Appendicitis in children

Appendicitis is relatively common in childhood, with around one in 40 Kiwi kids suffering from this inflammation of the appendix.

However, common or not, this is a potentially serious condition that can cause a sudden deterioration in your child’s health, particularly if they’re under five.

It’s important to get medical treatment quickly if you think your child has appendicitis symptoms, and a new study has found that some children aren’t getting healthcare quickly enough.

A study of 14 hospitals around the country has found that rural and Māori children are more likely to have severe appendicitis than their urban and non-Māori peers. So, let’s look at the symptoms of appendicitis, and explore the research in more detail.

What is appendicitis and what causes it?

Appendicitis is when the appendix becomes inflamed and swollen, and if you’re wondering what the appendix actually is, then KidsHealth describes it as a ‘small, finger-like tube’ that’s attached to the first part of the large intestine, usually on the lower right side of the tummy.

Appendicitis doesn’t often occur in young children, although it can happen to anyone. It’s most common between the ages of 10 and 30, and although the exact cause of an appendicitis case isn’t always obvious, a blockage can cause the appendix to swell and become infected.

KidsHealth says, ‘There’s some evidence that the risk of appendicitis increases when there is not enough fibre in the diet,’ and although appendicitis isn’t genetic, it’s possible for several family members to get it by chance.     

What are the symptoms of appendicitis?

The experts say, ‘Symptoms can vary widely among children,’ but the most common early sign is a pain that begins around the belly button, then moves to the lower right side of the stomach – becoming sharper and worse as it goes.

It often hurts to move around, cough or walk, and a child with appendicitis might also have:

• A low fever
• Loss of appetite
• Nausea, and sometimes vomiting
• Constipation or diarrhoea

When should medical help be sought?

If your child is exhibiting signs of appendicitis, it’s important to see your family doctor or visit an after-hours medical centre, so they can examine your little one and diagnose what’s going on.

This might involve an x-ray or ultrasound of their stomach, a blood test to check for inflammation or infection, and a urine sample to rule out a urinary tract infection.

If you can’t get in to see a general practitioner straightaway, KidsHealth says you need to go to the accident and emergency department of your local hospital.

You can give your child paracetamol to help with the pain (sticking to the recommended dose for their age/weight), but you shouldn’t give them anything to eat or drink until they’ve been examined by a doctor (in case they need surgery).

It’s very important to get medical help swiftly, because an inflamed appendix can sometimes burst if it’s not removed in time, and then leak its infected contents into your child’s stomach, which can make them very sick.

How is appendicitis treated?

Appendicitis is treated by removing the appendix, with an operation called an ‘appendicectomy.’ This is done with keyhole surgery or with a single incision, and if your child needs this surgery, your doctor will explain everything to you.

It’s comforting to know that the appendix isn’t thought to have an important role in the body (according to The Royal Children’s Hospital in Australia), but recovery time will vary, depending on how severe the appendicitis was.

KidsHealth says children will usually be in hospital for one to four days after an appendicectomy, but the stay can be longer if the appendix has burst, and Stuff reports that severe appendicitis increases the chances of surgery complications by 57 per cent.

What does the new study tell us about appendicitis?

This distinction between severe appendicitis (where the appendix has burst) and non-severe appendicitis is important and it shows that time is of the essence when treating appendicitis.

Dr Brodie Elliott is one of the brains behind the new study, and he’s told Stuff that, ‘If someone presents early and their appendix hasn’t ruptured, it can be removed and they can go back to life quickly, but if left, they're sicker for longer and spend more time in hospital.’

After seeing lots of patients arriving at hospital late, Dr Elliott decided to look at the reasons for this delay. He enlisted the help of 54 junior doctors around the country to see which children were more likely to get severe appendicitis, what effect a healthcare delay had, and why families were late getting their child to hospital.

The team looked at 182 confirmed cases of appendicitis across 14 New Zealand hospitals and found that:

• Some Kiwi kids are more likely to get a severe case of appendicitis

Specifically, rural children are four times more likely than urban kids to experience a burst appendix, and Māori children are twice as likely as non-Māori children to have this happen.

• There is a link between severe appendicitis and a healthcare delay

The study shows that children with severe appendicitis were sick for twice as long as those with uncomplicated appendicitis (48 hours compared with 20 hours) before going to hospital, and a delay in getting to hospital was a ‘key contributing factor’ to severe appendicitis.

• Child care and transport were the main reasons that families presented to the hospital late

Child care was the most common reason for a delay in getting to hospital, and in 42 per cent of cases, parents had to arrange child care for their other dependents before rushing their sick child to hospital.

The next most common reason for the delay related to transport.

On average, families had to drive 35km to take their ill child to hospital, and a family’s access to transportation was linked to the severity of their child’s appendicitis. Specifically, families who had to borrow a car or call an ambulance to get to hospital were twice as common in the ‘severe appendicitis’ group, compared with those in the ‘non-severe’ group.

• Going to hospital for appendicitis treatment impacted family finances

In more than 50 per cent of cases, families lost at least one parental income to access hospital care for their child, and this caused ‘significant financial stress’ for about 25 per cent of families.

What can we take from this?

Dr Elliott has told Stuff that these findings highlight the inequity in New Zealand. He’s calling for rural and Māori communities to have a greater say in healthcare funding, and for healthcare workers to focus on providing ‘culturally safe and acceptable service for our people.’

Dr Elliott says his research also ‘hints’ at a bacterial reason why rural children get more severe appendicitis, which could mean that it’s not just the distance travelled to hospital that has an impact on country kids’ medical condition.

And, of course, no matter where you live or what your culture, this research highlights the importance of being able to recognise signs of appendicitis and seek medical treatment quickly if there’s tummy trouble in your family.

References

KidsHealth

The Royal Children’s Hospital

Stuff