Kidney Stones (for Parents) – Nemours KidsHealth

en español: Piedras en los riñones

Reviewed by: Robert S. Mathias, MD

Nephrology (Kidney Care) at Nemours Children’s Health

What Are Kidney Stones?

Kidney stones happen when minerals form crystals inside the kidneys. Then they get bigger and become kidney stones. Kidney stones can move into the urinary tract. There, they can cause problems like pain and blood in the urine (pee). Some stones also can block the flow of pee.

Most kidney stones pass out of the body without causing any damage. Pain medicine and plenty of fluids help most kids with kidney stones get better.

What Are the Signs & Symptoms of Kidney Stones?

Usually, kidney stones don’t cause symptoms until they move around in the kidney or pass into the ureter (the muscular tube that connects the kidney to the bladder). Small stones can pass out of the body with little or no pain.

Larger stones in the urinary system may get stuck and cause symptoms like:

• pain, which usually:
  • starts in the side or back
  • spreads to the lower belly and groin as the stones move through the urinary tract
  • comes and goes in waves
• blood in the pee (hematuria)
• nausea and vomiting
• needing to pee often or urgently
• fever or chills (signs of a possible infection)

Sometimes, a stone that’s too big to move can create a backup of pee. This can make one or both kidneys swell, causing pain in the side and back. If it’s not treated, it may cause long-term kidney damage.

What Causes Kidney Stones?

Most kids who get kidney stones have a health condition that increases their risk for them. These include:

• some medicines
• special diets, like a ketogenic diet that is sometimes used to prevent seizures
• diabetes
• obesity
• problems with how the urinary tract is formed
• metabolic disorders (problems with how the body breaks down and uses food)
• gout (a type of arthritis)
• other kidney conditions 
• conditions that affect the thyroid or parathyroid gland
• some urinary tract infections (UTIs)

Other things that can make a kidney stone more likely are:

• not drinking enough water
• eating too much salt
• not having enough citric acid (the acid in citrus fruits such as oranges) in the urine
• having too much calcium in the urine

Kidney stones mostly affect adults. But kids and teens can get them. 

Some types of kidney stones run in families, so having a relative with kidney stones can make a person more likely to get them. Kids who have had kidney stones before are more likely to get them again.

How Are Kidney Stones Diagnosed?

The doctor will ask about:

• the symptoms and how long they’ve been going on
• your child’s diet
• whether your child could be dehydrated
• whether there’s a family history of kidney stones, or urinary or kidney problems

The doctor will do an exam and probably order:

• blood tests
• urine tests
• kidney function tests
• imaging tests, such as ultrasounds, X-rays, or CT scans. These can show a stone’s exact size and location. This helps doctors decide on the best treatment.

How Are Kidney Stones Treated?

Treatment depends on the type of kidney stone and its size. Some kids only need to drink a lot of water and take pain medicines to pass a kidney stone. Those with larger stones may need surgery or other treatments to help remove the stones.

There are different types of stones. A stone that passes in pee and is caught in a strainer can be tested to see what type it is. Knowing that can help doctors find the cause and offer advice how to treat it and prevent other stones.

Home Treatment

To help pass a small stone, give your child plenty of water to drink and medicine to ease the pain. Often, over-the-counter medicines such as ibuprofen and acetaminophen are enough. But sometimes, doctors prescribe pain medicine.

The doctor might ask you to strain your child’s pee for a few days to collect the kidney stones. Examining them can help the doctor decide if your child needs more treatment.

Hospital Treatment

Kids whose kidney stones block the urinary tract or cause severe pain or dehydration may need care in a hospital. They might get intravenous (IV) fluids and pain medicine to help the stones pass and treat dehydration.

Large stones rarely pass on their own. To get rid of large stones and stones that are damaging the kidneys, doctors can do a procedure to break up the stone. This lets the smaller pieces pass on their own or be removed with a scope or surgery.

Can Kidney Stones Be Prevented?

It’s not always possible to prevent some types of kidney stones. 

But all kids who’ve had kidney stones should:

• Drink a lot of liquids (water is best) throughout the day. Avoid dark sodas, soft drinks, and sports drinks. If their pee is almost clear, that’s a sign they’re drinking enough. Ask your doctor how much your child should drink.
• Limit the salt and protein in their diet.

