From the Guidelines
Red flags of abdominal pain in pediatric patients that require immediate medical attention include persistent pain, severe pain, fever, bloody stools, vomiting, abdominal distension, and changes in behavior. These warning signs can indicate serious conditions like appendicitis, intussusception, or other surgical emergencies that require prompt evaluation 1. The diagnosis of acute appendicitis in pediatric patients can be challenging due to atypical clinical features, and clinical scoring systems such as the Alvarado score and Samuel’s Pediatric Appendicitis Score (PAS) have been developed to aid in diagnosis 1. However, these scores have limitations, and the use of laboratory tests such as CRP and calprotectin levels can help accurately predict which children are at low risk of acute appendicitis and can be safely managed with close observation 1. Key red flags to watch out for include:
- Persistent pain lasting more than a few hours
- Severe pain that causes the child to be doubled over or unable to move
- Pain that awakens the child from sleep
- Fever above 100.4°F (38°C)
- Bloody or black stools
- Persistent vomiting (especially if green or containing blood)
- Abdominal distension or rigidity
- Pain localized to the right lower quadrant (possible appendicitis)
- Pain radiating to the back or shoulder
- Jaundice
- History of recent abdominal trauma
- Changes in behavior such as lethargy, irritability, or refusal to eat or drink If any of these red flags are present, parents should seek immediate medical attention rather than attempting home remedies or waiting to see if symptoms resolve, as delaying medical care can lead to complications including perforation, peritonitis, or bowel ischemia 1.