomach, but it usually soon moves to the lower right quarter of the abdomen. The pain is made worse by walking or just moving about. The abdomen is tender to a gentle pressure in the lower right quarter, more tender than in other areas. There may be nausea and vomiting, but these symptoms usually start only after the pain has started.
Generally, there is a low-grade fever (37.8°C, oral; 38.3°C, rectal), but the temperature may range anywhere from normal to 40°C. Bowel movements are usually normal, but there may be diarrhea. Diagnosis is difficult because all of these signs may not be present. Because diagnosis is so difficult and the condition is so serious, call your doctor if you have any reason to suspect appendicitis.
Home care
Try applying gentle heat, as with a heating pad turned to “low.” If pain gets worse, it is probably appendicitis. Never apply cold; this can mask the symptoms of appendicitis.
Do not give pain killers such as paregoric or codeine. Acetaminophen is safe but useless. Aspirin can affect the blood’s ability to clot, so it should not be given in case the child needs surgery. Allow only clear liquids by mouth. However, once you suspect that there is a strong possibility of appendicitis, do not give your child any food or drink until you consult your physician. Never give a laxative or enema.
Precaution
If pain persists in the lower right quarter of the abdomen, despite home treatment measures, call your doctor.
Medical treatment
The only acceptable treatment for appendicitis is surgical removal of the appendix (an appendectomy). Therefore, your doctor must be reasonably sure of the diagnosis. In addition to the abdomen, your child’s chest and throat will be examined because a throat infection and pneumonia can cause symptoms of appendicitis. A rectal examination will also be performed and a blood count and a urinalysis done. (These last two tests do not prove or disprove appendicitis, however.) An X ray may be called for.
Once tests are complete, your doctor may operate or admit your child to a hospital to watch the child for a few hours until the diagnosis becomes more certain. Unnecessary surgery is to be avoided, but the rule of safety is to operate on a child who may have appendicitis rather than postpone surgery until the appendix ruptures.
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