What are the signs of appendicitis in a child?


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What Is Appendicitis?

The appendix is a small organ attached to the large intestine in the lower right side of the belly. When it gets infected, it’s called appendicitis.

Appendicitis is an emergency. It’s important to know what to look for and get medical care right away.

What Are the Signs & Symptoms of Appendicitis?

The first signs of appendicitis are often a mild fever and pain around the belly button. It might seem like just a stomachache. But with appendicitis, the pain usually gets worse and moves to the lower right side of the belly.

If your child has belly pain, be on the lookout for these signs of appendicitis:

  • strong pain, mainly around the belly button or in the lower right part of the belly (the pain might come and go at first, then grow steady and intense)
  • low-grade fever
  • loss of appetite
  • nausea (feeling sick) and vomiting (throwing up)
  • diarrhea (especially small amounts, with mucus)
  • swollen belly

If pain spreads across the belly, it may mean the appendix has burst. Doctors call this ruptured appendicitis, and it’s serious. A high fever reaching 104°F (40°C) is another sign of a burst appendix.

Call your doctor right away if you think your child has appendicitis. The sooner it’s caught, the easier it will be to treat.

What Problems Can Happen?

If an infected appendix isn’t removed, it has the potential to burst about 48 to 72 hours after symptoms first start. This can spread

inside the body. The infection might form a large collection of pus (an abscess) or spread throughout the belly.

Who Gets Appendicitis?

Appendicitis mostly affects kids and teens between 5 and 20 years old. It is rare in infants.

What Causes Appendicitis?

When the appendix gets blocked, too much bacteria can grow and cause an infection. Some of the things that might block the appendix are:

  • hard, rock-like stool (poop)
  • swollen lymph nodes in the intestines
  • parasites and other infections

Appendicitis is not contagious. Kids can’t catch it from someone who has it.

How Is Appendicitis Diagnosed?

The symptoms of appendicitis can be a lot like those of other medical problems (like kidney stones, pneumonia, or a urinary tract infection). So it can be a challenge for doctors to diagnose.

To find out if a child has appendicitis, a doctor will examine the belly for signs of pain and tenderness. The doctor will order blood tests and urine tests. Some kids also get an X-ray of the abdomen and chest, an ultrasound, or a CAT scan.

The medical team may tell you not to give your child any food or drink. This is in case your child needs surgery.

How Is Appendicitis Treated?

A surgeon will operate to take out the infected appendix. This is called an appendectomy. Most of the time, surgeons use a small device called a

to remove the appendix through a small cut on the belly. Kids who get this surgery usually stay in the hospital for a day.

The care team may give your child intravenous (IV) fluids and antibiotics before and after surgery. This helps prevent problems such as an infection. Kids get pain medicine if they need it.

A child who had a burst appendix might need to stay in the hospital longer after an appendectomy. That gives the antibiotics time to kill any bacteria that spread into the body.

Can Appendicitis Be Prevented?

There is no way to prevent appendicitis. But when kids get the right medical care quickly, doctors usually find and treat it without problems.

Reviewed by: Ryan J. Brogan, DO Date reviewed: July 2018

Appendicitis in Children

Appendicitis occurs when the appendix, an appendage (extension) of the colon, becomes inflamed (swollen) and infected. In many cases, an obstruction (blockage) within the appendix causes the infection, resulting in bacterial overgrowth. In 20 to 30 percent of children, the appendix ruptures and releases the infection into the abdominal cavity.

How common is appendicitis?

Appendicitis affects 80,000 children per year in the United States. It is most common in the second decade of life. Fifty percent of children will have a family history of appendicitis. Appendicitis is the most common cause for emergency abdominal surgery in childhood.

Ruptured appendicitis occurs in 30 percent of patients and is more common in children under five years old.

What are the symptoms of appendicitis?

Because the appendix is located in the lower right portion of the abdomen, the most important symptom is low abdominal pain. This often starts around the belly button and moves to the lower right side later. Other symptoms include:

  • Nausea and vomiting
  • Loss of appetite
  • Low-grade fever
  • Diarrhea (after several days)
  • Pain with or increase in urination

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Key points to remember about appendicitis

  • the appendix is a small finger-like tube attached to the first part of the large intestine
  • appendicitis is an inflammation of the appendix
  • appendicitis is a potentially serious condition
  • children (especially those under 5 years old) with appendicitis can deteriorate quickly
  • go to your family doctor or after-hours medical centre first if you think your child has appendicitis symptoms – if you cannot get an appointment straightaway, go to your hospital’s accident and emergency department

What is appendicitis?

