Appendicitis

A surgeon has told me that my 10 year-old daughter should have her appendix removed because of repeated tummy pain. He said she had a “grumbling appendix”. My local doctor says there is no such thing. What is your take on this?

The party line in medicine is that there is no such thing as repeated appendicitis. Appendicitis is an acute illness with pain starting around the belly button and then moving to right side of the lower abdomen (tummy).

Having said this, I have met many people who swear that having their appendix out cured their repeated pain.

Children tend to have tummy pain with illnesses elsewhere in the body - for example, with sore throats. It is rather like adults developing headache when unwell from something that is not in their head. I would ask your local doctor to give her a thorough going over in the next episode i.e. look carefully at her Ear, Nose and Throat and other body systems as well as the tummy. A urine sample to exclude infection would be useful as 1% of girls her age suffer urinary infection and this can be a cause of abdominal pain.

Just as adults have headaches with stress, children suffer their stress pain in the tummy. The major causes of stress at this age are a problem at school, e.g. bullying, or problems between the parents which cause the child to want to stay at home and keep an eye on things. Migraine can cause abdominal pain rather than headache in children.

Thus, there are many things to be checked before a child should be subjected to an operation for repeated tummy pain.

Tonsillitis

I took my 6 year-old daughter to the doctor because of her sore throat. She said my daughter had tonsillitis, and swabbed her throat for the laboratory. My daughter has been given antibiotics to start immediately but I am to telephone for the laboratory result in 2 days’ time. Can you tell me about tonsillitis and why the throat swab was necessary?

Tonsillitis is a common infection of the tonsils in the throat. In about half of the cases the infection is due to a bacteria called Streptococcus, in the other half it is due to a viral infection. Your doctor can make the diagnosis of tonsillitis by seeing pus on the tonsils but cannot tell whether it is bacterial or viral. The laboratory will do that by culturing the swab.

Because there is a 50% chance that it will be the Streptococcus it is reasonable to start antibiotics. If it is due to the Streptococcus then a longer than usual course of antibiotic will be given.

In cases of tonsillitis it is important to tell the doctor if there is any family history of rheumatic fever because the Streptococcus can trigger this serious disease in those who are genetically predisposed. This aggressive approach demonstrated by your doctor has helped to make rheumatic fever uncommon in first-world countries.

Repeated tonsillitis will prompt your doctor to suggest having the tonsils removed. Otherwise tonsillitis is just an unpleasant infection except in those who are liable to develop rheumatic fever because there is a family history of it.

Introduction

This blog is to provide answers to questions from parents about childhood illnesses.

I’m David Robinson, a recently retired paediatrician, and I ran a successful and popular Q&A press column for some years.

I’ve always believed it’s better to answer the questions asked by parents rather than write articles about what I think they want to know.

I have six children, now adults, and three grandchildren.

To get the ball rolling, I’ll feature some answers to questions I’ve received in the past.

If you want to ask a question, or require a more detailed follow up question or answer is needed, please email me. I look forward to your questions!