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Writer's pictureMarabella Paediatric Services

5 questions to ask that will help you know if your child's belly pain is an inflamed appendix


So it is 3 am and your 5 year old awakes with belly pain and fever, and you begin to wonder- what could be wrong? Could this be something he ate last night or is this something more serious like appendicitis and requires surgery?

Today we shall discuss a little bit about abdominal/ belly pain in children that can be appendicitis.


One of the most worrying thing to anyone with belly pain, is if this requires some surgery. As a parent, my first advice would be- do NOT panic. Obviously this is easier said than done. But once you are cool headed, then you would need to gather some basic information to help figure out what’s going on.


I will try to keep this simple in question form. If you can get these 5 questions answered you will know if you should grab your child and go to casualty at once.


1) Where is the pain?


If the pain is surrounding the belly button this may be the pain of early onset appendicitis and would definitely warrant a closer observation. As appendicitis progresses, the pain would usually migrate from the belly button to the lower abdomen on the right side.


Having said that, appendicitis can present with right upper belly pain and even left abdominal pain in children with varying anatomies. The appendix is a little organ that usually sits in the right lower abdomen on the boundary of the small and large colon. However, because it can swing and move around, the pain’s location can move too. Therefore, if the pain is on the left, this can still be appendicitis. So we need more questions to help differentiate.


2) How severe is the pain?


Appendicitis pain is usually very severe. Most children would cry with pain. In older children they can rate their pain out of 10, with 10/10 being worst pain ever. In appendicitis, the child would be unable to walk because of the pain and would prefer to sit still. Even coughing or jumping will cause their belly to hurt and as such your little one would prefer to lie flat undisturbed. The pain is usually constant and will not go away with simple Panadol. Having said that, early onset appendicitis can be mild and intermittent so you would still need to observe for evolution into more severe pain.


3) Is there any fever?


Fever is a usual symptom with appendicitis and once present, it increases the possibility of appendicitis. So if we have fever with severe abdominal pain, this is a red flag and your child needs to be reviewed.


4) Is there any vomiting?


In children with appendicitis, they usually have no appetite. In fact this is sometimes called the “burger sign”. If you ask a child- “Do you want a burger”, (or in Trinidad- maybe “Do you want fry chicken” or “Doubles”), and they say-“Yes”, then it is unlikely they have Appendicitis. Vomiting usually happens with the abdominal pain in appendicitis. So if your child has no appetite, fever and belly pain then yes head down to the emergency department.

5) When last did your child pass stool?


So this one can be a tricky one. Diarrhea is usually associated with gastroenteritis especially if there is vomiting and a history of sick contacts and eating spoilt foods. However, if the dangling appendix touches the left colon then this can cause diarrhea as well. So, it needs to be taken in perspective with the other symptoms. On the other side, constipation can be a common cause of abdominal pain in children. So if there is no fever, no vomiting, mild pain with no stool passed for two days, then you may just need to observe for constipation.


 

So as you can see, that belly pain at 3 am may be something requiring urgent surgical attention like appendicitis. But there are a lot of possible in-between presentations. This is why some doctors recommend a period of close observation in hospital or at home- depending on proximity and parent’s understanding in some cases.


At the end of it all, belly pain in children is something that warrants evaluation. Always seek help once you are concerned.


These 5 questions can help you and your physician figure out what’s going on.


Dr. Zafir Latchan


This advice is not meant to diagnose or treat your child. Please consult your physician or the physician of your child for an appropriate diagnosis and treatment.




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