Pediatric Pancreatitis

Normally, the pancreas makes digestive enzymes that help break down food. These enzymes become active after they reach the small intestine. With pancreatitis, the enzymes can become active too early, while they are still inside the pancreas. This can cause inflammation and damage.

The most common symptoms are abdominal pain, nausea, and vomiting, although symptoms can vary from child to child.

What Are the Different Types of Pediatric Pancreatitis?  

Pediatric pancreatitis can occur in three forms:

• Acute pancreatitis: A single episode of inflammation that usually improves as the pancreas heals.  
• Acute recurrent pancreatitis: Two or more separate episodes of acute pancreatitis with recovery between episodes.  
• Chronic pancreatitis: Long-term inflammation that causes permanent damage and scarring of the pancreas – if irreversible structural damage is present.

What Causes Pancreatitis in Children?

Pancreatitis can have many causes. In children, genetic changes are a common cause. Genetic forms of pancreatitis can also run in families, so family members may be at increased risk.  

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Other causes may include problems with the pancreatic or bile ducts, gallstones, high triglyceride or calcium levels, certain medications, infections, or other medical conditions. Sometimes, no specific cause can be identified.  

Recurrent and chronic pancreatitis can have a significant impact on children and their families. Pain, emergency room visits, hospital stays, missed school, and difficulty participating in everyday activities can all affect a child's quality of life and mental health.  

There is currently no medication that can reverse permanent damage caused by chronic pancreatitis. Treatment focuses on managing symptoms, supporting nutrition and digestion, treating an underlying cause when possible, and helping children maintain their quality of life.  

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For some children with severe, ongoing pain that does not improve with other treatments, total pancreatectomy with islet autotransplantation (TPIAT) may be an option. During TPIAT, the pancreas is removed, and the insulin-producing cells, called islets, are collected and placed in the liver. The goal is to reduce pain while preserving as much insulin production as possible.

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Acute Pancreatitis in Children

Acute pancreatitis is a sudden inflammation of the pancreas. It can happen for many different reasons, including genetic conditions, gallstones, problems with the pancreatic or bile ducts, certain medications, or other medical conditions. When the pancreas is injured, inflammation develops. The severity can range from mild to severe.

Acute pancreatitis is usually temporary, and most children recover as the inflammation improves and the pancreas heals.

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How Long Does Acute Pancreatitis Last?

Most children begin to feel better within several days to about a week. Recovery time can vary depending on the severity of pancreatitis and its underlying cause. Children with more severe pancreatitis may need to stay in the hospital longer.

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Can Acute Recurrent Pancreatitis Become Chronic Pancreatitis?

Children with recurrent acute pancreatitis have a higher risk of developing chronic pancreatitis, but not every child will progress to CP.

Repeated inflammation and injury to the pancreas can, over time, cause permanent changes and affect how the pancreas functions. Certain genetic factors and other underlying causes may increase this risk.

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Because of this, children with recurrent pancreatitis should have ongoing follow-up with a healthcare team experienced in pediatric pancreatic diseases.

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Regular follow-up can help doctors monitor your child's health and look for changes over time. Depending on your child's situation, follow-up may include:

• Monitoring for additional episodes of pancreatitis
• Reviewing nutrition, growth, and weight
• Checking for signs of problems with digestion or blood sugar
• Evaluating ongoing or recurrent abdominal pain
• Monitoring pancreatic structure and function
• Reviewing genetic or other test results
• Connecting families with specialists, dietitians, pain specialists, or other members of the care team when needed

Chronic Pancreatitis in Children

Chronic pancreatitis occurs when the pancreas has been damaged over time. Repeated inflammation can cause permanent changes to the pancreas.  

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Chronic pancreatitis can affect the pancreas in several ways. Some children have ongoing or recurring abdominal pain with or without a rise in their blood levels. Others may have difficulty digesting food or absorbing nutrients because their pancreas does not make enough digestive enzymes. Over time, some children may also develop diabetes if their pancreas cannot make enough insulin.

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What Are the Symptoms of Chronic Pancreatitis?