Appendicitis is when the appendix becomes inflamed and swollen. The appendix is a small finger-like tube that is attached to the first part of the large intestine (called the caecum). It is in the lower right side of the abdomen.

What causes appendicitis?

Appendicitis is when the appendix becomes inflamed, often because of a blockage within it. The blockage causes the appendix to swell, and it can easily become infected by bacteria. In many children, the exact cause is not obvious, even during the operation.

What puts my child at risk of getting appendicitis?

Anyone can get appendicitis, but it occurs most often between the ages of 10 and 30. There is good evidence that the risk of appendicitis increases when there is not enough fibre in the diet.

What are the signs and symptoms of appendicitis?

Symptoms can vary widely among children. The most common early symptom is continuous tummy pain around the belly button (navel) which may move to the lower right side of the tummy (abdomen) and become sharper and more severe. It often hurts the child to move around, and the pain is worse with coughing or walking.

Your child may also have:

  • a low fever
  • loss of appetite
  • nausea (feeling sick)
  • vomiting
  • constipation or diarrhoea

How is appendicitis diagnosed?

A doctor can usually make a diagnosis of appendicitis after examining your child. Occasionally, a doctor may need to examine your child several times over several hours or even repeatedly over a day or two.

In some circumstances, your child may need other investigations such as:

  • an x-ray
  • an ultrasound scan
  • blood tests
  • a urine sample (to rule out a urinary tract infection)

Appendicitis can sometimes be difficult to diagnose, especially in younger children.

When should I seek help for appendicitis?

Go first to your family doctor or after-hours medical centre if your child has appendicitis symptoms.

Appendicitis is a potentially serious condition. You should first go to your family doctor or after-hours medical centre if your child has appendicitis symptoms. If you cannot get an appointment straightaway, go to your hospital’s accident and emergency department.

Do not give your child anything to eat or drink until the doctor examines them. This in case your child needs surgery.

You may give paracetamol to help reduce the pain. You must follow the dosage instructions on the bottle. It is dangerous to give more than the recommended dose.

What are the complications of appendicitis?

If doctors don’t remove an inflamed appendix, it can sometimes burst. If this happens, the infected contents of the appendix spill into the abdominal cavity. This is a more serious medical emergency. If left untreated, infection of the lining of the abdominal cavity (peritonitis) can be life-threatening. This requires immediate emergency treatment, including an intravenous line and antibiotics.

The signs of a perforated appendix include:

  • a severe worsening of symptoms – especially severe abdominal pain and swelling
  • reluctance to move because it makes the pain worse
  • collapse

What is the treatment for appendicitis?

The treatment for appendicitis is an operation to remove the appendix – an appendicectomy.

The 2 techniques used are:

  • open appendicectomy- a surgeon makes a single cut (incision) over the appendix
  • laparoscopic appendicectomy (‘key hole’ surgery) – a surgeon will make 3 small ‘key hole’ cuts over the lower abdomen – they will then insert special instruments to remove the appendix

Your child’s surgical team will discuss your child’s operation with you, including which technique they will use. You can ask them any questions you have then.

Sometimes a laparoscopic appendicectomy may need to become an open appendicectomy if the surgeon cannot safely remove the appendix any other way.

Occasionally, a surgeon will find another cause for the pain during the appendicectomy. If this happens, the surgeon will deal with it during the same operation.

Sometimes, if the symptoms have been going on for many days or if it is an advanced or complex case, doctors will give strong antibiotics through an intravenous drip. If this happens, your child’s doctor will delay the surgery deliberately.

What happens to my child before the operation to remove their appendix?

  • your child will not be allowed to eat or drink anything
  • your child will need to have an intravenous drip put into their hand or arm before the operation
  • your child’s surgeon will explain the operation, and any other treatment needed – you should feel free to ask the surgeon any questions you have
  • your child will receive antibiotics at the time of surgery
  • you will need to sign a consent form before the surgery

In some cases, your child may need a nasogastric tube – a tube through the nose to the stomach. Your child is more likely to need this if their appendicitis has been going on for a long time or they have vomited a lot.

What happens to my child after the operation to remove their appendix?

