Abdominal pain is very common in children, and most of it is not serious. Appendicitis, however, is a condition that must not be delayed; this is why it is important to know the distinguishing findings.

The typical course

The classic picture progresses in this order:

  1. Vague pain around the navel
  2. Loss of appetite and nausea
  3. The pain settling in the lower right abdomen
  4. Mild fever
  5. Pain that increases with movement, coughing and jumping

In young children the picture may not be this typical; there may only be irritability, refusal to let the abdomen be touched, and refusal of food.

Findings that suggest serious abdominal pain

  • Pain settling in the lower right abdomen and steadily increasing
  • The child bending forward while walking and being unable to jump
  • Rigidity and severe pain when the abdomen is touched
  • Persistent vomiting, bile-stained (green) vomiting
  • Accompanying fever
  • Bloody stool together with abdominal pain
  • Pain that wakes the child from sleep

If these findings are present, a healthcare facility should be consulted without waiting.

What should not be done at home

Masking the picture by giving painkillers and fever reducers makes the examination more difficult. Applying heat to the abdomen, enemas and herbal mixtures should not be tried. Not giving the child anything to eat or drink is important in view of a possible procedure.

How the diagnosis is made

Evaluation begins with the physical examination; blood tests and an ultrasound may be requested. In some cases the picture becomes clear within hours, so a repeat examination may be planned. This does not mean the diagnosis has been missed; this is the natural course of appendicitis.