Pancreatic Enzymes for Infants and Children

Important information:

Pancreatic enzymes help digest food when the pancreas is not working properly. These enzymes break down fats, proteins, and starches to help the body absorb nutrients. They are essential for weight gain, growth, and development when combined with a healthy diet.

How pancreatic enzymes work:

• They break down fats, proteins, and starches (complex carbohydrates).

• Enzymes must be taken right before eating most foods.

• Your healthcare provider will determine the correct number of enzymes for meals and snacks and the total number of enzymes safe to take in one day.

• Pancreatic enzymes come in capsules with tiny enzyme beads in different doses and sizes. It is important to know the brand and dose prescribed for your child.

Dosing pancreatic enzymes:

• Enzyme doses are based on your child's weight and the amount of fat in meals and snacks.

• The enzyme dose may need to be adjusted for snacks outside regular mealtimes, changes in meal patterns, or high-fat foods, such as:

  • Cream-filled donuts

  • Fried chicken

  • Cheesesteak

  • Pizza

  • Ice cream

• Do not exceed the total number of enzymes that is safe to take in one day.

Instructions for matching enzymes with food:

Foods that do not need pancreatic enzymes: These foods contain simple carbohydrates and do not require enzymes:

Identifying foods with fat:

Use the Nutrition Facts label to check for fat content, follow the steps below. 

• Look for key terms that signal fat content such as aioli, Alfredo, Au gratin, battered, buttered, creamy, crispy, country-style, fried, loaded, oil, smothered, tempura, and whole milk.

• Some foods naturally high in fat include avocado, coconut, nuts, olives, and seeds.

• Adding ingredients like bacon, butter, cream, margarine, mayonnaise, cream cheese, oil, and salad dressing increases fat content.

• Low-fat or fat-free foods rich in starch or protein still require enzymes.

• Speak with your dietitian or healthcare provider about adjusting pancreatic enzymes.

Instructions for giving enzymes to your child:

• Pancreatic enzymes come in capsules with tiny beads inside. Older children can swallow the prescribed number of capsules. Infants and young children will not be able to swallow an enzyme capsule. Give them only the beads inside the capsule until they are old enough to swallow the capsule, usually around age 4 or older.

• Always give the enzymes in applesauce. Not only does applesauce have the right acidity for enzymes, but it also creates a routine for your child. If you try to hide the enzymes in different foods, your child may learn to resist food in general, believing all foods contain medicine.

• Your healthcare team will tell you how many enzymes to give. The dose will change as your child grows.

1. Preparing pancreatic enzymes:

   • Use a soft, shallow baby spoon for infants or a regular teaspoon for older infants and young children.

   • Place a small amount of applesauce (about the size of an adult thumbnail) on the spoon.

     • For infants, use baby applesauce (Stage 1).

     • For older infants and young children who eat table food, regular applesauce can be used.

   • Hold the capsule upright so the beads settle at the bottom.

   • Twist off the top of the capsule carefully to avoid spilling the beads.

   • Pour all the beads onto the applesauce in the spoon.

2. Giving enzymes to infants and children:

   • Give the applesauce-enzyme mixture on the spoon right before feeding.

   • If your child spits it out, scoop up the mixture and offer it again.

   • Offer enough breast milk, formula, or milk to help them swallow the beads.

   • Your child will get better at swallowing enzymes after a few days.

3. Matching enzyme dose to food:

   • Give enzymes before fat, starch, or protein-containing foods as described above.

   • If a feeding lasts longer than 20 minutes, discuss splitting the enzyme dose with your healthcare provider.

   • Speak with your healthcare provider about adjusting doses for snacks and high-fat foods.

4. Ongoing management of pancreatic enzyme therapy

   • After starting pancreatic enzymes, you may notice changes in your child’s bowel movements. Signs that food is being absorbed include more formed stools, fewer bowel movements, and less stool odor, greasiness, gas, or belly pain. If your child still has digestive issues, contact a healthcare provider.

   • Contact your healthcare provider with questions about dosage, timing, or brand changes.

   • Only use the brand name enzyme and dose ordered by your healthcare provider Generic or over-the-counter pancreatic enzymes are not approved by the Food and Drug Administration. They are not safe and may not be effective.  If insurance does not cover the brand-name enzymes, contact your healthcare team.

   • Pancreatic enzymes require a prescription. Pharmacies may need a few days to order them. Refill the prescription before running out and always check the expiration date.

Storage and handling tips:

• Store enzymes in a cool, dry place. Do not refrigerate or store them in warm areas like above the stove or in a car. If traveling to the beach, keep them in a cooler but not directly next to freezer packs.

• Do not crush or chew enzyme beads.

• Enzymes activate when exposed to air or mixed with food, so give them right before a feeding. Do not mix ahead and store.

Special considerations:

• Check your infant's mouth after each feeding and wipe away any remaining enzymes to prevent mouth sores.

• Breastfeeding mothers should check their nipples after feeding to remove enzyme residue.

• Use barrier cream (such as Desitin®) with each diaper change to prevent skin irritation from enzyme beads.

Reviewed January 2025 by Erin Brewer, RN