  • the healthcare team will watch your child closely immediately after the operation and as often as necessary
  • they will check the wound from time to time
  • the nurses on the ward will give your child pain relief – older children may be able to control their own pain relief (see Patient controlled analgesia (PCA))
  • your child may have antibiotics through an intravenous drip for several days after the surgery if the appendix ruptured or there was peritonitis
  • your child’s hospital stay will usually be between 1 and 4 days but may be longer if the appendix ruptured or there was peritonitis

Can there be any complications from the operation to remove my child’s appendix?

All surgery carries some degree of risk. One of the most common complications following appendicectomy is infection. Around 20 percent of people who have a ruptured appendix develop an abscess (collection of pus) within their abdominal cavity 2 weeks or so after the appendicectomy.

If an abscess does develop, your child will need another operation to drain it. Often doctors can use a special x-ray to help guide them as they insert a narrow tube to drain out the pus. Your child won’t need a full operation if doctors use this technique.

Could That Stomachache in Your Child Be Appendicitis?

“My tummy hurts!” This common childhood cry can mean almost anything, from anxiety about school to a serious illness. Usually, it’s nothing to worry about. But how do you know when it might be appendicitis or something else that needs immediate attention?

“Determine the severity of the pain. If the child is complaining about stomach pain, but is still playing, laughing and eating, chances are it’s nothing serious,” says Pennsylvania pediatrician William J. Cochran, M.D. “If the child is complaining about very severe pain and is not doing these things, as they normally do, have the child seen by a doctor right away.”

Here are good reasons to take a troubled tummy to the doctor at once:

  • Pain that starts near the navel (bellybutton) and spreads to the lower right part of the stomach. This can mean appendicitis, a medical emergency.

  • Stomach pain associated with blood in either the vomit or stool.

  • Green liquid vomit. This could be bile, a sign of torsion—twisting or blockage—of stomach or intestines. The condition must be treated quickly.

  • Distended abdomen. This can mean obstruction or other problems such as appendicitis.

  • Pain when the abdomen is pressed, particularly if pressed and then released suddenly. This can mean that the peritoneal lining, the membrane lining the abdominal cavity, is inflamed. This can occur in conditions such as appendicitis.

  • Child complains of abdominal pain and lies on his or her side with legs drawn up toward abdomen. This often occurs when appendicitis is present.

  • Child complains of abdominal pain and walks bent at the middle. This can mean appendicitis.

Appendicitis is an inflammation of the appendix, which is found in the lower right abdomen near the beginning of the colon (large intestine). The pain for appendicitis usually begins near the navel; within a few hours, the pain may move down to the lower right abdomen. Symptoms that appear after the pain begins include loss of appetite, a low-grade fever, nausea and vomiting. In children 2 and under, the main symptoms are vomiting and a distended abdomen. Older children also may develop diarrhea and constipation.

Diagnosing appendicitis may be difficult because the symptoms in children can be similar to gastroenteritis, food poisoning or a respiratory illness.

Gastroenteritis, which is common in children ages 5 to 9, looks like an emergency but usually isn’t. Caused by a virus, it usually strikes fast and hard with abdominal discomfort, vomiting and diarrhea. Most cases ease up quickly. But if it doesn’t—or if your child is dehydrated and has a bloated abdomen or isn’t acting as he or she normally would—see the doctor. Food poisoning has similar symptoms to gastroenteritis and also is common in children.

When in doubt, call your pediatrician.

