What are Pancreatic Injuries?
The pancreas is not well protected in children due to their thin abdominal walls and underdeveloped muscles, so they are more likely than an adult to have a pancreas injury. A pancreatic injury can happen after a car crash, fall, bike wreck or any activity that causes a hard blow to the abdomen. A penetrating pancreatic injury can be caused by a gunshot, knife or other sharp object that cuts or tears the pancreas.
Function of the Pancreas
The pancreas is found behind the stomach and is divided into three parts: the head, body and tail. The part of the pancreas lying over the spine is most likely to be injured. The job of the pancreas is to aid digestion. The pancreas makes glucagon, insulin and digestive enzymes.
Diagnosis of a Pancreatic Injury
A child with a pancreatic injury will usually have belly pain. Nausea and vomiting are also common. After the trauma, the child may or may not have bruising on the abdomen. If a pancreas injury is suspected, the trauma surgery providers will thoroughly and carefully examine your child. X-rays, a computed tomography (CT) scan, ultrasound or blood tests may be done to determine how badly your child's pancreas is damaged.
The American Association for the Surgery of Trauma (AAST) grades pancreas injuries 1-5. The grade is determined by the size and location of the injury in the pancreas seen on CT scan. Grade 1 is the least severe and 5 is the most severe.
Treatment for Pancreatic Injuries
Children with lower grade pancreatic injuries (1-2) will be admitted to a general care unit for observation and management. Children with higher grade injuries (3-5) may need immediate surgery. If surgery is not needed right away, children are admitted for observation. They will need a specialized MRI that gives a more detailed picture of the injury to the pancreas. The trauma surgery provider will determine next steps based on that imaging. A gastroenterologist (doctor who specializes in the GI system) may be needed to assist the trauma surgery provider in caring for children with pancreatic injuries.
Your child will not be allowed to eat right away. When your child is allowed to eat will depend on their pain level, whether or not surgery is needed, or when the trauma surgery provider decides it is safe to eat. Your child will be given an IV (small tube in their vein for fluid hydration).
Medications and Pain Management
Speak to your trauma surgery provider about medications your child was taking before they were admitted to the hospital. They will let you know when it is okay to restart home medications. Your child may have some pain or soreness at home. Give acetaminophen (Tylenol®) for pain.
Your child's trauma surgery provider may also write a prescription for stronger pain medication. Give the stronger medication if the pain does not go away one hour after giving acetaminophen. Follow the directions on the prescription.
Do not give your child NSAIDs or ibuprofen (Motrin®, Advil®, Aleve®, etc.) until the trauma surgery provider says that it is okay. Your child may need a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements.
Wound and Skin Care
Your child may shower or take a bath, but they may need help for several days after going home. If your child had surgery, check with your trauma surgery provider about taking a shower or bath. Follow the instructions given by trauma surgery regarding any other injuries or wounds. If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry.
Activity After a Pancreatic Injury
Your child does not need to stay in bed but should walk and play quietly while they heal. Your child should not play rough with family, friends or pets. They should not participate in any contact activities or sports until instructed by the trauma surgery provider. The length of activity restrictions will depend on the grade of the pancreas injury.
Returning to Daycare or School
Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations regarding going back to school. If surgery was needed or your child has other injuries, they may be out of school longer. At school, your child should not be taking gym class until your trauma surgery provider says it's okay. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. Your child should not carry or lift more than one to two textbooks at a time, even if they carry a book bag or backpack.
Once it is okay for your child to return to normal activity, no further follow-up will be needed. After your child has healed, they are not at an increased risk to hurt their pancreas again.
When to Call Your Child’s Doctor
Call your child’s doctor or seek medical attention if your child has increased or worsening abdominal pain, fever over 100.5°, difficulty with bowel movements, shortness of breath, nausea / vomiting, dizziness, a fast heart rate, or redness, swelling, pus drainage or increased pain around the wound.
Emotional Recovery
After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read or do small craft projects for short periods of time. Infants and toddlers are harder to distract and will be more difficult to confine, but avoid high-risk activities such as wheeled activities or jungle gyms.
After any trauma, children may experience acute stress symptoms. If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms, please speak with the trauma surgery provider. Short-term therapy can be provided to help children heal and recover emotionally after a trauma.
Preventive Actions
It’s important to teach your child about all types of safety. Unintentional injury is one of the leading causes of death for children in the United States.
At Home: If you have guns in the home, they should be unloaded and locked with a locking device with ammunition stored separately.
At Play: Make sure your child wears the correct type of helmet when riding a bike, using other wheeled toys, or taking part in sports that require helmets.
On the Go: Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle. Children under 13 years should not ride in the front seat.
