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How can I tell if my child has appendicitis?

The appendix is a narrow, finger-shaped, hollow structure attached to the large intestine. While it serves no purpose in humans, it can cause serious problems when it becomes inflamed. Because of its location, this can happen quite easily; for instance, a piece of food or stool can get trapped inside, causing the appendix to swell and become infected and painfully inflamed. This inflammation—called appendicitis—is most common in children over the age of six, but can occur in younger children.

Once infected, the appendix must be removed. Otherwise it may burst, allowing the infection to spread within the abdomen. Since this problem is potentially life-threatening, it’s important to know the symptoms of appendicitis so you can tell your pediatrician at the first sign of trouble. In order of appearance, the symptoms are:

  1. Abdominal pain: This usually is the first complaint the child will have. Almost always, the pain is felt first around the umbilicus (belly button), and then may intensify in the lower right side. Sometimes, if the appendix is not located in the usual position, the discomfort may occur elsewhere in the abdomen or in the back, or there may be urinary symptoms, such as increased frequency or burning. Even when the appendix lies in its normal position and the pain is in the right lower abdomen, it may irritate one of the muscles that leads toward the leg, causing the child to limp or walk bent over.
  2. Vomiting: After several hours of pain, vomiting may occur. It is important to remember that a stomachache comes before the vomiting with appendicitis, not after vomiting. Abdominal pain that follows vomiting is very commonly seen in viral illnesses such as the flu.
  3. Loss of appetite: The absence of hunger occurs shortly after the onset of the pain.
  4. Fever: Unless the appendix ruptures (breaks open), the fever is usually less than 102.2 degrees Fahrenheit (or 39 degrees Celsius).

Unfortunately, the symptoms associated with appendicitis sometimes may be hidden by a viral or bacterial infection that preceded it. Diarrhea, nausea, vomiting, and fever may appear before the typical pain of appendicitis, making the diagnosis much more difficult.

Also, your child's discomfort may suddenly vanish, thus persuading you that all is well. Unfortunately, this disappearance of pain also could mean that the appendix has just broken open or ruptured. Although the pain may leave for several hours, this is exactly when appendicitis becomes dangerous. The infection will spread to the rest of the abdomen, causing your child to become much more ill, develop a higher fever, and require hospitalization for surgery and intravenous antibiotics. Recovery may take much longer, and there may be more complications than with appendicitis diagnosed and treated earlier.


Detecting the signs of appendicitis is not always easy, particularly with children under the age of three, who cannot tell you where it hurts or that the pain is moving to the right side. This is why it's better to act sooner rather than later if you have any suspicion that your child's pain or discomfort seems "different," more severe than usual, or out of the ordinary.

While most children with abdominal pain don't have appendicitis, only a physician should diagnose this serious problem. If the abdominal pain persists for more than an hour or two, and if your child also has nausea, vomiting, loss of appetite, and fever, notify your pediatrician immediately. If the doctor is not certain that the problem is appendicitis, she may decide to observe your child closely for several hours, either in or out of the hospital. During this time, she will perform additional tests or examinations to see if more conclusive signs develop. If there is a strong probability that appendicitis is present, surgery usually will be done as soon as possible since surgically removing the appendix is usually the treatment of choice.


Last Updated
Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.