Acute appendicitis remains the most common surgical emergency in childhood and a leading cause of acute abdominal pain requiring operative intervention. Despite advances in diagnostic modalities and perioperative care, diagnosis in pediatric patients remains challenging because of age-dependent symptom variability, communication barriers, and overlap with other abdominal conditions. Delayed diagnosis may result in perforation, abscess formation, sepsis, and prolonged hospitalization. Conversely, overdiagnosis may lead to unnecessary appendectomies and increased healthcare costs. This management of acute uncomplicated appendicitis in children includes the non-operative treatment with antibiotics and the laparoscopic appendectomy in children. Laparoscopic appendectomy continues to represent the standard treatment for uncomplicated appendicitis; however, antibiotic-first approaches may be appropriate in selected patients. In this review, we will look at the role of non-operative treatment and laparoscopic appendectomy in the management of acute, uncomplicated appendicitis. We will also review the role of appendicolith in the non-operative management of acute appendicitis in children.