If dietary changes don’t prevent kidney stones, medicines can help. Depending on the type of kidney stone your child had, the doctor can prescribe treatments or medicines to lower the levels of crystal-forming substances in the pee.

Doctors will keep an eye on kids who have had kidney stones and try to prevent new ones. The doctor might have your child use a 24-hour urine collection test. This measures the volume of pee within a 24-hour period and checks what’s in it.

Reviewed by: Robert S. Mathias, MD

Date reviewed: November 2019

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Appendectomy (for Parents) – Nemours KidsHealth

en español: Apendicectomía

Reviewed by: Loren Berman, MD

Pediatric General Surgery at Nemours Children’s Health

What Is an Appendectomy?

An appendectomy is surgery to remove the appendix. Surgeons remove the appendix when it gets blocked and becomes infected. This is called appendicitis.

Appendicitis needs urgent treatment. Usually, the appendix must be removed. Appendectomy is a common procedure, and most kids recover quickly and with few problems.

Why Is an Appendectomy Done?

The appendix is a small organ in the lower right side of the belly. It is attached to the large intestine. Sometimes the appendix can get blocked with hard poop, swollen lymph nodes, or parasites.

Appendicitis develops when bacteria (germs) grow and the appendix becomes inflamed and swollen.

What Happens Before an Appendectomy?

Most appendectomies are unplanned. So parents don’t need to do much to get ready.

You and your child will meet with the care team, review your child’s
medical history, and hear about what to expect. The anesthesiology team will also ask about your child’s medical history and when your child last ate and drank.

Before the surgery begins, the care team will set up monitors to keep track of your child’s vital signs (like blood pressure and oxygen level) and put in an intravenous line (IV) to give medicines and anesthesia.

What Happens During an Appendectomy?

Kids and teens having an appendectomy will get general anesthesia. This lets them sleep through surgery. 

Your child’s surgeon will choose the surgery method that’s best for your child. There are two types of appendectomy:

Laparoscopic appendectomy: Most of the time, surgeons remove the appendix with the help of a tiny video camera called a laparoscope. It lets them see inside the body while looking at a special TV monitor. The surgeon makes a small incision (cut) in the belly button and inserts the thin tube of the laparoscope. The laparoscope acts as the surgeon’s “eyes” as it is guided to the appendix. The surgeon may make two more small incisions for the medical instruments. Using the instruments, the surgeon carefully cuts the appendix away from the large intestine and removes it. The incisions are closed with dissolvable stitches and covered with small bandages.

Open appendectomy: This is the “traditional” way of removing the appendix. The surgeon makes an incision (cut) in the belly, then carefully cuts the infected appendix away from the large intestine and removes it. The surgeon closes the incision with stitches.

What Happens After an Appendectomy?

After an appendectomy, most kids stay in the hospital for less than a day. Kids at higher risk for infection may need to stay longer to get IV antibiotics. This is typical for kids whose appendix ruptures (bursts) before the appendectomy.

Before going home, you’ll get instructions on how to care for your child at home and when to come back for a follow-up visit. You’ll learn how to take care of the incision(s), manage any pain, and find out if there are any restrictions on physical activity or returning to school.

With a little rest and care, most kids recover from an appendectomy with little difficulty.

Are There Any Risks From an Appendectomy?

All surgeries come with some risks. The surgical team will discuss them with you before the surgery and do everything possible to minimize them. If you have any concerns, be sure to bring them up before the surgery.

Complications of appendectomy can include:

• infection
• problems from anesthesia
• bleeding
• an allergic reaction

How Can Parents Help?

At home, your child will need to rest and recover. During that time:

• Follow the care instructions the surgical team gave you.
• Call the doctor’s office if you have any questions.
• Tell the staff at your child’s school about the surgery and any restrictions your child has.

Reviewed by: Loren Berman, MD

Date reviewed: January 2023

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Acute appendicitis in children – causes, symptoms, diagnosis and treatment of appendicitis in a child in Moscow in the clinic for children and adolescents “SM-Clinic”

The surgeon is treating this disease

general information
Complications
Symptoms
Treatment result

Acute appendicitis is a disease that requires urgent (emergency) surgical care, because. inflammatory lesion of the process of the caecum can quickly move to the peritoneum, provoke peritonitis and other unfavorable ways of developing this clinical situation. In childhood, the disease proceeds quite quickly, so when the first suspicious symptoms appear, you should immediately contact a pediatric surgeon.

