Appendicitis is a fairly common condition worldwide, including in India. According to a study by the National Library of Medicine, 2019 saw 17.70 million new cases of appendicitis globally. In India, around 0.34% of school-age children have experienced appendicitis, while approximately 0.25% of adults in India are affected by the condition. 

What Is Appendicitis?

Inflammation of the appendix, known as appendicitis, occurs when the appendix becomes swollen and accumulates pus as blockages occur, disrupting the appendix's blood supply. The appendix is a small, finger-like pouch extending from the colon in the lower right area of the abdomen. Symptoms of appendicitis typically include pain localised in the lower right abdomen. The appendix doesn't serve a clear function in the body. 

Appendicitis initiates with pain in the lower right abdomen. Most people feel the pain near the belly button. As the inflammation progresses, the pain increases, eventually becoming severe. While appendicitis can affect individuals of any age, it predominantly occurs in those aged 10 to 30. Treatment typically involves a combination of antibiotics and surgical removal of the appendix. 

What Causes Appendicitis In Children?

Appendicitis in children usually starts when the lining of the appendix gets blocked. This blockage can happen because of hardened stool, foreign objects, or sometimes even tumours, which can result in an infection. The blocked appendix then swells and becomes inflamed due to bacterial growth. The accelerated bacterial growth within the appendix results in pus formation, leading to intense pain. 

In rare cases, parasites can also prompt appendicitis in children by obstructing and inflaming the appendix. Parasites like pinworm or roundworm can infiltrate the appendix, causing blockages and subsequent infection. Once infected, the appendix swells due to the rapid bacterial multiplication. 

Appendicitis in children sometimes can result from tumours located inside or close to the appendix. Both benign and cancerous tumours can block the opening of the appendix, causing bacterial infection and inflammation. This blockage can cause the appendix to swell, and if not addressed, it may rupture, posing a serious health risk. 

Appendicitis can be associated with a swollen lymph node in the vicinity. When a lymph node near the appendix becomes inflamed, it can block the appendix's passage, allowing bacteria to grow. This inflammation of the appendix causes intense discomfort, and if not treated, it can lead to serious health complications such as a ruptured appendix and peritonitis.

Symptoms Of Appendicitis In Children 

Appendicitis symptoms can vary from child to child, but some of the most frequently observed ones include:

• Abdominal pain: Intense pain, usually originating around the belly button or in the lower right part of the abdomen. Initially, the pain may be intermittent, but it can gradually become steady and intense. 

• Low fever: A child showing symptoms of appendicitis may experience fever. This mild fever often occurs with abdominal pain and may escalate as the condition progresses. While fever is the symptom of many other illnesses, its presence alongside intense abdominal pain or decreased appetite could signal potential appendicitis.

• Decreased appetite or loss of appetite: In cases of appendicitis in children, a significant decrease in appetite is frequently noticed. The child may unexpectedly reject food, including their favourite dishes. While loss of appetite can occur in various health issues, its presence alongside symptoms such as abdominal pain and nausea may suggest appendicitis.

• Nausea and vomiting: Nausea and vomiting are common symptoms in children with appendicitis, often appearing early in the course of the illness, sometimes even before the abdominal pain begins.

• Diarrhoea often with small amounts of stool and mucus or constipation: Children with appendicitis may see changes in bowel habits, such as diarrhoea or even constipation sometimes. The inflammation of the appendix can disrupt normal digestive processes, resulting in these symptoms. 

• Swollen belly: Abdominal swelling is a possible indicator of appendicitis in children. The child's abdomen might seem distended or feel abnormally firm when touched. If the child exhibits additional symptoms like bloating, appendicitis could be a potential explanation.

• Pain during urination: Some children with appendicitis may suffer from pain during urination. This can occur if the inflamed appendix is pressing on the urinary tract. 

Diagnosis Of Appendicitis In Children

The diagnosis of appendicitis in children includes a physical examination, during which doctors may check for tenderness in the lower right quadrant of the abdomen. The doctor may also conduct various tests including blood (complete blood count - CBC), and urine analyses. Imaging tests such as X-rays of the abdomen and chest, ultrasound, CT scan, or MRI can also be done to confirm the diagnosis. Diagnosing appendicitis can be challenging because its symptoms overlap with those of other medical conditions such as gastroenteritis, kidney stones, pneumonia, or urinary tract infections.

