When a belly ache or stomach pain might mean appendicitis

February 28, 2013 Swedish Blogger

girl with stomach ache_350

Updated June 22, 2018

  • Appendicitis can start with general stomach pain before localizing to the lower right side.
  • There are simple things parents can do to determine if appendicitis is an issue.
  • It’s important to treat appendicitis immediately before the appendix ruptures or perforates.

“Mommy, my tummy hurts.” Every parent has heard that more than once in their lives, and usually it’s just a run-of-the-mill stomachache. There are cases, however, where it may be appendicitis, which requires timely action to treat it before a ruptured appendix could cause serious issues. But how can a parent determine if the appendix is the problem? Robert Weinsheimer, MD, a general pediatric and thoracic surgeon and director of pediatric surgical services with Swedish Pediatric Specialty Care, offers parents these tips.

Know the signs

The appendix is a small extension of the intestinal tract; it’s located where the large intestine begins in the right lower part of the abdomen. If that’s the source of general stomach pain, there will be common intestinal symptoms such as loss of appetite, nausea and vomiting.

With appendicitis, the blood supply is cut off to the appendix and it eventually dies. When that happens, a hole will form in the appendix wall, which is called a perforation. Because the appendix is part of the intestines, it contains bacteria and stool inside that can leak into the abdomen through the perforation. If that reaches the bloodstream, it can lead to sepsis, which may cause serious complications. That is why it’s important to treat appendicitis as soon as possible.

As the appendix swells, anywhere from 12 to 36 hours after symptoms first appear, it presses on the nerves that trigger the well-known sign of appendicitis: pain in the lower right part of the abdomen. In addition to the location and duration of the stomach pain, it’s important to note the quality of the pain, Dr. Weinsheimer says.

“If the child has been feeling episodic pain on and off — there’s pain but then the child is fine and running around a few hours later — that scenario doesn’t fit appendicitis,” he says. “If there’s steady and slow pain that continues to build, that can be a sign of appendicitis.”

Do a little test at home

If you suspect your child has appendicitis, ask if he can tell you where he feels the stomach pain. After the age of five or six, kids can usually pinpoint the area, Dr. Weinsheimer says.

If your child is showing symptoms in line with appendicitis, there is a simple physical exam parents can do at home, he adds. “If the child has these symptoms, an easy way to get a sense of whether the appendix is causing the pain is to get the appendix to move around. The best way to jiggle the appendix is to have the child jump around,” Dr. Weinsheimer says. “If a child is sitting or lying down, have them try to jump. If they get up and jump eagerly, that’s not consistent with appendicitis. But if the movement causes them to grimace or they can’t do it, parents should be concerned for appendicitis.”
Don’t rush off to the emergency room right away

Generally, Dr. Weinsheimer says parents should call the child’s primary care provider to validate the symptoms and get guidance on next steps and where to get an evaluation, depending on the time of day and where the family lives. That medical evaluation could include taking a history to see if the symptoms are consistent with appendicitis, checking vital signs and body temperature, determining if a child looks unwell, conducting a physical exam, which could include the jump test or checking for tenderness in the appendix.

In cases that are suspicious for appendicitis, the doctor will commonly order labs and potentially an imaging test to confirm appendicitis. In the past, that used to be done with a CAT scan, but nowadays ultrasound is more common as the initial imaging study to avoid radiation exposure.

Understand the treatment options

If surgery is recommended, it’s typically done laparoscopically, which allows for faster recovery because the surgical incisions are small. During the procedure, the surgeon can see the entire abdominal cavity and address any area of contamination if the appendix ruptured.

If the appendix is removed while it’s still intact, a child can often recover the same day as the surgery. If it has ruptured, the child would normally stay in the hospital anywhere from a couple of days to a week to regain intestinal function and get antibiotics via an IV.  After the incisions are healed a few weeks later, the child can resume normal activities such as sports.

There is an alternative to surgery that has emerged in recent years: treating an intact appendix with antibiotics before a perforation forms. But Dr. Weinsheimer says while that can be done, the chance of appendicitis recurring is frequent enough that surgery is a better choice. “Knowing that recurrence rate is a big issue. Knowing that you can get out of the hospital faster with surgery which is very low risk, and knowing that you don’t need any more antibiotics (because we know prolonged courses of antibiotics have some risk to them), I think that surgery is a really good option,” he says.

Dr. Weinsheimer does add that antibiotic treatment can be a good option in unusual cases where surgery would be risky or the patient is in a fragile state.  “It can be a good for a ruptured appendix when the body has walled off the area around the perforation trying to contain the infection. Antibiotics are a great idea in that scenario because surgery under those circumstances carries more risks. In that situation, a child would be in the hospital receiving IV antibiotic for several days. A couple of months later, once the child has recovered and the area around the appendix is no longer walled off, parents could discuss with their surgeon whether to have the appendix removed to prevent recurrent appendicitis.”

Need to see a provider today? Schedule an appointment now at your neighborhood Swedish Express Care clinic. If you have questions about your child’s health and other parenting topics, you can find answers vetted by health care providers on the free Circle by Swedish app. Learn more about appendicitis in children

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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.

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