Does This Child Have Appendicitis? Watch Out for Key Signs – 08/01/2007

A 5-year-old with abdominal pain, nausea and fever may have appendicitis or any of a number of other problems. But how does the child’s doctor decide whether to schedule an emergency appendectomy to surgically remove a presumably inflamed appendix — a procedure that carries its own risks like any surgery — or wait and observe what could be a ticking time bomb that could rupture and kill the patient in a matter of hours? It’s a classic physician’s dilemma, but a new study led by the Johns Hopkins Children’s Center may ease the pediatrician’s problem-solving and parents’ anxiety.
Reporting on their review of the frequency of the most common symptoms of actual appendicitis in children, the researchers concluded that beyond fever, the most telltale signs are “rebound” tenderness or pain that occurs after pressure is removed abruptly from the lower right part of the abdomen; abdominal pain that starts around the belly button and migrates down and to the right; and an elevated white blood cell count (10,000 or more per microliter), which is a marker of infection in the body.
Notably, loss of appetite, nausea and vomiting, hallmark appendicitis symptoms in adults, were NOT predictive of appendicitis in children.
“These signs don’t give you an absolute diagnosis, but they should prompt the doctor to refer the child to a surgeon for evaluation,” said study lead author David Bundy, M.D., M.P.H., a pediatrician at the Johns Hopkins Children’s Center.
Appendicitis is most common in teens and young adults in their early 20s. However, children younger than 4 years are at the highest risk for a rupture. Up to 80 percent of appendicitis cases in this age group end in rupture, partly because young children have fewer of the classic symptoms of nausea, vomiting and pain localized in the lower right portion of the abdomen than do teenagers and young adults, making the diagnosis easy to miss or delay.
In the study report, published in the July 25 issue of the Journal of the American Medical Association, the researchers said ultrasound and CT scan images can be helpful, but are not always conclusive, even if they are available on an emergency basis. And CT scans in particular expose young children to radiation, which should be avoided if possible.
“In a very young child, the presentation of symptoms associated with appendicitis tends to be different from adults, so when trying to decide between fast-track surgery versus watchful observation, you’re often damned if you do and damned if you don’t,” Bundy said. “In our analysis, we’ve identified some of the more powerful telltale signs that should help residents, general pediatricians and ER doctors narrow down what is seldom a clear-cut diagnosis.”
The appendix is a small tube extending from the large intestine, and infections and inflammation of the organ can be dangerous. The only absolute way to diagnose the condition is surgery, and each year, appendicitis sends 77,000 American children to the hospital. An estimated one-third of them suffer a ruptured appendix, a life-threatening complication, before they reach the OR.
In their analysis of previous research, investigators searched hundreds of studies, weeding out weak from solid science. The 25 studies that made the final cut examined symptoms and outcomes in children who presented with abdominal pain and in whom appendicitis was considered a possible diagnosis.
Abdominal pain in children is one of the most common and vaguest symptoms, and can suggest anything from innocent constipation to serious infections or blockages of the intestines. Doctors advise parents that any abdominal pain should be evaluated for appendicitis.
“We really want parents to keep in mind that children with appendicitis don’t always show up with the classic story that we see in adults,” Bundy says. “There isn’t a perfect formula, but we think the signs we’ve identified can help.”
Other researchers in the study: Julie Byerly, M.D., E. Allen Liles, M.D., Eliana Perrin, M.D. M.P.H., Jessica Katznelson, M.D., all of the University of North Carolina at Chapel Hill; and Henry Rice, M.D., Duke University Medical Center.
The research was funded in part by the Robert Wood Johnson Clinical Scholars Program and by the National Institutes of Health.

Appendicitis in Children: Signs, Symptoms, and More

The signs and symptoms of appendicitis, as well as the treatment, can be different in children than in adults.

When children have pain in the belly-button area that spreads to the lower-right belly area, appendicitis is often the culprit. Getty Images

A stomachache is a very common occurrence, especially in children. While abdominal pain accounts for about 9 percent of childhood visits to primary care offices, according to a report published in May 2016 in American Family Physician, (1) the abdominal pain your child experiences is usually the result of something non-life-threatening, (2) such as:

  • Constipation
  • Gas
  • Strep throat
  • Swallowing lots of air
  • Anxiety
  • A mild food allergy
  • A stomach or intestinal infection (gastroenteritis)

If your child’s stomachache intensifies or lasts for more than a day, it could be a sign of a serious condition. But again, there’s a long list of diseases that could cause this abdominal pain, including:

  • A stomach ulcer
  • Inflammatory bowel diseases, such as Crohn’s disease or ulcerative colitis
  • Benign or cancerous tumors
  • A urinary tract infection (UTI)
  • Gallstones
  • Complications that twist, block, or obstruct the bowels, such as a hernia

But if your child’s pain begins in the belly-button area and spreads to the lower right abdominal area, it may be the result of appendicitis, a medical condition in which the appendix — a small, finger-shaped pouch attached to the large intestine in the lower right belly area — becomes inflamed. In children who’ve gotten emergency medical care for acute abdominal pain, about 10 to 30 percent have had appendicitis or another condition requiring surgical intervention. (1)

Appendicitis most often affects teens and those in their twenties, but it can occur in children as well. According to the Cleveland Clinic, approximately 80,000 children in the United States are affected each year. (3) It’s usually caused by an abdominal infection that has spread to the appendix, or by a blockage that has obstructed the appendix.

If your child’s abdominal pain worsens with movement, deep breaths, coughing, or sneezing, the possibility that he or she has appendicitis should be seriously considered.

Still, it’s important to look for other signs of appendicitis.

