First signs of inflammation
It is traditionally believed that physiologically the appendix is located in the lower right iliac abdomen. In most cases, this is true, but due to the mobility of the process, it can move to the left side or rise to the navel. The onset of an attack of appendicitis in a child is not quite standard, if we compare the course of the pathology with adults.
Quite often, the baby develops symptoms of a cold: there is a slight increase in body temperature, the child complains of general weakness, and chills may occur. The patient eats poorly, becomes lethargic, and refuses to play.
Important! If you observe a child, when appendicitis develops, he tries to protect his stomach.
Since the condition is accompanied by cold symptoms, appropriate treatment is begun, which does not bring the expected result. The inflammation continues to progress and by the third or fourth day, symptoms characteristic of an attack are formed. Body temperature rises to high levels, and the baby begins to complain of abdominal pain.
Children with an inflamed appendix react painfully to attempts to touch the abdomen
Typical symptoms of the inflammatory process in children
An attack of acute appendicitis in children begins suddenly and develops rapidly, and the first symptoms appear approximately 4 hours after the onset of the pathological process, reaching maximum intensity after 6-8 hours. In order to provide the child with the necessary help in a timely manner, parents must know the clinical picture of the disease, as well as the basics of differential diagnosis, because at the initial stage (catarrhal stage) the disease can be confused with other diseases of the gastrointestinal tract and abdominal organs.
Nausea and vomiting
Nausea appears within about 2 hours after the onset of inflammation. The child becomes lethargic, capricious, and refuses to eat. Appendicitis is characterized by wave-like occurrence of attacks of nausea, that is, it may subside for a short time, and then appear again, taking a more intense course. Vomiting in this disease may be absent, but a single release of vomit is possible, which is the result of acute intoxication.
Note!
If a child has repeated and profuse vomiting, a high fever, and complains of severe abdominal pain, the most likely cause is an intestinal infection, poisoning, or intestinal flu.
Coated tongue
A fairly typical sign for acute or chronic inflammation of the appendix. The plaque usually appears only on the surface of the tongue and is a gray, beige or milky mass of dense texture, difficult to remove with a spoon or a special spatula. Sometimes children develop plaque in the form of small dense lumps. There is usually no bad breath - this sign can be used to distinguish appendicitis from diseases of the digestive system: pancreatitis, esophagitis, gastritis.
Temperature
The catarrhal stage of appendicitis can occur without fever, but many children experience slight fluctuations within the subfebrile range (up to 38°). The temperature rises above this limit when the pathology enters the phlegmonous stage, in which all layers of the appendix are involved in the pathological process, and the production of purulent exudate begins.
Important!
A temperature of 38.5° (rarely 39° and above) is typical for children aged 3 to 8 years. Older children and adolescents tolerate the disease a little easier, but even in them, phlegmonous and gangrenous appendicitis occurs when the temperature exceeds the boundaries of subfebrile values.
Changing the stool
In approximately 15% of adolescents, appendicitis begins with acute diarrhea. This sign may be one of the first, before the appearance of pain, nausea and other clinical manifestations of the inflammatory process. Stool with appendicitis is frequent, profuse, has a watery or mucous consistency and is light yellow in color. There is usually no putrid or pungent odor; pieces of poorly digested or undigested food may be present in the stool.
In children under five years of age, digestive disorders most often manifest themselves as constipation. Constipation usually occurs 2-3 days before the onset of an attack, and during acute inflammation the child experiences intense pain when trying to empty the intestines.
Important
! Pain with appendicitis occurs not only during bowel movements, but also during urination. If a child complains of pain when going to the toilet, combined with abdominal pain and a rising temperature, it is necessary to exclude the possibility of catarrhal or phlegmonous appendicitis.
Possible symptoms
When appendicitis develops, a child may experience:
Nature of pain in appendicitis
- Nausea ending in vomiting. Inflammation of the appendix is characterized by a wave-like appearance of attacks of nausea: it can disappear completely and then return with greater force. The appearance of vomiting indicates severe intoxication of the body. As a rule, with appendicitis it will be single.