Acute appendicitis – a pathology that does not have an age group, can occur even in newborns. However, most often the disease develops in children older than 7 years, reaching a peak in the age category 9-12 years old. Acute appendicitis with the same prevalence is recorded among both girls and boys.

Complications

Acute appendicitis can lead to a variety of complications, the rate of development of which depends on the individual characteristics of the child’s body.

• Appendicular infiltrate is a conglomerate that consists of intestinal loops and omentum that envelop the inflamed appendix.
• Perforation of the appendix – purulent fusion of the appendix wall.
• Diffuse and diffuse peritonitis is an acute inflammatory lesion of the peritoneum of the entire abdominal cavity, which threatens with infectious-septic shock.
• Intestinal insufficiency syndrome – against the background of inflammation, intestinal peristalsis is disturbed.

The diagnosis of acute appendicitis is a clear indication for surgery. Conservative treatment does not allow to stop the inflammatory process. The operation consists in the removal of the appendix and sanitation of the abdominal cavity.

Surgery is performed laparoscopically. This option is the gold standard for surgical treatment of acute appendicitis. Laparoscopic appendectomy has a good aesthetic result, quick recovery and minimal tissue trauma. However, for laparoscopic appendectomy, there must be necessary conditions, in particular, the absence of total peritonitis. Therefore, it is so important to seek medical help in the first hours after the development of the disease.

The duration of the operation in the absence of complications is from 10 to 50 minutes, in case of their presence or an atypical anatomical location of the appendix, it can increase up to 2 hours.

In the first case, the child spends 3-5 days in the hospital, and in the second – at least 10 days. In some cases, with a long preoperative illness of the patient and the presence of complicated forms of appendicitis, the patient needs to stay in the intensive care unit.

Symptoms

The main symptom of incipient acute appendicitis in children is abdominal pain, which has no clear localization. It can hurt both in the umbilical region and in the epigastrium. The pain syndrome is accompanied by nausea and refusal of food, and vomiting may also occur, which does not bring relief. After a few hours, the pain becomes more localized and the child indicates the place where it hurts – in the right iliac region of the abdomen.

Due to pain, the child is in a forced position – he bends and pulls his legs up to his stomach and lies on his right side. As the pathological process progresses, the child spares the stomach, therefore, turns off the participation of the abdominal wall in the act of breathing.

During the first hours of acute inflammation of the appendix, body temperature is normal or slightly elevated. A fever above 38°C usually indicates the development of purulent and destructive forms of appendicitis, and an immediate appeal to a pediatric surgeon is required. Delay can threaten the development of infectious-toxic shock and the threat of perforation of the appendix.

A child with acute appendicitis usually has no stool. However, if the blind-ending process has a pelvic location, then diarrhea is observed (accelerated stools of a liquid consistency with an admixture of mucus). Against the background of acute appendicitis, intoxication of the body develops. This is manifested by increased heart rate and the presence of a white coating on the tongue.

Let us dwell separately on the symptoms of acute appendicitis in children under 3 years of age. Despite the fact that this is a rare disease for this age, it still occurs, and it is distinguished by a particularly violent and aggressive course. Symptoms appear in the midst of complete well-being. The baby becomes capricious, refuses to eat, and the temperature almost immediately rises to 38-39°C. There is repeated vomiting and frequent loose stools, which may be streaked with blood and mucus. In the presence of such symptoms, it is important to immediately contact the clinic, which provides round-the-clock medical care.

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Result of treatment

After a surgical intervention for acute appendicitis, the child fully recovers – the causative focus is removed from the body. Early postoperative treatment continues for several days (after laparoscopy – 2-3 days). The child in 1-2 weeks can return to his usual way of life.

Children’s department “SM-Clinic” is a clinic that specializes in providing urgent care to children 24/7. Our experts will help you understand and cope with even the most difficult clinical situation.

