Pancreatitis in children is a relatively rare but serious condition that can cause significant discomfort and complications. While it is more commonly associated with adults, cases of acute pancreatitis in children and chronic pancreatitis in children are increasing. Managing pancreatitis in children is complex and requires a team approach.

This guide offers valuable insights about this condition including diagnostic criteria, treatment options, and preventative strategies. With contributions from experts, it aims to enhance care and outcomes for paediatric patients with pancreatitis.

Understanding Pancreatitis in Children

Pancreatitis is the inflammation of the pancreas, an essential organ that plays a role in digestion and blood sugar regulation. The pancreas produces digestive enzymes that break down food and hormones such as insulin and glucagon. When the pancreas becomes inflamed, it can lead to abdominal pain, digestive issues, and serious complications.

Types of Pancreatitis in Children

Pancreatitis in children is rare but can be serious. It is classified into different types based on cause, duration, and severity. Some main types include:

Acute Pancreatitis

Acute pancreatitis is a sudden inflammation of the pancreas, typically caused by infections, medications, trauma, or metabolic disorders. Symptoms include severe abdominal pain, nausea, vomiting, and fever. The condition usually resolves within a few days with supportive care.

Chronic Pancreatitis

Chronic inflammation can cause permanent harm to the pancreas. It may be caused by genetic conditions, autoimmune diseases, or repeated acute pancreatitis. Symptoms include constant belly pain, digestion issues, and losing weight.

Hereditary Pancreatitis

A rare genetic condition that causes childhood pancreatitis has been linked to gene mutations such as PRSS1 and CFTR. This condition can result in chronic pancreatitis and an increased risk of developing pancreatic cancer in adulthood.

Autoimmune Pancreatitis

This is a rare type of disease where the immune system attacks the pancreas. It can be linked to other autoimmune disorders. Symptoms include jaundice, weight loss, and abdominal pain.

Traumatic Pancreatitis

Abdominal injuries can be caused by accidents, falls, or trauma related to sports. These injuries can result in sudden abdominal pain, nausea, and vomiting.

Causes of Pancreatitis in Children: Why Does It Occur?

Pancreatitis in children occurs due to various factors, ranging from infections to genetic conditions. Some common causes include:

Genetic Factors

Some children have a genetic predisposition to pancreatitis, particularly if they have mutations in genes like PRSS1, SPINK1, or CFTR (linked to cystic fibrosis).

Infections

Certain viral infections, such as mumps, Epstein-Barr virus, and cytomegalovirus, can trigger inflammation in the pancreas.

Medications

Some drugs, including certain antibiotics, chemotherapy agents, and seizure medications, can induce pancreatitis as a side effect.

Gallstones and Biliary Disorders

Gallstones or abnormalities in the bile ducts can block the pancreatic duct, leading to inflammation.

Trauma and Injury

Abdominal injuries from falls, car accidents, or sports can damage the pancreas and lead to inflammation.

Autoimmune Diseases

Conditions like autoimmune pancreatitis occur when the immune system attacks the pancreas, causing inflammation.

Metabolic Disorders

High levels of calcium (hypercalcaemia) or lipids (hyperlipidaemia) in the blood can contribute to pancreatitis.

Structural Abnormalities

Congenital issues such as pancreas divisum (abnormal development of the pancreas) can lead to recurrent pancreatitis.

Symptoms of Pancreatitis in Children: Recognising the Warning Signs

Recognising the symptoms of pancreatitis in children is crucial for early diagnosis and treatment. The warning signs can vary based on the severity and type of pancreatitis but commonly include:

• The most prominent symptom is usually pain located in the upper abdomen, which may radiate to the back and worsen after eating. The child may vomit frequently, which in turn, may lead to dehydration.
• Infections or inflammation can cause an increase in body temperature. The child may experience bloating and sensitivity to touch. Greasy, foul-smelling stools can indicate poor digestion due to enzyme deficiency.
• General discomfort and weakness can affect daily activities. Another symptom is loss of appetite due to discomfort. Pancreatitis which has affected the lungs can lead to difficulty breathing or low oxygen levels.

