An Illness Even M.D.s Can Miss: Appendicitis in Children

Parents -- and physicians -- often mistake appendicitis for a bad stomachache. Would you be able to spot it in your child?

When Catherine Holecko's 6-year-old daughter, Josie, complained of a stomachache the day before the family was to fly to California, Catherine and her husband, Jeff, briefly considered postponing. But Josie had eaten a large cinnamon roll and Jeff had also just had a stomachache. They figured Josie's symptoms would pass.

During the two-hour ride to the airport the next afternoon, Josie's stomach still hurt. Catherine treated her with acetaminophen and antacids. After arriving at their rented apartment in San Francisco, Josie threw up. At 3 a.m. she awoke, still in pain.

That's when Catherine called their family practitioner back home in Neenah, Wisconsin, for advice. Once the doctor heard Josie's symptoms, he told Catherine it was possible that it was her daughter's appendix and she should be seen by a doctor within the next four hours. "I wasn't thinking she had anything serious," she says. "It never occurred to me that a 6-year-old could get appendicitis."

The truth is, anyone with an appendix can get appendicitis, a painful inflammation of the hollow finger-shaped organ attached to the end of the large intestine. Untreated, an inflamed appendix can rupture, leading to a lengthy hospital stay for complications including abdominal infection and bowel obstruction.

When surgeons removed Josie's appendix 12 hours after her mother brought her to a San Francisco emergency room, it had already ruptured, probably days earlier. Catherine was overwhelmed with guilt. "We dragged her 2,000 miles from home when she felt so awful, and we kept giving her Tylenol and Tums. We were so clueless."

A Confusing Condition

Child with stomach pain

Appendicitis eludes doctors too. Approximately 80,000 children in the United States suffer from it every year. Although it's most common in kids over age 10, more than 80 percent of children younger than 3 who have the illness already have a rupture by the time they reach the operating room. Many of them had been seen and sent home at least once by a health-care professional. That's because in the very early stages, the condition can be hard to diagnose, especially when patients are too young to accurately describe their symptoms.

"We'll have kids come in and say, 'My stomach hurts,' when they may have pneumonia or strep throat," says Geeta Singhal, M.D., head of pediatric hospital medicine at Baylor College of Medicine, in Houston. She coauthored a recent study in Pediatrics that addressed the confusion surrounding appendicitis. Pediatricians had to rank ten common ailments based on how commonly they were misdiagnosed; appendicitis came in fourth. "Children can't always point to their right lower quadrant and say, 'It hurts here,'" she says. "It can be challenging, depending on a child's developmental level and how verbal he is." Part of the problem is that the symptoms -- abdominal pain, loss of appetite, nausea, vomiting, diarrhea, fever -- are common to so many conditions. And not every child will have every symptom.

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