The Signs and Symptoms of Appendicitis in Children

In most adults, there is a very specific set of appendicitis symptoms that accompany abdominal pain. These often include:

  • Loss of appetite
  • Nausea
  • Vomiting
  • Low-grade fever
  • Inability to pass gas or stool
  • Abdominal swelling
  • Constipation or diarrhea

But research suggests that appendicitis can affect children differently than adults. Along with abdominal pain, most kids with appendicitis often experience fever and a symptom known as “rebound tenderness,” (1) a sharp pain that develops after pressure is placed on the lower right abdominal area and quickly released. Children may also have an elevated white blood cell count, which is a sign of an infection. Your doctor can check this with a blood test. (4)

Importantly, although some kids with appendicitis do experience other hallmark symptoms of the condition, including nausea, vomiting, and lack of appetite, these signs are not predictive of appendicitis in children, according to a study published in July 2007 in the Journal of the American Medical Association. (5)

Appendicitis may also cause different sets of symptoms with very young children. Some studies suggest that kids between ages 2 and 5 most often experience stomachaches and vomiting if they have appendicitis; fever and loss of appetite also frequently occur.

For infants younger than 2 years old, appendicitis usually causes vomiting, a bloated or swollen abdomen, and fever, though diarrhea is also not uncommon. (6)

To confirm a diagnosis of appendicitis, doctors often use imaging procedures. For children, the American College of Radiology recommends performing an ultrasound first, followed by a computed tomography (CT) scan only if the ultrasound is inconclusive. This is due to caution concerning radiation exposure in kids. (7)

Treating Complicated and Uncomplicated Appendicitis in Children

An appendectomy, which involves the surgical removal of the appendix, is the standard treatment for appendicitis in children as well as adults. If appendicitis isn’t caught in its early stages, the appendix can rupture and cause an infection of the peritoneum, the membrane that lines the abdominal cavity. This infection, called peritonitis, can quickly spread, potentially causing death.

Because appendicitis is more difficult to diagnose in children than adults — especially in children younger than 5 — some 30 percent of kids with the condition will suffer from a perforated (ruptured) appendix before being treated. (3) (Some data suggests that in children younger than five, it may be up to 51 percent). (8)

For kids with acute, nonperforated appendicitis (meaning the appendix hasn’t ruptured), an urgent appendectomy is the accepted, optimal treatment. When the appendix has ruptured, though, there are two surgical courses of action: early appendectomy (performed within 24 hours of admission) or interval appendectomy (performed several weeks later) after antibiotics are used to treat infection.

As a study published in October 2017 in Pediatrics and Neonatology notes, there hasn’t been a clear consensus on which is the best way to manage ruptured appendices in children — with conservative treatment (antibiotics followed by interval appendectomy) or early appendectomy. (9)

Traditionally, the conservative treatment has been preferred, but other research, including a studypublished in the journal JAMA Surgery, suggested that kids recover more quickly and are less likely to suffer from post-surgery complications, such as surgical site infections, if their ruptured appendices are removed within 24 hours of diagnosis. (10)

Researchers conducting the 2017 Pediatrics and Neonatology study found that such patients may benefit from early appendectomy, as it could shorten the duration of antibiotics, reduce the need to increase antibiotics, and decrease the length of hospitalization. They note that more research is needed to confirm their findings. (9)

When acute appendicitis is uncomplicated and the appendix hasn’t ruptured, there’s increasing evidence supporting antibiotics as an alternative to surgery in adults, and recent studies have also examined if this holds true in pediatric cases. A meta-analysis of studies published in March 2017 in Pediatrics found that data suggests nonoperative treatment is safe and effective in children with acute uncomplicated appendicitis. (11)

Again, study authors say more research is needed. Clinical trials investigating appendectomy versus nonoperative treatment in children whose appendices are not ruptured are currently underway in the United States and the United Kingdom. (12,13)

Additional reporting by Deborah Shapiro.

Appendicitis in Children and Teens

Appendicitis happens when the inside of the appendix is blocked by something, causing swelling and infection. It can also occur because of stool, parasites, or viral inflammation.

The appendix then becomes inflamed and swollen. This is because the germs (bacteria) in the appendix begin to increase quickly. As the swelling and soreness get worse, the blood supply to the appendix is cut off.

All parts of the body need the right amount of blood flow to stay healthy. When blood flow is reduced, the appendix starts to die. The appendix will burst or rupture as its walls start to get holes. These holes let stool, mucus and other substances leak through and get inside the belly or abdomen. A serious infection called peritonitis may occur in the belly when the appendix bursts. If not treated, it can be fatal.

