Pediatric pancreatitis

Updated December 8, 2024

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of pediatric pancreatitis are prepared by our editorial team based on guidelines from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN 2021,2018), the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN/NASPGHAN 2018), and the INternational Study Group of Pediatric Pancreatitis: In search for a cuRE (INSPPIRE 2018,2017).

Screening and diagnosis

Diagnostic criteria: as per NASPGHAN 2018 guidelines, diagnose pediatric acute pancreatitis according to the INSPIRE criteria.

INSPPIRE diagnostic criteria for pediatric acute pancreatitis

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When to use

Abdominal pain suggestive of or compatible with acute pancreatitis (abdominal pain of acute onset, especially in the epigastric region)

Yes

Serum amylase and/or lipase activity at least > 3 times the upper limit of normal

Yes

Imaging findings characteristic of or compatible with acute pancreatitis

Yes

Calculation

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The INSPPIRE (International Study Group of Pediatric Pancreatitis: In Search for a Cure) diagnostic criteria is a clinical calculator specifically designed for the diagnosis of acute pancreatitis in pediatric patients. This scoring system is used to identify children who are likely to have acute pancreatitis based on a combination of symptoms, physical examination findings, and laboratory results. The INSPPIRE criteria include abdominal pain characteristic of pancreatitis, serum amylase and/or lipase levels greater than three times the upper limit of normal, and imaging findings consistent with acute pancreatitis. The clinical utility of this calculator is to provide a standardized method for diagnosing acute pancreatitis in children, which can help guide treatment decisions and predict prognosis. There are no specific exclusion criteria for its use, but it should be noted that it is not intended to replace clinical judgment or to be used in isolation. It should be used in conjunction with a comprehensive clinical assessment.

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Diagnostic investigations

Laboratory testing: as per NASPGHAN 2018 guidelines, obtain liver enzymes (ALT, AST, GGT, ALP, bilirubin) triglycerides, and calcium in patients with a first-time attack of acute pancreatitis.

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Cross-sectional imaging (acute pancreatitis)
Cross-sectional imaging (chronic pancreatitis)
MRCP/ERCP/EUS
Genetic testing
Nutritional assessment
Screening for celiac disease

Diagnostic procedures

Upper gastrointestinal endoscopy: as per NASPGHAN 2018 guidelines, do not perform upper gastrointestinal endoscopy routinely in pediatric patients with acute pancreatitis. Determine its indication on a case-by-case basis.

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Medical management

Intravenous fluids: as per NASPGHAN 2018 guidelines, administer crystalloids either with lactated Ringer or normal saline in the acute setting for initial resuscitation of pediatric patients with acute pancreatitis. Administer a bolus of 10-20 mL/kg in case of hemodynamic compromise. Provide 1.5-2 times maintenance IV fluids with monitoring of urine output over the next 24-48 hours in pediatric patients with acute pancreatitis.

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Pain management
Pancreatic enzyme replacement therapy
Antibiotics
Corticosteroids
Therapies with no evidence for benefit

Inpatient care

Clinical and laboratory monitoring

As per NASPGHAN 2018 guidelines:

Monitor vitals at least every 4 hours during the first 48 hours of admission and during periods of aggressive hydration to monitor oxygen saturation, BP, and respiratory rate in patients admitted to an inpatient ward. Adjust the frequency based on clinical status. Obtain specialist assessment in case of abnormalities in vital signs.

Monitor BUN, creatinine, and urine output routinely during the first 48 hours as a marker of appropriate fluid management and to screen for AKI. Obtain nephrology assessment in case of abnormalities.

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Imaging monitoring (acute pancreatitis)
Imaging monitoring (chronic pancreatitis)

Nonpharmacologic interventions

Nutritional support: as per ESPGHAN/NASPGHAN 2018 guidelines, provide a regular diet in pediatric patients with chronic pancreatitis, with or without EPI.

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Specific circumstances

Patients with biliary pancreatitis: as per NASPGHAN 2018 guidelines, perform cholecystectomy before discharge in patients with mild uncomplicated acute biliary pancreatitis.

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Patients with necrotizing pancreatitis
Patients with autoimmune pancreatitis (clinical presentation)
Patients with autoimmune pancreatitis (laboratory tests)
Patients with autoimmune pancreatitis (diagnostic imaging)
Patients with autoimmune pancreatitis (histopathology)
Patients with autoimmune pancreatitis (corticosteroids)
Patients with autoimmune pancreatitis (management of relapse)
Patients with autoimmune pancreatitis (long-term surveillance)
Patients with congenital pancreatic anomalies

Follow-up and surveillance

Surveillance for complications: as per ESPGHAN/NASPGHAN 2018 guidelines, monitor for pancreatic exocrine insufficiency every 6-12 months with fecal elastase or 72-hour fecal fat collection in pediatric patients with chronic pancreatitis.

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