Symptoms can vary from child to child and may include:

• Ongoing or recurring abdominal pain  
• Nausea or vomiting  
• Diarrhea  
• Oily or greasy stools  
• Weight loss or difficulty gaining weight  
• Difficulty digesting food  
• Poor growth

There is no single test that can diagnose pancreatitis.

Doctors usually look at three things:

• Your child's symptoms  
• Blood tests that show signs of pancreatic inflammation  
• Imaging, such as an ultrasound, CT scan, or MRI

Amylase and lipase are blood tests commonly used to look for pancreatic inflammation. These levels can increase when the pancreas is injured, although other conditions can also cause them to increase. A child is generally diagnosed with acute pancreatitis when at least two of these three areas support the diagnosis.  

If a child has repeated episodes of pancreatitis, doctors may recommend additional testing to look for an underlying cause, such as a genetic condition or a problem with the pancreatic or bile ducts.

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How Is Chronic Pancreatitis Diagnosed?

Doctors look for signs that the pancreas has been permanently damaged or is no longer functioning normally.

Testing may include:

• CT or MRI scans  
• Endoscopic ultrasound  
• ERCP, a specialized procedure used to examine the pancreatic and bile ducts  
• Tests that measure how well the pancreas is digesting food  
• Tests that check how well the pancreas is making insulin

Your child's healthcare team will determine which tests are appropriate based on their symptoms and medical history.

How Is Acute Pancreatitis Treated?  

There is no specific medicine that cures acute pancreatitis. Treatment focuses on keeping your child comfortable and supporting the body while the pancreas heals.  

Treatment may include:

• Pain medicine  
• Medicine to control nausea and vomiting  
• Fluids to prevent dehydration  
• Food and nutrition as your child is able to tolerate it

Most children can begin eating again within a day or two. If a child cannot eat for a longer period, nutrition may be provided through a feeding tube or, in some cases, through an IV. Early nutrition is generally preferred rather than keeping children without food for prolonged periods.

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How Is Chronic Pancreatitis Treated?  

There is currently no medication that can reverse permanent damage to the pancreas. However, treatment can help manage symptoms, support nutrition, and treat certain underlying causes.

Treatment may include:

• Treating an underlying condition, such as high triglycerides or calcium  
• Procedures or surgery to treat certain problems with the pancreatic or bile ducts  
• Pancreatic enzyme replacement therapy (PERT) to help digest food  
• Nutrition support and vitamin supplements  
• Pain management  
• Treatment for diabetes, if it develops

For some children with severe, ongoing pain that does not improve with other treatments, TPIAT may be considered.

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Nutrition and Pancreatitis  

There is no single diet that works for every child with pancreatitis. Your child's nutrition needs depend on their symptoms, overall health, and how well their pancreas is functioning. A healthcare provider or dietitian can help determine the best eating plan.  

Children who do not make enough digestive enzymes may need pancreatic enzyme replacement therapy (PERT) with meals and snacks to help their bodies digest food and absorb nutrients. Talk with your child's healthcare team before making significant changes to their diet.

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EPI and Pancreatitis  

The pancreas makes digestive enzymes that help the body break down and absorb food. When the pancreas does not make enough of these enzymes, a condition called exocrine pancreatic insufficiency (EPI) can develop.  

Children with EPI may need PERT with meals and snacks. Some children may also need fat-soluble vitamins, including vitamins A, D, E, and K.

Pancreatitis can be challenging for children and their families, especially when symptoms or hospital visits interfere with school, activities, and everyday life. With the right care and support, many children can continue to participate in the activities they enjoy.

Ongoing care may include managing pain and other symptoms, maintaining good nutrition and healthy growth, taking medications as prescribed, and attending regular follow-up appointments. It can also help to work closely with a healthcare team that understands pediatric pancreatitis.

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Parents and caregivers can support their child by keeping track of symptoms, medications, treatments, and questions for the healthcare team. Emotional support is also important. Children may feel frustrated, worried, or different from their peers. Connecting with other families living with pancreatitis can help children and caregivers feel less alone.