Diagnosis: How Is Pancreatitis in Children Identified?

A thorough evaluation by a paediatrician or gastroenterologist is necessary to diagnose pancreatitis in children. The diagnostic process includes:

Medical History & Physical Examination

During the consultation, the doctor will enquire about any symptoms, recent infections, trauma, medications, and family history of pancreatitis. A thorough physical examination will be conducted to assess for abdominal tenderness, bloating, and jaundice.

Laboratory Tests

• Amylase & Lipase Levels: Elevated levels of these pancreatic enzymes in the blood indicate pancreatitis.
• Complete Blood Count (CBC): Helps detect infection or inflammation.
• Liver Function Tests: Assess bile duct obstruction or liver involvement.
• Triglyceride & Calcium Levels: High levels may indicate metabolic causes.
• Genetic Testing: Checks for hereditary pancreatitis or cystic fibrosis-related issues.

Imaging Studies

• Ultrasound: Identifies gallstones, pancreatic swelling, or duct blockages.
• CT scan (Computed Tomography): Provides detailed images to detect inflammation, fluid collections, or complications.
• MRI/MRCP (Magnetic Resonance Cholangiopancreatography): Helps visualise pancreatic ducts and structural abnormalities.
• Endoscopic Ultrasound (EUS): A specialised test used if other imaging is inconclusive.

Additional Tests (If needed)

• Stool Tests: If chronic pancreatitis is suspected, stool tests may check for fat malabsorption.
• ERCP (Endoscopic Retrograde Cholangiopancreatography): Used in specific cases to diagnose or treat bile duct and pancreatic duct issues.

Treatment of Pancreatitis in Children: Managing the Condition

The treatment of pancreatitis in children depends on its severity and underlying cause.

Hospitalisation and Supportive Care

Children with acute pancreatitis often need to be hospitalised for monitoring and care. Treatment includes IV fluids to prevent dehydration, pain management with medications such as acetaminophen or ibuprofen, and sometimes temporary fasting to give the pancreas a break.

Nutritional Support

This plan of care starts with clear liquids, advances to bland foods, and eventually allows for a normal diet as tolerated. A low-fat diet can help reduce strain on the pancreas. In severe cases, nutrition may be given through feeding tubes or IV.

Treating the Underlying Cause

• Gallstone Removal: If gallstones are causing pancreatitis, surgery or ERCP (Endoscopic Retrograde Cholangiopancreatography) may be needed.
• Stopping Certain Medications: If pancreatitis is drug-induced, alternative medications may be considered.
• Managing Metabolic Disorders: High triglyceride or calcium levels are treated accordingly.
• Genetic Counselling: For hereditary pancreatitis, specialists may recommend lifestyle changes and monitoring.

Surgery (In Severe or Chronic Cases)

In cases where complications such as pseudocysts develop, drainage of pancreatic fluid collections may be necessary. While pancreatic surgery is not commonly needed, it may be required in instances of severe chronic pancreatitis.

Paediatric Pancreatitis – Diet: The Role of Nutrition

Proper nutrition plays a crucial role in managing paediatric pancreatitis. A well-planned diet helps reduce strain on the pancreas, supports healing, and prevents complications like malnutrition or digestive issues. The dietary approach depends on whether the child has acute or chronic pancreatitis.

Nutritional Guidelines for Acute Pancreatitis

During an acute episode of pancreatitis, the primary objective is to allow the pancreas to rest and recuperate. This typically entails fasting with intravenous fluids, followed by a gradual transition to clear liquids and soft foods. As symptoms begin to improve, it is advisable to consume small, frequent meals consisting of low-fat, easily digestible foods such as rice, toast, applesauce, and boiled vegetables. It is important to avoid greasy, fried, and heavy foods during this recovery period.

Nutritional Guidelines for Chronic Pancreatitis

For individuals suffering from chronic or recurrent pancreatitis, it is crucial to make long-term dietary adjustments to prevent malnutrition and enhance digestion.

