Acute pancreatitis represents inflammation of the pancreas that has been well identified in the literature for several centuries. However, the phenomenon has only relatively recently gained prominence in the pediatric literature. The incidence can be as high as 13 per 100,000 per year, a level which approaches that seen in adults, and the diagnosis has been increasingly common over the last two decades. It affects all ages of children (including infants) evidenced by well-established age appropriate diagnostic criteria. The precise pathophysiological basis of the inflammation is not always as clear. Currently, the prevailing theory is that there is an insult to the acinar cells of the pancreas likely via an atypical calcium signal that releases a cascade of cellular activity and that ultimately results in a disseminated cytokine storm. While there is certainly debate as to the inciting event to this cascade, one thing that is clear is that extensive end-organ damage can occur if this cytokine storm reaches systemic circulation. Therefore, the mainstay of management is bowel (and specifically pancreatic) rest with significant fluid support to minimize or mitigate the effect of the cytokines on the pancreas and other systemic organs such as the lungs, heart, and kidneys. The remainder of therapy consists of appropriate analgesia and antiemetics.