Appendicitis is one of the most common diagnoses in children and is frequently the focus of alleged malpractice. Causes for medical malpractice claims and outcomes of disputes in pediatric patients with appendicitis are currently unknown. A retrospective database review of all medical malpractice claims concerning the diagnosis of appendicitis from 1984 to 2013 in pediatric patients was performed. Alleged claims, causes of malpractice, and outcomes were recorded and analyzed. Of the 203 included cases, failure or delays in diagnosing appendicitis are the most common causes of malpractice lawsuits and account for the majority of the largest payments to plaintiffs outcomes. Cases that ultimately went to trial resulted in defense verdicts in 67.5%. Mortality occurred in 19.9% of included cases. Timely diagnosis of appendicitis in children should be the focus of physicians across all specialties to improve patient safety and potentially reduce medicolegal liability.