Acute appendicitis is one of the most common surgical emergencies in children. Traditionally, appendectomy has been regarded as the standard treatment; however, increasing evidence supports non-operative management (NOM) for selected cases of uncomplicated appendicitis and as an initial strategy for complicated appendicitis presenting with abscess or phlegmon. The role of interval appendectomy (IA), defined as the elective removal of the appendix weeks after successful NOM, remains controversial. Historically, IA was routinely recommended to prevent recurrent appendicitis and to exclude underlying pathology. More recent evidence has challenged this practice, highlighting relatively low recurrence rates after successful NOM, advances in imaging and follow-up protocols, and the morbidity and costs associated with additional surgery. This review examines the current evidence regarding IA in children following NOM for both complicated and uncomplicated acute appendicitis. The literature suggests that routine IA may not be necessary in all children after successful NOM. While certain subgroups, particularly those with appendicoliths, persistent symptoms, or recurrent disease, may benefit from interval appendectomy, a selective rather than routine approach appears increasingly justified. Shared decision-making involving children, parents, and clinicians is essential when balancing the risks of recurrence against the morbidity and costs of surgery.