Appendicitis has been called the great pretender, meaning that even doctors can have trouble diagnosing it. You might wonder how you'll recognize the signs of appendicitis if doctor's don't always get it right. You might not make the right call every time, but you're safer as a parent to over-diagnose than under-diagnose potential appendicitis. Doctors do the same; they'd rather operate on a suspicious case and be wrong than miss the diagnosis.
The reason why appendicitis is hard for layman and professionals alike to diagnose is that the symptoms mimic many other gastrointestinal disorders. Many parents worry about appendicitis every time their child has a stomachache, even though appendicitis affects just four in 1,000 children, according to the Encyclopedia of Children's Health. Appendicitis often starts with common symptoms, such as a vague abdominal discomfort and loss of appetite. Fever normally doesn't develop immediately. Toddlers and infants may have no appetite and behave lethargically. Abdominal discomfort normally precedes nausea and vomiting in appendicitis. Up to 30 percent of appendicitis cases are initially misdiagnosed, the Encyclopedia of Children's Health cautions. Fewer than 50 percent of people with appendicitis have traditional symptoms, according to the Merck Manual.
Course of Appendicitis
Appendicitis doesn't normally progress from early symptoms to acute disease very quickly. It takes a day or longer of vague, poorly defined abdominal pain to settle into the right-lower quadrant, although exceptions can occur, Dr. Mark Anderson warns on his website Riparia.org, which gives symptoms of emergencies that can occur when medical care isn't immediately available. In most cases, as the disease progresses your child will prefer to lie still and complain of increased pain when he moves or if you touch his abdomen. If the appendix ruptures, he might feel temporary relief. Perforation can occur within 48 to 72 hours after symptoms begin, according to the Merck Manual, and occurs more frequently in young children.
As many as 15 percent of people who go in for an appendectomy come out of surgery with a normal appendix in the specimen jar, the Merck Manual reports. To reduce the risk of unnecessary surgery, your doctor will often suggest imaging studies such as computed tomography, or CT scanning. Bringing your child to the doctor early enough to do imagining studies as well as blood work and other diagnostic procedures reduces surgeries on a normal appendix. In a Texas Tech University study reported in the January 2004 issue of "Pediatrics," 62 percent of children evaluated for appendicitis underwent appendectomy. Of these, 95 percent had an infected appendix. Sixty-six percent had acute appendicitis and 33 percent had advanced appendicitis, half with perforation and half without.
Increasing Your Odds
The key to having your child treated for appendicitis if he does have it is not to wait too long. In an abstract presented at the 2011 American Academy of Pediatrics (AAP) National Conference and Exhibition in Boston, delay beyond two days of symptoms caused a higher incidence of perforation, or rupture of the appendix, which can cause generalized infection throughout the abdominal cavity, or abscess formation. If your child has abdominal pain that persists more than a few hours, or if the pain localizes to the lower-right quadrant, don't wait; call your pediatrician.