Pediatric emergency medicine trisk 3739 3739

children younger than 2 years of age. Predictably, the diagnosis is very difficult in
children younger than 5 years of age. The emergency physician must accurately
evaluate the child and promptly consult a surgeon when the diagnosis is clear or
when appendicitis cannot be safely ruled out. Such consultation is especially
urgent in younger children, in whom perforation can occur within 8 to 24 hours of
the onset of symptoms. Usually the child with appendicitis initially complains of
poorly defined and poorly localized midabdominal or periumbilical pain.
Unfortunately, this symptom is common to many other nonsurgical intraabdominal problems. In the young and, to a lesser extent, the older child,
vomiting and a low-grade fever often occur. Characteristically, the pain then
migrates to the right lower quadrant ( Table 116.1 ).