Diagnosing appendicitis in infants is challenging due to varied and heterogenous presentations. Whilst the condition is uncommon, the consequences of missing this in a busy Emergency Department (ED) can be catastrophic. We report an 8-month-old infant who presented to ED with a brief history of reduced feeding, lethargy and vomiting with normal observations. Excessive crying was noted when the child was supine, he was consolable when placed prone. Due to these paroxysms of crying which varied with position, investigations were commenced. He had a good clinical outcome. A high degree of suspicion is needed in preverbal children. Clinical examination, observation of the behaviour of the child and parental concern remain key to diagnosis. Through this paper we aim to explore the clinical conundrum of making the diagnosis in this age group and the modalities which help in decision making.