Appendicitis is the most common cause of emergency stomach surgery in kids. Appendicitis affects 30 percent of kids under 5 years and rarely occurs in kids under 1 year of age. Knowing early on the causes and symptoms of appendicitis in kids is very important to prevent ruptured appendicitis that can threaten your child’s life. The question is how to find out that kids have appendicitis, which needs to be done as soon as possible for an emergency appendectomy, which this procedure carries its own risks or allows that can cause appendicitis to rupture and threaten the child’s life. Some studies answer the symptoms of appendicitis in kids such as abdominal pain around the navel, vomiting, diarrhea, fever, increased white blood cells, and others.
The importance of knowing early symptoms of appendicitis in kids
Appendicitis in kids aged 4 years and under has a high risk for rupture because it has fewer symptoms than teenagers and adults. Appendicitis in kids is also difficult to diagnose because pain is localized to the lower right part of the abdomen, and parents usually delay checking. This causes 80 percent of appendicitis in kids to end with rupture.
Appendicitis in kids needs attention when your child has severe stomach pain or persistent fever and you suspect the appendix has ruptured. A ruptured appendix causes bacteria to infect organs in the abdominal cavity and cause peritonitis.
Appendicitis ruptures in kids causing more infections, and if not treated immediately can have serious consequences. Rupture of the appendix rarely occurs after the first 24 hours of symptoms, but the risk of rupture will increase after 48 hours of symptoms. Therefore, it is very important to recognize the early symptoms of appendicitis so that we can immediately seek appropriate medical treatment.
Symptoms of appendicitis in kids
Knowing the symptoms of appendicitis in kids early can help narrow the diagnosis of a pediatrician so that treatment can be faster. Some of the symptoms that we have identified are strong signs of appendicitis in kids, generally, are lower abdominal pain. This is related to the appendix which is located in the lower right part of the stomach.
Abdominal pain is not always a sign of appendicitis, you must determine the severity of the pain. If your child complains of a stomachache but can still laugh, play and eat, then it’s likely not a serious problem.
Stomach ache is a common occurrence that is often experienced by kids and is not life-threatening, as revealed in an American Family Physician report in 2016 if it relates to constipation, gas, laryngitis, anxiety, snacking allergies, swallowing a lot of air, and stomach or intestinal infections (gastroenteritis). Abdominal pain in children can also occur due to peptic ulcers, urinary tract infections (UTI), gallstones, cancer, and hernias.
Stomach pain associated with appendicitis usually occurs more than one day and continues to increase. Other symptoms if he complains of extreme pain, and do not do what they normally do, then you should take the child to the doctor.
Appendix symptoms also occur when kids complain of abdominal pain and lie on their side with legs raised toward the abdomen, they usually also complain of pain and walk bent in the middle. Abdominal pain due to appendicitis in kids begins in the area around the navel and moves to the lower right side of the navel. Abdominal pain also often worsens over time and will get worse when your child moves, is touched, coughs, sneezes, and when taking deep breaths. This pain will also be felt throughout the stomach if the appendix ruptures.
Abdominal pain due to appendicitis involves the onset of pain, cramps throughout the abdomen gradually. Abdominal pain is also a result of the peritoneum, which is an irritation in the lining of the abdominal wall. Other symptoms such as lower back pain or pelvic pain occur when some people have appendicitis behind the large intestine.
In addition to abdominal pain, other symptoms of appendicitis in kids are nausea and vomiting, loss of appetite, mild fever, changes in behavior, diarrhea for several days, flatulence or swelling, difficulty in defecation (constipation), and increased urination.
Symptoms of a mild fever due to appendicitis occur due to infection when your appendix ruptures, the appendix which ruptures can also increase heart rate. Appendicitis causes fever between 99 ° F (37.2 ° C) and 100.5 ° F (38 ° C) and when your child’s appendix ruptures, your child will have a fever greater than 101 ° F (38.3 °C).
Symptoms of appendicitis in kids can also be marked by your child having difficulty passing gas. This is a sign of partial or total obstruction of your intestine related to appendicitis. A distended child’s stomach is also known as one of the symptoms of appendicitis or obstruction problems.
