Medical Management of Chronic Pancreatitis in Children

Patient Guideline Summary

Publication Date: February 1, 2021

Objective

Objective

This patient summary means to discuss key recommendations from the North American Society for Pediatric Gastroenterology, and Hepatology for the medical management of chronic pancreatitis in children.

Overview

Overview

  • Pancreatitis is inflammation of the pancreas, a digestive organ beneath the stomach. Pancreatitis can be acute, chronic, or recurrent and mild, moderate, or severe in intensity. It is uncommon in children.
  • Some of the most common causes of pancreatitis in children are genetic. Other causes include obstruction of the outflow tract, injury, infections, smoking, and alcohol consumption.
  • Common symptoms of chronic disease are pain in the upper abdomen, stomach upset, and weight loss.
  • Because the pancreas secretes digestive chemicals, your child may suffer several specific nutritional deficiencies as well as overall insufficient nutrition.
  • This patient summary focuses on treating chronic childhood pancreatitis.

Diagnosis

Diagnosis

  • Your child should be evaluated and followed for general as well as specific nutritional needs by a team of healthcare specialists that includes a dietitian.
    • Weight, height, vitamin intake, and laboratory studies should be monitored at regular intervals of 6-18 months.
  • Since the pancreas also controls blood sugar, periodic diabetes screening is also necessary.
    • If diabetes is diagnosed, referral to an endocrinologist/diabetologist is recommended.

Treatment

Treatment

Nutrition
  • Your child’s treatment team will monitor all elements of a complete nutritional program and make changes based on laboratory tests as well as overall growth and health.
    • Deficiencies in fat-soluble vitamins (A, D, E, and K) are particularly likely.
  • Pancreatic enzyme replacement therapy may be recommended.

Pain
  • Your child’s pain treatment team ideally will consist of a pediatric pain physician, pediatric gastroenterologist, psychologist, nurse, and physical therapist.
  • Treatment can involve:
    • Cognitive Behavioral Therapy (CBT)
    • Physical therapy
    • A pain medication “ladder” that begins with the safest medications and adds opioids cautiously as needed.

Lifestyle
  • Throughout your experience with your child’s medical team, you will learn about living with chronic pancreatitis — things to do and not to do to enhance the quality of your child’s life.
    • You and your child will be advised of certain behaviors that can worsen chronic pancreatitis, such as alcohol and tobacco use.
    • Nutrition education will be a centerpiece of your education.

Abbreviations

  • CBT: Cognitive Behavioral Therapy

Source Citation

Freeman AJ, Maqbool A, Bellin MD, Goldschneider KR, Grover AS, Hartzell C, Piester TL, Szabo F, Kiernan BD, Khalaf R, Kumar R, Rios M, Husain SZ, Morinville VD, Abu-El-Haija M. Medical Management of Chronic Pancreatitis in Children: A Position Paper by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Pancreas Committee. J Pediatr Gastroenterol Nutr. 2021 Feb 1;72(2):324-340. doi: 10.1097/MPG.0000000000003001. PMID: 33230082; PMCID: PMC8054312.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.