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 naval; 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.