- The appearance of plaque on the tongue. This is one of the most likely signs of inflammation of the appendix. A dense layer of gray, beige or milky color is located in the center of the tongue. Difficult to remove with a spoon. The child’s breath remains clean, which eliminates the exacerbation of pathologies of the digestive system.
- Temperature. The initial stage proceeds with a slight increase in its indicators. A rise in temperature above 38 degrees indicates the involvement of all layers of the appendix in the inflammatory process.
- Changes in the consistency of stool. In approximately 15% of children, an attack of appendicitis is accompanied by the development of diarrhea. Feces are abundant, liquid in composition, without an unpleasant odor, and may contain particles of undigested food.
Important! With appendicitis, a child may complain of pain both when urinating and when bowel movements.
Symptoms of appendicitis in a child
How do appendicitis and symptoms in children differ from those in adults? The main sign of the development of appendicitis is abdominal pain. Their peculiarity is that they can be of varying degrees of intensity, they can intensify and weaken, but they never stop. Signs of appendicitis in children:
- The characteristic pain in the abdomen with classic appendicitis is on the right in the lower part under the liver. But the child may complain of pain throughout the abdomen. His position is characteristic - he lies with his knees bent and his legs pulled up to his stomach.
- Increased body temperature - 38°C or higher with rapid development of the disease with the risk of complications.
- Lethargy, nausea, vomiting, diarrhea;
- Rapid deterioration of the condition: pale skin, thirst, dry mucous membranes. The pain becomes intense and constant.
If there is abdominal pain, parents should not give their child any painkillers, give an enema, or use a heating pad on the abdominal area. All that is necessary in cases of suspected appendicitis in a child is to seek medical help.
Symptoms depending on the child’s age
It is possible to understand that the baby has begun to have inflammation of the appendix not only by general signs. There are also characteristic age-related symptoms. The peak incidence occurs between the ages of 5–14 years. But there are exceptions when the disease is diagnosed in children who have not yet turned 3 years old.
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Under 5 years old
In this age group, the condition develops slowly. There is no significant increase in temperature, but nausea often occurs, ending in vomiting. Children are capricious, anxious and refuse to eat.
Under 3 years old
Children at this age develop symptoms of dehydration - the skin and mucous membranes become dry. The child constantly asks for a drink. The baby tries to protect his stomach, not allowing anyone to touch it. Abnormal bowel movements are possible: either constipation or diarrhea may occur.
Appendicitis is very rare in children under 3 years of age.
Under 10 years old
At this age, the disease is accompanied by an increase in body temperature to 38 degrees. In severe cases, this figure increases to 39 degrees. The patient feels nauseous, but there is no vomiting. There is no stool disturbance. There is severe abdominal pain, aggravated by palpation. The child tries not to lie on his side, since in this case the pain intensifies.
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Over 12 years old
At this age, the disease proceeds as in an adult. Initially, pain forms in the umbilical region, then descending to the right iliac region of the abdomen. Body temperature rises slightly. The pain is paroxysmal in nature, there are no strong spasms. Nausea, vomiting and bowel disturbances are not noted. But quite often symptoms of dehydration develop - the mucous membranes become dry, the teenager is thirsty.
Important! If the above symptoms develop, the patient must be shown to a doctor. It is impossible to diagnose the disease at home with 100% certainty.
Features of the course of appendicitis in children
After a child turns 7 years old, the first signs of appendicitis will be the same as in most adults. Despite this similarity, making a correct diagnosis can be complicated by the fact that the child is scared, may be capricious and cry. A lot of children are simply afraid of surgery, which is why they can say that their stomach has stopped hurting and everything is fine, anything, just to stay at home.