Appendicitis in kids also causes an increase in the number of white blood cells which is a sign of infection. An increase in the number of 10,000 or more white blood cells per microliter can be proven by examining blood tests by doctors. Some kids also experience symptoms such as vomiting green liquid that indicates there is a blockage in the stomach or intestine and must be treated quickly.
How to diagnose appendicitis in kids
Diagnosing appendicitis in kids may be more difficult than appendicitis in adults because there are many possible reasons. Research in the journal of the American Medical Association in 2007 revealed that some symptoms such as nausea, vomiting, and decreased appetite are not always symptoms of appendicitis in kids.
If the doctor is not sure that your child has appendicitis, the doctor may advise your child to get treatment at the hospital and watch them, see if symptoms worsen. The doctor will examine the child every few hours to find out whether the pain is getting better or worse. The doctor will also do several tests to find out what really happened to your child.
Appendicitis symptoms in children are very similar to gastroenteritis, respiratory ailments, and symptoms of food poisoning. Common symptoms of appendicitis such as vomiting, diarrhea, and stomach discomfort also occur in gastroenteritis and food poisoning.
Symptoms of appendicitis in children are also similar to other medical problems such as pneumonia, urinary tract infections, mesenteric adenitis, and kidney stones so that it becomes a challenge for doctors when diagnosing. Mesenteric adenitis is caused by a viral infection so that the lymph nodes in the abdomen expand. It is important to diagnose clinically whether mesenteric adenitis will develop into appendicitis.
Doctors diagnose appendicitis in kids by examining the stomach to see signs of pain. The doctor will also ask for a history of your child’s symptoms and illness, they also ask your child to walk to assess their pain. When a physical examination and history are convincing for appendicitis, the doctor may not need further testing.
The abdominal examination also includes abdominal ultrasonography, a diagnostic imaging technique using high-frequency sound waves. Ultrasound examination is used to see the function of internal organs and to assess blood flow through various vessels.
In addition to ultrasonography, the abdominal examination can also be done by scanning computed tomography (CT) or called a CT scan. This procedure uses a combination of X-rays and computer technology to show detailed images of parts of the body such as bones, muscles, fat, and organs. A CT scan is most useful when the diagnosis is unclear or if appendicitis ruptures.
Examination of appendicitis symptoms in children by ultrasound and CT scan is used to determine whether the appendix is inflamed. This examination as revealed by the Journal of the American Medical Association as much as possible avoided because radiation can be dangerous in children.
Other tests that can be used to diagnose appendicitis in kids are blood tests and urinalysis. Blood tests are used to evaluate infections, and to find out if there are problems with other organs such as the liver or pancreas. While urinalysis is used to detect bladder or kidney infections, this examination is needed to find out the child has a bladder infection or appendicitis, because both have similar symptoms.
What causes appendicitis in kids?
Appendicitis is inflammation of the appendix which becomes red, swollen, and irritated. The appendix is a small organ that attaches to the large intestine on the lower right side of the stomach and has a different length depending on age. Some medical experts claim that the appendix is not a vital organ so that it is not dangerous to remove it.
Appendicitis in kids generally occurs in kids who have a family history of appendicitis, and in kids with cystic fibrosis. Appendicitis in kids is not contagious but is more caused by an infection in the appendix. Appendicitis in kids occurs when the inside of the appendix is blocked by something causing infection. This blockage can occur due to hard stools, mucus buildup or parasites that increase rapidly causing inflammation or swelling that eventually leads to appendicitis.
Appendicitis can also occur due to swelling of lymph tissue inside the appendix wall due to infection. Some cases of appendix blockage also occur due to worms that block the appendix. The blockage of the appendix causes the bacteria to multiply in the appendix and the appendix cannot empty the mucus and fluid that it produces.
The swelling of the appendix also causes pain and the blood supply to the appendix is interrupted. When blood flow to the appendix is interrupted, it causes the appendix to die and break when the wall starts to hollow. Holes in the appendix cause feces, mucus, and other substances to leak into the stomach which causes a serious infection called peritonitis. Complications of appendicitis that rupture in kids can be life-threatening, so appendicitis in kids needs serious attention and needs immediate treatment.
