Acute Pancreatitis in Children

Pancreatitis has been broadly defined as pancreatic injury that is followed by a local inflammatory response. Although there are multiple underlying etiologies of injury, the resulting inflammation is the commonality and what treatment targets. In the pediatric population, there are three classes of pancreatitis: acute pancreatitis (AP), acute recurrent pancreatitis (ARP), and chronic pancreatitis (CP).¹ This article focuses on AP. The incidence of AP in the United States is stable; however, it is higher than once previously thought.^2,3 Previously a condition more common in the adult population, the increased incidence in the pediatric population presents challenges to preparedness for presentation in both acute care outpatient and inpatient settings. Despite the recent publication of consensus statements on the management of pediatric AP, an update on the rapidly evolving epidemiology, etiologies, and management would greatly enhance clinical preparedness for treatment of pediatric acute pancreatitis.^4–6 This review highlights the most common etiologies for the pediatric population including novel etiologies such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and multisystem inflammatory syndrome in children (MIS-C). We discuss current diagnostic criteria for AP in children and how they differ from adults. Lastly, to prepare pediatric providers in all settings, we discuss current clinical management, including acute bowel rest with goals for early refeeding.

Epidemiology

There are many reports that pediatric AP incidence has continued to rise and approach the incidence in adults.^7,8 The reported rise in pediatric AP has been correlated with increasing pediatric obesity.⁷ However, more recent reports make use of large pediatric catchments and publicly available insurance claims data to assess both inpatient and outpatient management of pediatric AP. These efforts provide different and clearer information about recent incidence and trends compared to adult pancreatitis. These data suggest that, in 2014, the incidence of pediatric AP requiring inpatient admission ranged from 6.4 to 6.6 per 100,000 children compared to 60.1 per 100,000 in adults.^2,3 Specifically, unlike in the adult population, 23% to 50% of AP is managed in the outpatient setting, and thus many previous estimations of incidence using hospital-centered data have been underestimates.^2,9 Including outpatient management data increased the 2014 incidence of AP in children to 12.3 per 100,000.² Lastly and most importantly, the incidence of...