So our patient Chloe appears to be pretty well. She has a history of abdominal pain but when she is examined is not showing any signs of an acute abdomen. It is likely that she has functional abdominal pain (very real abdominal pain in which no medical cause can be found) but this will be a diagnosis of exclusion based on a detailed history, examination and a few, targeted and hopefully non invasive tests.
But children will present with abdominal pain in which the features will point to a more concerning diagnosis or a surgical diagnosis such as appendicitis. As with many presentations in paediatrics your initial impression is important. A child with appendicitis will not move around comfortably. Even the most stoical will give away that moving from laying down to sitting is painful. Look for a grimace, look in their eyes. Do they flinch when they move? In established appendicitis children will walk hunched to relieve the pain.
They will probably have a history of central abdominal pain which has now moved to the right iliac fossa (RIF), low grade fever and maybe some slight diarrhoea. Almost universally they will not want to eat, even when offered their favourite food. This might seem frivolous but it is important. A child with RIF pain who is keen to tuck into a burger is unlikely to have acute appendicitis. In the ones who have less obvious signs the hopping test can be useful. Get them to hop and, if they can’t or it’s very painful, consider appendicitis.