"Paediatric Pancreatitis: The Silent Storm in the Belly"

When we think of pancreatitis, we often associate it with adults and causes like alcohol or gallstones. Yet, children too can suffer from pancreatitis — an under-recognized and often misunderstood condition in paediatric practice.

🔍 What is Paediatric Pancreatitis?

Pancreatitis is the inflammation of the pancreas, an organ that plays a critical role in digestion and insulin production. In children, it may present differently than in adults, often making diagnosis challenging.

⚠️ Causes in Children

Unlike adults, where lifestyle factors dominate, paediatric pancreatitis has varied causes:

• Structural anomalies (pancreatic divisum, choledochal cysts)

• Genetic factors (CFTR, PRSS1, SPINK1 mutations)

• Medications (valproate, L-asparaginase, steroids)

• Infections (mumps, EBV, Mycoplasma)

• Trauma (bicycle handlebar injury – a common culprit in active children)

• Metabolic disorders (hyperlipidemia, hypercalcemia)

• Idiopathic (sometimes, the cause remains elusive)

🧒 Clinical Presentation

Symptoms often mimic other abdominal conditions:

• Severe, sudden-onset abdominal pain (often upper abdomen radiating to back)

• Nausea & vomiting

• Abdominal tenderness

• Fever (sometimes)

• Bloating or poor appetite

Because children can’t always express pain precisely, younger patients may present with irritability or refusal to eat.

🧪 Diagnosis

• Blood tests: Elevated amylase & lipase levels

• Ultrasound / CT / MRI: To assess swelling, fluid collections, gallstones, or anomalies

• Genetic testing: In recurrent or idiopathic cases

🛠️ Management

Most cases of acute paediatric pancreatitis are managed conservatively:

• Hospital admission

• IV fluids for hydration

• Pain relief (opioids/NSAIDs as needed)

• Bowel rest with gradual reintroduction of feeds

• Antibiotics only if infection is proven

• Surgery or ERCP if gallstones or structural anomalies are identified

Chronic or recurrent cases may need enzymatic supplementation, genetic counseling, and in rare situations, surgery.

🌟 Prognosis & Challenges

• Most children recover well with supportive care.

• Recurrent or chronic pancreatitis can impact growth, nutrition, and quality of life.

• Early diagnosis, especially in trauma or genetic causes, is key to preventing long-term complications like pancreatic insufficiency or diabetes.

💡 Takeaway

Paediatric pancreatitis may be rare, but it’s real. A high index of suspicion in children with unexplained severe abdominal pain can save lives. Awareness among parents, paediatricians, and surgeons is the first step toward early intervention.