Appendicitis treatment in kids
Appendicitis in kids is a medical emergency that requires immediate treatment. Appendicitis treatment for kids will depend on the age, symptoms, and health of kids in general. Some doctors may only give antibiotics if you see the symptoms are not severe, but in general treatment for appendicitis in kids is surgery.
Surgery is the treatment of appendicitis in kids with surgical removal of the infected appendix. Appendectomy in most children recovers without long-term problems. There are two types of appendicitis surgery in children, namely open surgery and laparoscopic surgery.
If the appendix has burst the doctor will usually open surgery and cause the child to stay longer in the hospital. While a laparoscopic operation is performed, if the appendix has not ruptured, and only uses a few small incisions and a camera called a laparoscope to look inside the stomach. Laparoscopic surgery using the laparoscopic method requires a shorter treatment time because it has a lower risk of wound infection as revealed in Pediatrics and Neonatology study in 2017.
Before appendicitis, intravenous (IV) fluids and antibiotics are given to kids to prevent infections and pain medications if needed. The pediatric anesthesiologist will also provide anesthesia to make him sleep.
Treatment for appendicitis that has ruptured will take longer because antibiotics are needed within a certain time to kill all bacteria that have spread into the body. The doctor will usually treat the infection first and then do the operation to remove the appendix or referred to as an interval appendectomy.
According to a study published by Pediatrics and Neonatology in 2017, there is no consensus on the best choice for managing appendicitis rupture in kids with conservative care or early appendectomy. Whereas studies published in the journal JAMA Surgery prefer early appendectomy because it is less likely to suffer post-operative complications and recover more quickly when the appendix is removed 24 hours after diagnosis.
Treatment of infections due to ruptured appendicitis usually takes 10 to 14 days. Appendix removal surgery will be done about 6 to 8 weeks later after infection and inflammation disappear. After surgery, some children need to take antibiotics and drugs through an IV for a period of time. After surgery, it’s usually also forbidden to eat or drink for a period of time so that the intestine can heal. Your child is only given intravenous fluids before being allowed to start drinking fluids.
At some point, after surgery, your child can drink water or nutritious drinks before switching to solid food. Your child will also be banned from doing strenuous activities such as sports after being discharged from the hospital for several weeks. If your child experiences minimal pain at home, you can give paracetamol or ibuprofen as directed.
Some drugs given for pain relief after surgery can cause constipation and cause decreased appetite. Stool softeners and laxatives will be needed to help you defecate regularly after surgery.
At this stage, highly nutritious foods such as fruit juices, cereals, vegetables, and whole wheat bread are needed to speed healing and usually to overcome weight loss after appendectomy. Within a few days after returning from the hospital, your child can take a shower, as usual, choose a waterproof dressing over the wound so that the scar can heal and to prevent the wound from becoming infected. Usually, the surgeon will tell you specific guidelines about wound care, and when you can take a shower.
You can visit the surgeon after 2-3 weeks after surgery to ensure proper postoperative wound healing. You need to call the doctor immediately if your child’s stomach experiences pain, fever, vomiting, diarrhea, urination problems, and if the surgical wound is red or there is fluid flowing.
Prevention of appendicitis in kids
The appendix is the most common cause of abdominal pain that causes surgery as revealed by the National Institute of Diabetes and Digestive and Kidney Diseases, in the United States. Appendicitis is not only experienced by adults but also by kids and teens. Prevention of appendicitis in kids can be done by dieting fiber. Make your kids happy to eat healthy foods that contain fresh vegetables and fruits.
Vegetables and fruits have a high amount of fiber that can prevent kids from experiencing constipation and fecal buildup. Stool buildup is the most common cause of appendicitis in kids. Some foods that are high in fiber such as raspberries, apples, pears, artichokes, green beans, broccoli, beans, black beans, barley, oatmeal, and whole grains.
What the next
Appendicitis in kids is a medical emergency that has symptoms such as loss of appetite, mild fever, nausea, vomiting, distended stomach, constipation, and diarrhea. You need to know immediately the symptoms of appendicitis in your child because if the appendix rupture can cause more infections that can be fatal. Therefore a rapid diagnosis of appendicitis is needed to treat appendicitis immediately before rupture. Appendectomy is needed to remove appendicitis and some children need to take antibiotics to avoid infection after appendectomy.
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