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Appendicitis in children. Symptoms, diagnosis, treatment – health articles

11/10/2022

When a child’s stomach starts to hurt, do not write off the possibility of inflammation of the appendix. Try as soon as possible to get an appointment with your doctor so that he can conduct an examination and confirm or refute your fears. Acute appendicitis most often occurs in children.

For doctors, the task of making a diagnosis in case of pain in the abdomen becomes more complicated at times if they have a small patient in front of them. A child often simply cannot tell in detail about the nature and focus of pain, everything hurts him and very much.

Inflammation of the appendix is ​​most often observed in children aged 9-13 years – 13-20%. Less common in preschoolers, only 10-12% of cases. Most often, 70-75% is adolescence 14-19 years. In infants, inflammation of the appendix is ​​extremely rare. The reason for this is the immaturity of their digestive system.

Causes

It is impossible to say with exact certainty what exactly caused appendicitis in a particular child. Doctors are sure of one thing for sure: for inflammation of the appendix to occur, bacteria must be present in the intestine, and the lumen of the process of the caecum must be clogged. Only with the simultaneous presence of these two conditions does appendicitis occur.

A blockage of the appendix occurs due to excessive eating of seeds, seeds or stool that enters the lumen.

Doctors also identify several reasons why appendix inflammation can also occur: low immunity, frequent colds, foreign objects or helminths (worms) that have entered the intestines.

Symptoms

In children under 3 years of age, behavioral abnormalities can be noticed from the very beginning of the disease: they refuse to eat, act up, sleep poorly and become noticeably less active. Babies won’t be able to tell you exactly where it hurts. They will point to the whole stomach, claiming that it hurts everywhere. The strongest reaction of the baby can be observed on the first night after the onset of the inflammatory process, his sleep will be very restless, with periodic waking up and screaming. And also in case of accidental touching of the tummy in the navel. The pain may increase when dressing or bending to the right, lying on the right side.

Note that when the appendix is ​​inflamed, the baby may feel sick and vomit, diarrhea may also be present, and there is often some mucus in the stool. Less common is just a delay in stool. Severe pain in the abdomen will also be accompanied by pain when urinating. A high temperature will also speak about the inflammatory process, which can rise up to 40 °. Although in children who are breastfed, the temperature often does not rise above 37.5 ° for quite a long time.

Due to the peculiarities of the structure of the intestines, appendicitis very rarely occurs in children under 2 years of age.

If the child is older, then he is already more or less clearly and clearly able to tell his mother when his stomach began to hurt. At the same time, it will not be possible to notice any changes in his usual behavior. Children older than 3 years are already at a more conscious age, so they can indicate exactly where the pain was localized. If the painful area is near the navel, slightly above it, this is only the beginning of inflammation of the appendix. Everything is much more serious if the lower abdomen hurts, closer to the right side. When moving, the pain can become much stronger, and also if you lie on your right side. The child can tell what kind of pain he is experiencing: severe sharp or aching dull.

The very first signs of appendicitis in this case will be lethargy, vomiting and nausea. In children older than 3 years, diarrhea is unlikely, more likely just stool retention, but not constipation. An increase in body temperature within 38-39 ° is also an indicator of the inflammatory process in the child’s body.

Diagnosis of appendicitis

Recognition of appendicitis in children requires a physical, laboratory, and, if necessary, instrumental examination.

Palpation of the child’s abdomen is accompanied by muscle tension and severe pain in the iliac region. In young children, the examination is performed during physiological or medication sleep.

A complete blood and urine test is also performed. For girls of childbearing age, the examination program includes a consultation with a pediatric obstetrician-gynecologist.

Ultrasound of the abdominal cavity reveals an enlarged (more than 6 cm in diameter) appendix, the presence of free fluid in the right iliac fossa.

In younger children, electromyography of the anterior abdominal wall is used to detect protective muscle tension.

If there is ambiguity in the interpretation of clinical and physical findings, the child may require an x-ray or CT scan of the abdomen.

Treatment

Inflammation of the appendix is ​​treated only by surgery, removal of the process of the caecum during laparoscopy. During this operation, small incisions are made on the abdomen, through which the clogged organ is removed.

Many patients seek qualified medical care almost at the last moment. Such a negligent attitude to one’s health is a common cause of various complications after surgery, sometimes during it.