Appendicitis Explained Simply: Early Signs Parents Miss

Intro

Appendicitis is one of the most common surgical emergencies in children — and one of the easiest to miss early.

The reason is simple:

Appendicitis rarely starts dramatically.

Early symptoms can look like a mild stomach bug, constipation, or anxiety-related pain. Understanding the pattern of progression is far more important than any single symptom.

What the Appendix Is (and Why It Hurts)

The appendix is a small pouch attached to the large intestine.

When it becomes blocked and inflamed:

Pressure builds inside
Blood supply becomes compromised
Inflammation spreads to the surrounding lining

Pain increases as inflammation progresses — which is why worsening pain over time is a critical clue.

The Typical Progression Pattern

Many children follow a similar sequence:

Vague pain around the belly button
Pain that worsens over hours
Pain that moves to the right lower abdomen
Loss of appetite (often striking)
Pain with movement (walking, jumping, coughing)

Vomiting and fever often appear later, not at the start.

Why Appendicitis Is Often Missed

Appendicitis is commonly missed early because:

Pain starts mild and non-specific
Children may struggle to describe location
Early tests can be normal
Symptoms overlap with:
- viral illness
- constipation
- functional abdominal pain

The key difference is progression.

Behavioural Clues That Matter

Often more telling than pain descriptions:

Observation	Suggests
Child lies very still	Concerning
Avoids walking/jumping	Concerning
Appetite suddenly gone	Concerning
Pain improving	Less likely appendicitis
Distractible pain	Less likely appendicitis

What Does Not Rule Out Appendicitis

Mild pain at first
Normal blood tests early
Temporary symptom fluctuation
Young age (appendicitis occurs in toddlers)

Clinical reassessment over time is often the diagnostic tool.

When to Seek Urgent Care

Seek urgent medical assessment if a child has:

Abdominal pain worsening over 6–12 hours
Pain that localises, especially to the right lower abdomen
Pain with walking, jumping, or coughing
Persistent vomiting
Fever with abdominal pain
Sudden testicular or pelvic pain

Appendicitis vs Other Common Causes (Quick Contrast)

Feature	Appendicitis	Anxiety-related	Constipation
Time course	Progressive	Recurrent/stable	Chronic/recurrent
Localisation	Often right-sided	Central	Diffuse/lower
Appetite	Drops off	Usually normal	Variable
Movement pain	Yes	No	Usually mild
Response to reassurance	No	Yes	Sometimes

Decision Pathway

flowchart TD A[Child with abdominal pain] --> B{Pain worsening or localising?} B -->|Yes| C[Urgent medical assessment] B -->|No| D{Red flags present?\nMovement pain, vomiting,\nfever, appetite loss} D -->|Yes| C D -->|No| E{Stable or improving?} E -->|Yes| F[Monitor with safety net] E -->|No| C

FAQ

Q: Can appendicitis start with diarrhoea or vomiting?
A: Yes. Early appendicitis can mimic gastroenteritis, especially in younger children.

Q: Can appendicitis resolve on its own?
A: Untreated appendicitis usually progresses and can lead to perforation.

Q: Should painkillers be avoided?
A: Appropriate pain relief does not mask appendicitis and should not be withheld while seeking care.