Appendicitis is uncommon in children under 5, but carries a ⚠️ very high risk of perforation (up to 90%), making early recognition critical.
Differentials include 🤒 viral gastroenteritis, 🚽 UTI, and 🧩 mesenteric adenitis due to often atypical presentations.

🧍 Clinical Presentation

History:
- 📍 Pain → usually localises to RLQ, but may be vague/diffuse in young children.
- ⏳ Typically no prior recurrent abdominal pain (distinguishes from functional pain).
- 🍽️ Anorexia and 🤢 vomiting common but non-specific.
- 🚫 Absence of cough or urinary symptoms helps exclude chest or urinary causes.
Examination:
- 🌡️ Fever and ❤️ tachycardia suggest infection.
- 🚶 Ability to hop or sit forward comfortably → appendicitis less likely.
- 👩‍⚕️ Abdominal tenderness (esp. RLQ) ± guarding → key clinical sign.

🧪 Diagnosis and Tests

🧩 Lab tests (WCC, CRP) may be raised but are not diagnostic.
🖼️ Imaging: Ultrasound or CT may be inconclusive due to small size or poor visualisation.
🧑‍⚕️ Clinical judgment remains the cornerstone of diagnosis.

📊 Age-Stratified Appendicitis Features & Perforation Risk

Age Group	Typical Presentation	Perforation Risk	Clinical Pearls
<5 years	Vague/ diffuse abdominal pain, vomiting, irritability, anorexia	Up to 90%	High index of suspicion; atypical signs; imaging often inconclusive; early surgical referral essential
5–10 years	RLQ pain, anorexia, vomiting, mild fever	30–50%	More classical signs develop; still consider early imaging if uncertain
>10 years / Adolescents	RLQ pain, anorexia, nausea, vomiting, fever, localized tenderness, rebound	10–20%	Often presents classically; Alvarado score or Paediatric Appendicitis Score can guide diagnosis

🩺 Management

👨‍⚕️ Early referral to a paediatric surgeon if appendicitis suspected.
🚑 Children with severe pain or prolonged history → high risk of perforation → need urgent surgery.
🔪 Appendectomy: usually laparoscopic for non-perforated cases.
💊 If perforated → surgical drainage + IV antibiotics with broad-spectrum + anaerobic coverage.

✅ Key Points / Conclusion

🧒 Appendicitis <5 years is rare but dangerous due to ⚠️ high perforation risk.
🧑‍⚕️ Diagnosis relies on history + examination + clinical judgment; tests often inconclusive.
🚑 Early surgical review and ⏱️ timely appendectomy are essential to prevent peritonitis or sepsis.

📚 References

NICE Guideline NG187 – Suspected Acute Appendicitis
Royal College of Paediatrics and Child Health – Appendicitis in Children
Svensson JF, et al. Pediatric Appendicitis: Diagnosis and Management. J Pediatr Surg. 2015;50(9):1456–1462.
Andersson RE. Paediatric Appendicitis: Clinical Features and Diagnosis. BMJ. 2004;329:530–534.
Wiersma F, et al. Perforation Risk in Young Children with Appendicitis. Pediatr Surg Int. 2016;32:189–196.

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Acute Appendicitis in Children ✅

🧾 Introduction