Treating Appendicitis In Children

1. Surgical Treatment (Appendectomy)

In most cases, children with appendicitis undergo surgery to remove the infected appendix, a procedure known as an appendectomy. Surgeons make three small incisions in the abdomen and use a laparoscope, a small device, to extract the appendix. Before surgery, intravenous (IV) fluids and antibiotics may be administered to your child. This helps reduce the risk of complications such as infection. Surgery can sometimes cause discomfort, so children are provided with pain medication if necessary. Following this surgery, some children may be discharged on the same day, while others may require a longer hospital stay for observation and recovery. While any surgery and anaesthesia carry risks, such as infection or bleeding, appendectomies have been performed safely for many years to treat appendicitis in children. Children who do not show improvement with antibiotics and also those who get infected with appendicitis more than once will require an appendectomy. 

2. Non-Operative Treatment (Antibiotic Treatment)

In certain instances, doctors may opt to manage early or mild cases of appendicitis in children solely with antibiotics, rather than resorting to surgery. This alternative approach is known as non-operative treatment. It allows children to avoid the pain and discomfort of surgery and resume normal activities more quickly. Initially, they receive intravenous antibiotics in the hospital, followed by a seven-day course of oral antibiotics at home. Non-operative treatment is rarely used for children with ruptured appendicitis as well. In such cases, antibiotics are initially administered to address the infection, with the removal of the appendix scheduled for a later time.

Food to Avoid While Suffering From Appendicitis 

Fried food

Consuming fried, oily food can negatively impact your digestive system. It's advisable to minimise intake of fried junk food as much as possible, as it may lead to symptoms of appendicitis. 

Sugar

Apart from natural sugar found in fruits, consuming refined sugar can have detrimental effects on health. Refined sugar may trigger diarrhoea and potentially worsen symptoms of appendicitis in children. It is advised to minimise intake of foods such as sweets and chocolates and reduce overall sugar consumption in your diet.

Fatty food

Food high in fat content can pose challenges for digestion. It is recommended to avoid fatty food and fatty meats. Fatty food can escalate appendicitis in children. 

A healthy and balanced diet can help you deal with appendicitis better. Fenugreek Seeds might help lessen pain by stopping mucus and pus from building up in the appendix. Incorporating buttermilk into your daily diet may manage appendicitis symptoms better. It is recommended to prepare buttermilk at home and consume it regularly in small quantities. Switching from white rice to brown rice can contribute to overall health and improve digestion. Drinking vegetable juices, such as carrot, beetroot, and cucumber, can help deal with pain. Ginger is renowned for its medicinal properties, including anti-inflammatory and detoxifying effects. Mixing ginger with turmeric and honey and consuming it twice daily can help reduce swelling, nausea, and other symptoms associated with appendicitis. Adding fresh fruits, boiled sprouts, and oats into your diet with minimal oil and spices can provide a high-fibre, easy-to-digest meal option.

Appendicitis cannot be prevented, but with prompt and appropriate medical attention, doctors can diagnose and treat it without complications in children. It is essential to consult a doctor if your child shows any of the above mentioned symptoms. Appendicitis is a painful condition that needs immediate medical attention and mostly requires surgery. 

Frequently Asked Questions

1. Is appendicitis in children common?

Around 70,000 children in the United States are affected by appendicitis every year. In India, around 0.34% of school-age children experience appendicitis. It is most common in kids aged 10 to 19 years. Appendicitis is the leading reason for emergency abdominal surgery in childhood.

2. How long can appendicitis in children last?

The appendix can become infected, and if left untreated, it can burst or rupture. This can occur within 48 to 72 hours after symptoms start. Therefore, appendicitis is considered a medical emergency and it is crucial to consult a doctor if your child exhibits any symptoms. 

3. What are the early symptoms of appendicitis in children?

The most common symptoms of appendicitis in children include abdominal pain starting around the belly button and then moving to the lower right side of the abdomen. This pain tends to worsen with activities like walking, jumping, or coughing and usually gets worse over time. Fever is also commonly observed.

4. Can appendicitis in children be prevented?

Appendicitis in children cannot be prevented. However, with prompt and appropriate medical attention, doctors can diagnose and treat it without complications. Appendicitis is a painful condition that needs immediate medical attention and mostly requires surgery. 

5. Can appendicitis in children be treated without surgery?

Appendicitis in children can be treated solely with antibiotics. However, in most cases, the preferred treatment involves surgically removing the child's appendix. This procedure, known as an appendectomy, is the standard approach for treating appendicitis.

Sources

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9945388/

https://www.mayoclinic.org/diseases-conditions/appendicitis/symptoms-causes/syc-20369543#:~:text=Appendicitis%20occurs%20when%20the%20appendix,in%20the%20lower%20right%20abdomen

https://pharmeasy.in/blog/what-to-eat-and-what-to-avoid-in-appendicitis/

https://my.clevelandclinic.org/health/diseases/10792-appendicitis-in-children