Which physical findings are characteristic of pediatric appendicitis?

Updated: Oct 25, 2018
  • Author: Adam C Alder, MD; Chief Editor: Carmen Cuffari, MD  more...
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Answer

The physical examination findings in children may vary depending on age. Irritability may be the only sign of appendicitis in a neonate. Older children often seem uncomfortable or withdrawn. They may prefer to lie still because of peritoneal irritation. Teenaged patients often present in a classic or near-classic fashion.

Examination of the child requires skill, patience, and warm hands. Initial and continued observation of the child is of critical importance. An ill-appearing quiet child who is lying very still in bed, perhaps with the legs flexed, is much more a cause for concern than a child who is laughing, playing, and walking around the room.

The examination should be thorough and start with areas other than the abdomen. Because lower lobe pneumonias can cause abdominal findings, a history of such should be elicited and a thorough chest examination performed. It is also important to exclude urinary tract infection (UTI) as a cause of abdominal pain.

Children vary in their ability to cooperate with the physical examination. It is important to tailor the physical examination to the child's age and developmental stage.


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