The decision to operate for pediatric acute appendicitis is based on the staging of appendicitis, so the dynamics of disease development must be checked accurately. Most children with limited stage disease can control the infection naturally; surgery has the potential to spread the infection and increase injury. Abscesses generally do not require surgery, and those with tension only require aspiration or incision and drainage. If the abdominal pain and tenderness are definitely mild, early appendicitis can be diagnosed within 12 hours, and if it remains mild for 24 hours or more, catarrhal appendicitis should be considered; if it is significantly aggravated within 12 hours, typical septic appendicitis should be considered, and if the symptoms are more significantly aggravated and the tenderness extends to the whole abdomen beyond 24 hours, perforated peritonitis should be considered. All of the above should be operated on immediately to remove the appendix. If the general condition of the child (mental, appetite, activity) is “worse today than yesterday” for more than 3 days, surgery should be performed to address the continued spread of the lesion. If “today is better than yesterday”, surgery should not be performed. Only antibiotics, fluids and rest are needed. In order to clarify the pathological process, abscesses and infiltrated areas are visible on ultrasound, and an infiltrated mass in the right lower abdomen can be palpated on duplex examination. Although the appendectomy is simple, the necessary treatment should still be given before surgery. These include: antibiotics, fasting and water fasting, nasogastric decompression for advanced peritonitis and distention, and intravenous fluids to ensure water-electrolyte balance. Even if the child is seen very early and is generally completely normal, a dose of antibiotics should be given, along with 10% glucose saline at 30 ml/kg. The drip should be continued on the operating table until the general condition stabilizes after surgery. Early appendicitis should be operated immediately regardless of the type. In the infiltrative and abscess stages, if the general condition has improved, continue the above mentioned medical therapy. If the diet has normalized, the treatment should be switched to oral broad-spectrum antibiotics and antibiotics that are effective against anaerobic bacteria.