Two girls, aged 8 months and 3 years respectively, presented with dehydration, vomiting and fever. The youngest girl was diagnosed first with gastroenteritis and was treated accordingly. Her condition deteriorated however, and she showed symptoms of a high bowel obstruction. Laparotomy revealed a perforated inflamed appendix. An intestinal invagination was suspected in the older girl, yet laparotomy revealed a perforated appendix. Appendicitis can be difficult to diagnose in very young children due to atypical presentation and age-related difficulties in communication. Most importantly, physicians must be aware that appendicitis may also occur in very young children. Although the Paediatric Appendicitis Score (PAS) is a helpful tool in diagnosing appendicitis in young children, a solid physical examination is most important. When in doubt, early surgical consultation is necessary to limit the delay in diagnosis and to prevent complications.