The incidence of acute pancreatitis in children appears to be rising over the past few decades and the cause of this remains unclear and is probably a combination of a “real” rise and increased awareness of this condition. The incidence ranges from 1 in 7,500 per year in an American study, to 1 in 28,000 per year in data from Australia. The aetiology is very different from adults where gallstones and alcohol appear to be the main causes. In children we see trauma, idiopathic and systemic causes being the main culprit based on three large studies. The condition is generally mild and self- limited and responds well to a conservative approach including early enteral feeding. There is no role for the use of octreotide, pancreatic enzyme therapy or total parenteral nutrition in the management of children with acute or relapsing pancreatitis. There is emerging information with respect to the possible aetiology of idiopathic disease where mutations in cationic trypsinogen [PRSS1], anionic trypsinogen [PRSS2], pancreatic secretory trypsin inhibitor [SPINK1], chymotrypsinogen [CTRC] and cystic fibrosis transmembrane conductance regulator [CFTR] may result in acute and recurrent pancreatitis and will be discussed in this presentation.