Background Pediatric pancreatitis is increasing, whether due to an increase in cholelithiasis or factors such as increased awareness and testing. This study was to describe previously undescribed pre-adolescent children with pancreatitis to illuminate this population and clarify who should be screened for pancreatitis. Methods This is a descriptive retrospective study of emergency department patients <13 years old over 10 years with the diagnosis of pancreatitis. Demographics, laboratory values, imaging results and final diagnoses/etiologies were recorded and evaluated using descriptive statistics. Results 100 patients presented with acute pancreatitis and median age of 8 years (IQ range 5-11). 25% were attributed to an unknown etiology. 16 were medication induced, 13 genetic/congenital/structural, 14 traumatic/post surgical, 14 had gallstones, and 17 had autoimmune or systemic illness-related pancreatitis. 29 patients had recurrent pancreatitis. Conclusions Cholelithiasis is a much less frequent etiology in children than in adults. Genetic/structural factors represent a larger proportion of acute cases and higher proportion of recurrent pancreatitis. Concurrent systemic and viral illnesses are more common than in adults. Patients on pancreatitis-causing medications or with known genetic/structural issues should be tested for pancreatitis. Patients without risk factors rarely developed recurrent pancreatitis. Hypertriglyceridemia was not found to be an etiology. Chronic pancreatitis was uncommon.