When your child is feverish and nauseated with a stomachache, it’s often just a 24-hour bug. However, pancreatitis — an inflammation of the pancreas — can also appear as a stomach virus. Although we typically only hear about pancreatitis being a problem for adults, children can also be affected. In adults, gall stones and alcohol are the two leading causes of pancreatitis and can cause major morbidities, with prolonged hospitalization. In children, the causes are often different, and morbidities are fewer. In order to lessen the risk of complications, it’s important for parents to recognize the symptoms of pancreatitis early.

Factors and Causes of Pancreatitis in Children

The pancreas is a digestive gland in the back of the abdominal cavity. The pancreas makes digestive juices that drain into the upper part of the small intestine, and it’s important in the digestion of carbohydrates, fats and proteins. It’s an amazing phenomenon that the pancreas, despite making the digestive juices, never digests itself due to the natural checks and balances in the gland. When these checks and balances are interrupted, pancreatitis can occur. These checks and balances include producing digestive secondary to certain hormonal signals when food reaches the beginning of the small intestine, free flow of digestive juices into the small intestine through tubes called ducts and prevention of activation of the digestive enzymes.

There are two main types of pancreatitis: acute and chronic. When pancreatitis occurs one time, it’s known as acute pancreatitis, and when it occurs repeatedly, it’s called chronic pancreatitis. When pancreatitis does not heal or improve (chronic pancreatitis), more long-term problems can occur. For example, the pancreas can become scarred and develop calcium deposits in the gland, as well as sludge and stone in the pancreatic duct.

Although in children, exact cause of pancreatitis is unknown half the times, acute pancreatitis may be caused by medications, a viral infection or trauma. On the contrary, recurrent pancreatitis may be due to genetic defects or due to congenital abnormalities in the pancreatic duct. Although rare, two genetic defects associated with repeated pancreatitis include cystic fibrosis gene changes and mutations causing activation of a digestive enzyme called trypsin in the pancreas.

[See: 10 of the Biggest Health Threats Facing Your Kids This School Year.]

Symptoms of Pancreatitis

Pancreatitis can be extremely painful for children. If your child complains of persistent upper abdominal pain — often to the middle and left and sometimes with radiation of pain to the back — that could be a sign than it’s more than just the flu or a tummy ache. The pain is often intense and associated with nausea or vomiting. Pain can be unrelenting and almost always is not associated with diarrhea. Occasionally, children can develop dehydration, breathing difficulty and even shock due to fluid loss into the tissues.

— When pancreatitis is associated with gall stones: Patients may develop jaundice due to obstruction of bile from the liver to the intestine.

— When pancreatitis becomes chronic: Patients often can discern if their abdominal pain is similar to their pancreatitis pain or different. In chronic pancreatitis, the pancreas may burn out, limiting digestive capacity, leading to malabsorption and loose, foul-smelling stools and poor growth. Pain in this setting can become continuous and debilitating.

[See: Your Guide to Over-the-Counter Pain Relief.]

Diagnoses and Treatment of Pancreatitis

Pancreatitis can be difficult to diagnose, and it takes a high degree of suspicion to start testing for it. The best screening test for acute pancreatitis is a simple blood test that looks for elevation of two enzymes: amylase and lipase. A rise in the levels of these enzymes more than three times the upper limit for the lab range is highly suggestive of pancreatitis. An ultrasound may also be a helpful tool in evaluating the pancreas, and a CT scan may be required if the symptoms are severe and if there’s concern for significant inflammation. An MRI may be required if the pancreatitis becomes recurrent or if there are concerns for obstruction by a gall stone causing pancreatitis. Once pancreatitis become recurrent, the help of a genetics doctor may be enlisted to look for genetic mutations that may be associated with pancreatitis.

When treating pancreatitis, the help of a pediatric gastroenterologist should be sought. Although specific therapies are limited, there are many management tools that can help control the symptoms. Overall treatment includes adequate pain management, avoiding an oral diet in order to rest the pancreas and correcting fluid losses. When the pain and nausea improves, oral nutrition or feeds by a nasogastric tube can be started. There is good medical evidence that early commencement of nutrition orally or through a feeding tube speeds recovery and shortens the hospital stay.

[See: 10 Weird Things That Can Make You Poop.]

When pancreatitis becomes recurrent, a low-fat diet may help reduce the frequency of attacks. Sometimes, digestive enzyme supplementation is required if the patient develops digestive enzyme deficiency. When attacks of pancreatitis become more frequent, the pain can become debilitating. In this situation, more intense treatment options are available, such as total pancreatectomy (removal of the pancreas) and islet cell autotransplant (injection of the patient’s own insulin-making cells from the pancreas to the liver). These have both been shown to improve quality of life and decrease the risk of diabetes.

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Could Your Child’s Tummy Pain Be Pancreatitis? originally appeared on usnews.com