Perforation is more likely in younger kids because:
1. The appendix has a thinner wall
2. Younger children can’t communicate as well, resulting in prolonged symptoms before diagnosis
3. The level of suspicion for appendicitis is lower in younger age groups

Pro-Tip: In addition, appendicitis can progress to peritonitis quicker in infants, because they have a less well developed omentum, and thus cannot contain infection as well. Some studies have indicated that the rate of perforation on presentation is as high as 70%!