Appendicitis is the most common condition in children requiring emergency abdominal surgery. Delayed or missed diagnosis in young children is common and is associated with increased rates of perforation. Although several scoring systems have been developed, there is still no consensus on clinical, laboratory, and imaging criteria for diagnosing appendicitis. This issue reviews key age-based historical and physical examination findings, as well as clinical scoring systems, that can help guide the workup of appendicitis in children. The existing literature is reviewed to provide guidance for the management of children with appendicitis, including recommendations for diagnostic studies, prophylactic antibiotics, pain medication, and surgical consultation.