•Shared decision-making is critical to patient-centered care in pediatric surgery.•Shared decision-making can be performed effectively in a high acuity surgical setting in children.•Treatment choice requires timely, informed decisions that allow for incorporation of personal values, and preferences.•Nonoperative management of uncomplicated appendicitis is an effective treatment alternative that maybe preferred by families. Nonoperative management (NOM) of uncomplicated appendicitis is a safe and effective treatment alternative to surgery that may be preferred by some families. Surgery and NOM differ significantly in their associated risks and benefits. Choosing a treatment for acute appendicitis requires patients and their caregivers to make timely, informed decisions that allow for incorporation of personal perspectives, values, and preferences. This article will address the concept of shared decision-making and establish its role in patient-centered care. It will demonstrate the effectiveness of shared decision-making in a high acuity surgical setting for children and highlight how the choice for management of acute appendicitis may be impacted by patients’ and families’ individualized circumstances and values.