Shared Decision-Making (SDM) in pediatric surgery is challenging given that the treatment decision typically involves three parties (surgeon, caregiver, and patient), and at least one of the treatment choices usually involves an operative intervention. There has been mounting evidence to support the safety and efficacy of non-operative management of pediatric uncomplicated acute appendicitis with antibiotics alone, making SDM an essential and valuable tool for pediatric surgeons. This chapter highlights both the importance and challenges of applying SDM in pediatric surgery by exemplifying its application to the treatment choice between non-operative and operative management of pediatric uncomplicated acute appendicitis. The appendicitis example is one of several in which SDM has the potential to reduce healthcare resource utilization and costs by increasing uptake of non-operative conservative treatments.