Each child’s symptoms may vary. Below are some common symptoms of appendicitis.

Pain in the belly (abdomen) is the most common symptom. This pain:

  • May start in the area around the belly button, and move to the lower right-hand side of the belly. Or it may start in the lower right-hand side of the belly.
  • Often gets worse as time passes
  • May be worse when the child is moving, taking deep breaths, being touched, or coughing and sneezing
  • May be felt all over the belly if the appendix bursts.

Other common symptoms include:

  • Upset stomach (nausea) and vomiting
  • Loss of appetite
  • Fever and chills
  • Changes in behavior
  • Trouble having a bowel movement (constipation)
  • Loose stool (diarrhea)
  • Swollen belly in younger children.

Your child’s doctor will take a health history and do a physical exam. The doctor may also order tests, including:

  • Abdominal ultrasound. This imaging test uses high-frequency sound waves and a computer to create images of blood vessels, tissues and organs. It is used to see internal organs as they work. Learn more about having an ultrasound at CHOC Children’s.
  • CT scan. This imaging test uses both X-rays and computer technology to show detailed images of any part of the body. This includes the bones, muscles, fat and organs. It is more detailed than a general X-ray. Learn more about having a CT scan at CHOC Children’s.

Other tests may include:

  • Blood tests. These tests check the infection. They can also see if there are any problems with other abdominal organs, such as the liver or pancreas. Learn more about having a blood test at CHOC Children’s.
  • Urine test. This test can tell if there is a bladder or kidney infection, which may have some of the same symptoms as appendicitis.

Symptoms of appendicitis may look like other health problems. Always see your child’s health care provider for a diagnosis.

How is appendicitis treated?

Treatment will depend on your child’s symptoms, age and general health. Appendicitis is a medical emergency. It is likely the appendix will burst and cause a serious, deadly infection. For this reason, your child’s doctor will likely advise that your child have surgery to remove the appendix.

In most cases, the appendix is removed using laparoscopic surgery. Your child is given anesthesia by our pediatric anesthesiologists. This method uses a few small incisions and a camera called a laparoscope to look inside the belly. The surgical tools are placed through one or more small incisions. The laparoscope is put in through another incision.

Sometimes the appendix bursts, and a collection of infected fluid or pus (abscess) may form. If this happens and your child is stable, the provider may recommend not removing the appendix right away. Instead, the provider may want to treat the infection first and drain the infected fluid from the abscess. The appendix will be removed later. This delayed surgery is called an interval appendectomy.

For an interval appendectomy, your child may first have IV antibiotics. These are given through an IV tube called a PICC line, or a peripherally inserted central catheter. This is done for about 10 to 14 days. In addition, the provider may use CT or ultrasound-guided images to drain the abscess. Once the infection and inflammation are gone, your child will have surgery to remove the appendix about 6 to 8 weeks later.

What happens after surgery?

A child whose appendix ruptured will have to stay in the hospital longer than a child whose appendix was removed before it burst. Some children will need to take antibiotics by mouth for a certain period of time after they go home.

After surgery, your child will not be allowed to eat or drink anything for a certain period of time. This lets the intestine heal. During this time, fluids will be given by IV into the bloodstream. Your child will also have antibiotics and medicines to ease pain through the IV.

At some point, your child will be able to drink clear liquids such as water, sports drinks or apple juice. He or she will slowly move on to solid foods.

After your child leaves the hospital, the doctor will likely limit his or her activities. Your child should not do any heavy lifting or play contact sports for a few weeks after surgery. If a drain is still in place when your child goes home, he or she should not take a bath or go swimming until the drain is removed.

You will be given a prescription for pain medicine for your child to take at home. Some pain medicines can make a child constipated, so ask your doctor or pharmacist about any side effects. Moving around after surgery rather than lying in bed can help prevent constipation. Drinking fruit juices may also help. Once your child can have solid foods again, eating fruits, whole grain cereals and breads, and vegetables can also help stop constipation.

Most children who have their appendix removed will have no long-term problems.

An irritated appendix can quickly turn into an infected and ruptured appendix. This can happen in a few hours. A ruptured appendix is an emergency situation. If not treated, it could be fatal. When the appendix ruptures, germs (bacteria) infect the organs inside the abdominal cavity. This causes a bacterial infection called peritonitis. The bacterial infection can spread very quickly. It may be hard to treat if diagnosis is delayed.

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