Principles of management in a child

The child with suspected acute appendicitis presents a challenging problem. History and examination should include special attention to:

• features of a urinary tract infection
• previous sore throat and cervical lymphadenopathy - possible mesenteric adenitis
• the liveliness of the child - a lively child who is smiling and laughing does not have appendicitis
• temperature, which if much over 38ø C is more likely to be due to an acute viral illness

If the diagnosis of acute appendicitis is made then the child should be operated on immediately.

If the diagnosis is uncertain then:

• urinary tract infection should be excluded by microscopy
• child kept under close review and examined at intervals of several hours. The clinician must look for a trend in presentation.
• if features of appendicitis become apparent then the patient should be operated on as soon as possible.