What is the typical presentation of appendicitis in children?
Classically, periumbilical abdominal pain precedes the onset of vomiting and is associated with low-grade fever, nausea/vomiting, and anorexia. As the inflammation of the appendix advances and touches the adjacent peritoneum, the pain localizes to the right lower quadrant at McBurney’s point. However, the clinical course often does not follow the “textbook” description, so the diagnosis can be difficult to make and the physician must maintain a high index of suspicion. Remember that history of abdominal pain preceding vomiting is a clue to differentiate appendicitis from acute gastroenteritis.
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Marin JR, Alpern ER: Abdominal pain in children. Emerg Med Clin North Am 2011;29:401-428.