Recommended Foods

Low-Fat Foods:

• Lean meats (skinless chicken, turkey, fish)
• Low-fat dairy (skim milk, yoghurt)
• Whole grains (brown rice, oats, quinoa)
• Fresh fruits and vegetables

Adequate Fluids:

• Proper hydration is essential for preventing dehydration and promoting healthy digestion. This can be achieved by consuming a variety of fluids such as water, clear soups, and herbal teas.

Nutrient-Dense Foods:

• Nutrient-dense foods are essential for promoting healing and overall health. Protein-rich foods are particularly important for supporting the body’s healing process. Additionally, vitamins such as A, D, E, and K are crucial for optimal health, especially if fat absorption is compromised and supplementation may be necessary. It is important to incorporate a variety of nutrient-rich foods into your diet to ensure proper healing and overall well-being.

Foods to Avoid

High-Fat & Fried Foods:

• Butter, cream, fatty meats, and fast food are all examples of high-fat foods that can contribute to an unhealthy diet. Similarly, heavy sauces, mayonnaise, and full-fat dairy products can also add unnecessary calories and fat to your meals. It is important to be mindful of these choices and opt for healthier alternatives whenever possible to maintain a balanced and nutritious diet.

Processed & Sugary Foods:

• Consuming processed and sugary foods, such as soda, pastries, candy, and refined carbohydrates, can result in heightened inflammation in the body.

 Gas-Producing Foods:

• Consuming gas-producing foods such as beans, cabbage, and carbonated drinks can lead to bloating.

Special Considerations for Severe Cases

Feeding tubes are commonly utilised for children experiencing challenges with eating. In cases of malabsorption, healthcare providers may recommend vitamin and mineral supplements, including vitamins A, D, E, and K, to ensure proper nutrition.

Long-Term Dietary Tips for Prevention

Encourage the consumption of small, frequent meals to aid in digestion. It is important to maintain a balanced diet that includes an adequate number of proteins, healthy carbohydrates, and low fats. Collaborate with a paediatric dietitian to ensure that the child is receiving the necessary nutrients for optimal health.

Long-Term Management of Chronic Pancreatitis in Children

Managing chronic pancreatitis in children involves a multidisciplinary approach to address symptoms, prevent complications, and maintain overall well-being. Careful monitoring and lifestyle adjustments are crucial due to the impact on digestion, nutrition, and growth.

Pain Management

Chronic pancreatitis can result in recurrent or constant abdominal pain. For mild pain, acetaminophen or ibuprofen may be recommended. In severe cases, stronger medications like opioids may be used under close medical supervision. Nerve blocks and endoscopic procedures may be necessary for severe pain that does not respond to medication.

Nutritional Support

Children with chronic pancreatitis may have trouble digesting fats and proteins, leading to weight loss. Treatment options include enzyme supplements, a low-fat diet with lean proteins and vegetables, vitamin supplements, and eating small meals frequently to aid digestion.

Regular Medical Monitoring

Children with chronic pancreatitis require consistent medical monitoring by a gastroenterologist to assess pancreatic function, track enzyme levels and structural changes, and screen for diabetes.

Lifestyle Adjustments & Prevention Strategies

To reduce pancreatic stress, avoid fatty and fried foods, stay hydrated, engage in physical activity, and manage stress and anxiety using relaxation techniques or counselling if needed.

Emotional & Social Support

Counselling and support groups help children and families deal with chronic illness challenges. Teachers and caregivers should be aware of the child’s condition to make necessary accommodations in school and activities.

Sources:

• https://www.stanfordchildrens.org/en/services/advanced-endoscopy/conditions/pediatric-pancreatitis
• https://kidshealth.org/en/parents/pancreatitis
• https://www.cincinnatichildrens.org/health/p/chronic-pancreatitis
• https://www.cincinnatichildrens.org/health/p/acute-pancreatitis
• https://ufhealth.org/conditions-and-treatments/pancreatitis-children
• https://pancreasfoundation.org/pancreas-disease/pediatric-pancreatitis/
• https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes
• https://www.webmd.com/digestive-disorders/digestive-diseases-pancreatitis
• https://my.clevelandclinic.org/health/diseases/pancreatitis