Kids Health Info

Appendicitis

  • The appendix sits in the lower right side of the abdomen (stomach). It is quite small and is a normal part of the bowel, but it is not thought to have an important role in the body. 

    Appendicitis is an inflammation of the appendix. Inflammation is most commonly caused by a small, hard piece of faeces (poo) getting stuck in the tube of the appendix. If the appendix is inflamed it is usually necessary to remove it with an operation called an appendicectomy (uh-pen-deh-sect-a-me).

    Anyone can get appendicitis, but it tends to be most common in teenagers. It is rare for someone under the age of five years to get appendicitis.

    Signs and symptoms of appendicitis

    There are many variations of the symptoms of appendicitis. Symptoms may include:

    • pain that starts around the belly button, then moves to the right side of the abdomen
    • fever
    • diarrhoea (loose poo)
    • nausea and vomiting
    • loss of appetite.

    When to see a doctor

    If you think your child has appendicitis, take them to your GP or local emergency department. A diagnosis of appendicitis is important because the inflammation causes the appendix to swell, and sometimes it can leak its contents into the stomach. This can make your child very sick.

    If your child is in significant pain, which is made worse by moving or touching the stomach, go straight to your local emergency department.

    How is appendicitis diagnosed?

    The doctor will ask for a history of your child's symptoms and illness. They will examine your child by checking the site of the pain and pressing on the abdomen. The doctor may also ask your child to walk to assess their pain.

    Sometimes it can be difficult to work out the cause of stomach pain as there are many possible reasons. If the doctor is not sure if it is appendicitis, they may keep your child in hospital and watch them to see if their symptoms get worse. Sometimes tests will be performed to help work out what is going on, but these tests are not always helpful or reliable. 

    Your child may need an ultrasound or X-ray to take pictures of their abdomen. The doctor may also do a blood test to look for signs of infection or inflammation. In cases where children are sick and it is not clear why, your doctor may recommend an operation to check the appendix even if they are not certain it is inflamed.

    Treatment for appendicitis

    Most cases of appendicitis need an appendicectomy. There are two different ways to take out the appendix:

    • Laparoscopic – through a tiny telescope. There will be three small keyhole cuts about 1–2 cm long each, made in different parts of your child's abdomen.
    • Open – there will be a single, small cut across the abdomen about 5–7 cm long.

    Before the operation

    A surgeon, an anaesthetist (a doctor who puts your child to sleep during the operation) and nurses will explain all the procedures to you before they begin. If you have any questions or anything is unclear, ask staff to explain as many times as needed.

    After the operation

    After the operation, your child can be given medicine directly into a vein through a drip (intravenous or IV therapy) to stop them feeling sick or vomiting.

    Your child may need to have strong pain medicine, such as morphine, and they will be given antibiotics to prevent infection of the wound.

    Your child will be in hospital for about one to three days, depending on what is found during the operation. However, if your child has had a burst appendix then they will have to stay in hospital for longer to receive extra antibiotics. This is normally about five days.

    Eating and drinking

    After the operation, your child will be given fluids through their IV drip until they can eat and drink again. This may be four to six hours after the operation.

    Doctors will tell you when and what your child can eat and drink. It is very important to follow staff instructions. The bowel may need to be empty of food or fluid so it can rest after the operation.

    Care at home

    When your child comes home from hospital, they should:

    • Stay home from school for one week and avoid sports for two weeks, but these times will depend on how sick your child has been. Always ask your GP or surgeon if you're not sure.
    • Be able to eat and drink as normal.
    • Be able to shower and bathe as normal. There will be a waterproof dressing over the wound/s. The dressing needs to be left on so the scar can heal, and to stop the wound from getting infected. The stitches will be dissolvable and do not need to be taken out. The dressing can come off after seven days.
    • Be in minimal pain. You can give paracetamol or ibuprofen as directed, if your child is in pain. See our fact sheet Pain relief for children.

    Follow-up

    Before you leave the hospital after the operation, a follow-up appointment will be made for your child to come back and see the surgeon. Make sure that you either have this appointment or know who to contact.

    There is a risk of developing an infection after having a burst appendix. Contact your surgeon earlier than the scheduled appointment if:

    • your child gets a fever (above 38.5°C)
    • the wound starts to look infected (e.g. it looks red and inflamed, has a discharge, or it becomes more painful)
    • your child has increasing pain that is not controlled by paracetamol or ibuprofen.

    Key points to remember

    • A diagnosis of appendicitis needs to be made quickly. A burst appendix can make a child very sick.
    • An appendicectomy is an operation to remove the appendix. The appendix is not useful to the body.
    • Your child will be in hospital for three to seven days depending on the severity of the appendix infection.
    • Once you are home from hospital, contact your surgeon if you think your child is developing an infection.

    For more information

    Common questions our doctors are asked

    How can I tell if my child has appendicitis or if it is just gastro?

    It can sometimes be difficult to tell what it causing your child's stomach pain, because some of the symptoms of gastro and appendicitis overlap. Generally, the pain will only be in the right side of your child's stomach if it is appendicitis, and any vomiting or diarrhoea will be mild.

    If your child has bad pain or you are worried at all, see your GP.  Starting treatment early for a child with appendicitis will mean they get better faster and will lessen the chance of any long-term problems.

    What is mesenteric adenitis?

    Mesenteric adenitis occurs when the lymph nodes in the abdomen enlarge in response to an infection – most commonly a viral infection. This causes stomach pain. The symptoms of mesenteric adenitis are similar to the symptoms of early appendicitis. Both conditions are diagnosed clinically (without the need for blood tests or imaging). It is important that children who are diagnosed with mesenteric adenitis are reviewed to determine if it is developing into appendicitis. 

    What are the risks of surgery to remove the appendix?

    All operations have some risks associated with them, such as the risk of bleeding or infection. Complications due to surgery are uncommon. Talk to your surgeon and anaesthetist about any concerns you have.


    Developed by The Royal Children's Hospital Surgery department. We acknowledge the input of RCH consumers and carers.

    Reviewed May 2018.

    Kids Health Info is supported by The Royal Children’s Hospital Foundation. To donate, visit www.rchfoundation.org.au.

Kids Health Info app

The app will enable you to search and browse more than three hundred medical fact sheets and work offline.

Apple store Google play


Disclaimer
This information is intended to support, not replace, discussion with your doctor or healthcare professionals. The authors of these consumer health information handouts have made a considerable effort to ensure the information is accurate, up to date and easy to understand. The Royal Children's Hospital, Melbourne accepts no responsibility for any inaccuracies, information perceived as misleading, or the success of any treatment regimen detailed in these handouts. Information contained in the handouts is updated regularly and therefore you should always check you are referring to the most recent version of the handout. The onus is on you, the user, to ensure that you have downloaded the most up-to-date version of a consumer health information handout.