Pediatric acute appendicitis, one of the most common acute abdominal conditions in pediatric patients, is referred to as those acute conditions that require early detection, early diagnosis, and early surgical treatment, which can have serious consequences if the diagnosis and treatment are delayed. Pediatric acute appendicitis is not as typical and easy to diagnose as adult appendicitis. Pediatric acute appendicitis is characterized by atypical clinical manifestations and rapid progression of the disease course. First of all, the main symptom of acute appendicitis is abdominal pain, and the tolerance of pain in pediatric patients is greater than that of adults, and at the same time, pediatric patients have limited ability to express pain narratives due to their age, and the main manifestation of abdominal pain in infants and children is crying, and even in school-aged children, it is more difficult to express the time and exact location of pain. Therefore, the main symptom of pediatric acute appendicitis is often vomiting first, and abdominal pain is found only when the doctor examines the patient, so its clinical manifestations are not typical, and many pediatric acute appendicitis is often diagnosed when they come to the doctor with upper sensation, tonsillitis or enteritis. The younger the child, the more difficult it is to diagnose, and it is very easy to misdiagnose. Many infants with acute appendicitis are often treated as internal diseases, and by the time the diagnosis is confirmed, the appendix is already perforated. According to data, the misdiagnosis rate of acute appendicitis in young infants can be as high as 50.9%. Secondly, in terms of physiological anatomy, the appendix wall is thinner and less muscular than that of adults, so once the appendix is inflamed, the disease progresses rapidly and perforation is likely to occur within a short period of time. It has been reported that the rate of appendiceal perforation in pediatric appendicitis under 2 years of age can be as high as 65% or more at the time of consultation. Moreover, the large omentum of the pediatric abdominal cavity is significantly shorter than that of adults, so the appendix is not easily confined after septicemia and perforation, and the infection spreads to the entire abdominal cavity, forming a generalized peritonitis, and even death by systemic infection and poisoning. However, if pediatric acute appendicitis can be seen by a doctor in time, a clear diagnosis can be made, early surgery can be performed, and the patient can recover after a week or so, usually without complications and with a good prognosis. But once the diagnosis is late, especially for small babies, or even delayed for just a few hours, when they come to the hospital, they will already be septic and perforated, causing generalized peritonitis, which not only increases the difficulty of surgical treatment, but more seriously, a series of complications will often arise after surgery, such as appendicitis surgery combined with peritonitis, after surgery, residual infection of the abdominal cavity is very likely to occur, forming abscesses between the intestinal tubes, pelvic cavity or under the diaphragm of the child, after surgery prolonged high fever, chest pain, abdominal pain, and diarrhea. Adhesive intestinal obstruction is also one of the common complications. Postoperative paroxysmal abdominal pain, abdominal distension, vomiting, inability to eat, intestinal necrosis can occur in serious cases, even life-threatening, and some have to undergo a second operation, which not only increases the pain of the child, but also increases the mental and economic burden on the family. As the patron saint of pediatric health, it is crucial for parents to be able to detect certain abnormal manifestations of pediatric acute appendicitis early. However, as mentioned above, the atypical symptoms and lack of specificity of pediatric acute appendicitis are one of the main reasons for late presentation and easy misdiagnosis. In general, the sudden depression of a lively and active child, accompanied by bouts of crying (a sign of abdominal pain), should attract the attention of parents, especially when accompanied by unexplained vomiting, fever and diarrhea, etc., and should be alert to the possibility of acute appendicitis, and attentive parents may find that at this moment the child likes to lie in a curled position, and the abdomen is afraid of touching and refuses to be pressed, including parents picking up and shaking, patting and hypnotizing, even during sleep. This is the case. At this point, the child must be taken to the hospital promptly. In addition, parents should pay attention to two points: 1. suspend feeding milk and food to the child in case the diagnosis of appendicitis is confirmed and accidents occur during surgical anesthesia, such as accidental aspiration and asphyxia; 2. never apply analgesics to the child before the diagnosis is confirmed, because although analgesics can temporarily relieve the child’s pain, they can easily mask the symptoms of appendicitis, delaying the diagnosis and causing serious consequences. Therefore, the key to the diagnosis of pediatric acute appendicitis is early. The word “early” is worth a thousand dollars!