Background: Acute appendicitis is common in children, with appendectomy as the traditional treatment. Scoring systems like Alvarado and RIPASA help assess patient eligibility for conservative treatment, considering symptoms and additional factors like age, sex, and symptom duration. Recent studies recommend antibiotics as an initial treatment for uncomplicated cases, to avoiding surgery in many cases. 
Objectives: To evaluate non-operative management of appendicitis in pediatrics.
Patients and methods: A cohort study done at pediatric surgery unit in Qena University Hospitals from Sep 2022 to Mar 2023 included children with acute uncomplicated appendicitis. Diagnosis was based on the available scores for diagnosis of appendicitis. Conservative management involved diagnosis antibiotics, clinical evaluation and radiological evaluation.
Results:  Thirty patients were included in this study. Common symptoms: abdominal pain (100%), appetite loss (56.67%), nausea/vomiting/diarrhea (60%). All diagnosed with appendicitis. Pediatric Appendicitis Score: tenderness (80%), leukocytosis (90%), cough/percussion (66.67%), nausea/vomiting (60%), anorexia (83.33%), pain migration (86.67%), median score 8. IV antibiotics: median 1.925 g (range: 0.35-5.9 g). Outcomes: 90% symptom resolution, median 4-day hospital stay (range: 2-7 days), 6.67% recurrence, 6.67% appendectomy. Post-intervention, significant improvement in signs/symptoms, ultrasonography, CRP; WBC count improved variably.
Conclusion:  Conservative treatment for uncomplicated pediatric appendicitis is safe, successful (90% cure rate), cost-effective, and efficient with short hospital stays. Although it has a high success rate but may require a few patients undergo appendectomy.