Typically, inflammation of the appendix occurs unpredictably. This can happen on weekends at home, in kindergarten, on a walk, and even at a party. In children under 3 years of age, from the very beginning of the disease, behavioral deviations can be noticed: they refuse to eat, are capricious, sleep poorly and become noticeably less active. Kids won't be able to tell you exactly where it hurts. They will point to your entire stomach, claiming that it hurts everywhere. The baby's strongest reaction can be observed on the first night after the onset of the inflammatory process; his sleep will be very restless, with periodic awakenings and screams. And also if you accidentally touch your tummy in the navel area. The pain may intensify when dressing or bending to the right, or lying on the right side.
Please note that when the appendix is inflamed, the baby may feel sick and vomit, and diarrhea may also be present, and there is often some mucus in the stool. Less commonly, there is simply stool retention. Severe abdominal pain will also be accompanied by pain when urinating. A high temperature, which can rise up to 40°, will also indicate an inflammatory process. Although in breastfed children the temperature often does not rise above 37.5° for quite a long time.
During play, the child may cry very hard when squatting, pulling his right leg towards himself, in an attempt to relieve pain or take the most comfortable position.
Due to the structural features of the intestines, appendicitis very rarely occurs in children under 2 years of age.
If the child is older, then he is already more or less clearly able to tell his mother when his stomach began to hurt. At the same time, it will not be possible to notice any changes in his usual behavior. Children over 3 years of age can tolerate mild pain without telling their parents about it, in the hope that he just ate something wrong and after some time everything will go away on its own. They are already at a more conscious age, so they can indicate where exactly the pain was localized. If the painful area is located near the navel, a little above it, this is just the beginning of inflammation of the appendix. Everything is much more serious if the pain is in the lower abdomen, closer to the right side. When moving, the pain can become much stronger, and also if you lie on your right side. The child can tell what kind of pain he is experiencing: strong sharp or dull aching.
The very first signs of appendicitis in this case will be lethargy, vomiting and nausea. In children over 3 years of age, diarrhea is unlikely, rather just stool retention, but not constipation. An increase in body temperature within 38-39° is also an indicator of the inflammatory process in the child’s body. When changing body position, the nature and severity of pain may change. For example, if the child is placed on his left side, this will significantly reduce pain.
Characteristics of pain syndrome
You can recognize appendicitis in a child by the nature of the pain. Inflammation of the appendix is characterized by a certain path of spread. At the beginning of the development of the condition, the area of localization is the epigastric zone. It then moves lower to the navel and migrates to the lower right quadrant of the abdomen. When purulent contents accumulate, pain can spread to the area of the arm, under the shoulder blade.
You can find out about the onset of an attack by examining the child’s stomach. He will note:
- asymmetry of the abdomen;
- tension in the anterior abdominal wall;
- swelling.
The character also differs. At the catarrhal stage, the child complains of severe pain, felt as stabbing or cutting. After the state transitions to the phlegmonous stage, they become aching with periodic intensification.
A characteristic sign of inflammation of the appendix is the child adopting a forced position. He lies on his right side, tucking his legs to his stomach. The pain intensifies significantly when the baby turns to the left side and straightens his legs.
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Professional diagnostics
Diagnosis of appendicitis in children involves the use of various techniques. The examination includes a physical examination and clinical tests. If necessary, instrumental studies are prescribed. Physical examination consists of palpation of the abdomen. The doctor notes the presence of acute pain, tension in the anterior abdominal wall when trying to palpate the inflamed appendix.
Ultrasound is a mandatory method for diagnosing inflammation of the appendix
Sometimes an additional rectal examination is performed. To check the preliminary diagnosis, urine and blood tests are performed. With appendicitis, an increased content of leukocytes is noted in both biological fluids, which indicates existing inflammation. If necessary, instrumental tests are performed - ultrasound of the abdominal organs, x-rays, computed tomography.
Techniques are used to determine the location of the appendix, assess its condition and current size. It is necessary to carry out differential diagnosis to exclude other pathologies accompanied by similar symptoms. Appendicitis is a serious disease that requires urgent medical attention. This is why it is so important to identify pathology at the beginning of its development.
