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When a belly ache or stomach pain might mean appendicitis

As a pediatric surgeon, I am often asked when to “worry” about abdominal pain. Children often report aches or pains near the belly button (umbilicus), and the question arises around when this might mean something significant such as appendicitis.

Appendicitis is a common occurrence affecting about 7% of people over their lifetime, and it begins with vague abdominal pain of the central abdomen. Once the appendix becomes obstructed and begins to suffer from lack of circulation (ischemia), the body can detect more accurately the exact source of the pain. After this localization occurs, children older than 6 or so can identify that the pain is most severe in the right lower part of the abdomen. The localization usually occurs within 24 hours of feeling unwell. The pain is typically worse with movement of the appendix during activities such as walking, coughing, and change in position. I often ask children to jump up and down (on their bed is something kids are excited to do!) and watch their face to see if they wince. Typically with appendicitis, a child will either refuse to jump or may try it once but will not continue due to the pain.

Distraction is also frequently used in children that seem to be particularly “focused” on their pain. In gently feeling the abdomen of a child with early appendicitis that is distracted, the abdomen is soft until palpating the area of the appendix. This right lower part of the abdomen is...

Helping your child cope with medical experiences

The hospital or any medical experience can be a stressful and frightening place for anyone, especially a child. They may encounter new faces, scary equipment and overwhelming feelings of loss of control.

Did you know that there are professionals who aim to reduce negative effects of medical experiences that may affect the development, health and well-being of children and families? These professionals are called certified Child Life specialists and are available at most hospitals who serve children to help you and your child cope with these experiences.

Swedish has four full-time Child Life specialists who cover First Hill and Issaquah campuses from surgery to radiology to inpatient stays. At Swedish, our Child Life team strives to reach every pediatric patient who walks through our doors in an attempt to make their stay a little easier.

Here are some tips for parents on how to help your child cope with medical encounters:

What to do if you suspect your child has an ear infection

Ear infections are the most common illness in kids. Almost every child will have at least one ear infection by the age of 5. What do you do when your child complains of ear pain?

Ear pain in children is most often caused by a middle ear infection. These infections often follow an upper respiratory illness, like a cold or the flu. Common symptoms include fever, ear pain and irritability, like not sleeping through the night. It is possible for the buildup of pressure from fluid and infection behind the eardrum to cause the eardrum to rupture. In this situation you will most likely see drainage from the ear.

What should you do if you suspect your child has an ear infection?

  • Treat the pain. Ibuprofen (Advil) and acetaminophen (Tylenol) are best.
  • Have a doctor look in your child’s ear to confirm an ear infection.
  • Decide with your doctor...

Helping kids eat, thrive, and grow

Is your child under the age of 6 and having problems with feeding or weight gain? Swedish’s GAINS program can help you and your pediatrician by doing a full assessment and providing specific recommendations. The Growth and Integrated Nutrition Service at Swedish (GAINS) is a multidisciplinary program, which includes doctors, nurses, dietitians, behavioral specialists, and feeding therapists.

There are many medical conditions that lead to growth and nutrition problems in children. We are experts at working with children with:

  • Feeding difficulties
  • Poor weight gain
  • Malnutrition
  • Failure to thrive
  • Prematurity
  • Children with feeding tubes
  • Aspiration
  • Breastfeeding Difficulties

Here are some frequently asked questions about the GAINS program:

Increasing Your Child’s Comfort with Nitrous Oxide

You may be familiar with “laughing gas” as something you find at the dentist’s office but did you know it can also be used when your child is a patient at Swedish? Laughing gas is a mix of nitrous oxide and oxygen, but you might hear your pediatric nurses just call it “nitrous.” In pediatrics, we use it to help a patient relax and feel more comfortable during certain procedures such as IV placement or urinary catheterization.

Once your doctor or nurse has determined that your child is a good candidate for nitrous (without any contraindications such as conditions where air may be trapped in the body, pregnancy, or impaired level of consciousness), your nurses and certified child life specialist (CCLS) will explain the process: Your child will choose a flavor for the inside of their mask used to administer the gas. They will be on a stretcher or bed and have a saturation probe attached to a finger to monitor their oxygenation. One nurse will administer oxygen, then the nitrous, gradually increasing the amount until your child is suitably relaxed for the procedure, while remaining responsive to directions. Another clinician will perform the procedure, e.g., place the IV. A doctor is also available.

As a parent ...

Flu vaccine for children

A lot of parents have questions about the flu vaccine and many parents refuse the vaccine as they feel it does not very effective. Some parents are concerned about vaccines in general and refuse vaccinating their child as they don’t want to administer “another vaccine” to their child. The best way to prevent getting flu is by vaccination.

What is flu (Influenza)?

Flu (influenza) is not just a common cold or a stomach virus as most people think. Influenza usually occurs during the winter in our region although it can occur all year around in other parts of the world. It can be a serious respiratory illness that can lead to complications especially in children and older adults. Symptoms are generally similar to any other common cold infections and can vary from fever, runny nose, nose congestion, cough, body aches and headaches. The body aches and headaches are mostly reported by older children and adults. Children may not be able to explain their symptoms and may just be fussy.

Most children get over the flu without any complications. In some children and adults, however, it can lead to serious complications including pneumonia.

How to prevent the flu:

Influenza is ...

Hernias: why are some watched while others are repaired?

The most common thing that I see as a pediatric surgeon is a child with a lump that is thought to be a hernia. A hernia is a bulging of tissue through an opening in the muscle layers that isn’t normally present. In children, these openings are usually the result of a developmental process that just didn’t quite reach completion. Some hernias need surgery emergently, while others are observed for years with the expectation that they will close on their own.

Here are some pointers to help understand this wide range of approaches to hernias:

Location is very important in considering how aggressive to be with hernias. Belly button (umbilical) hernias are...

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