Purpose <p>Pediatric pancreatic trauma is uncommon, but it is associated with significant morbidity and an ongoing debate regarding its management. Hemodynamic stability and pancreatic duct involvement are key factors in treatment decisions.</p> Methods <p>A retrospective study analyzed 25 pediatric patients with pancreatic trauma treated between 2010 and 2020 at two high-complexity hospitals in Medellin. Clinical variables, trauma mechanism, imaging findings, management, and complications were analyzed.</p> Results <p>Blunt trauma was the predominant mechanism (64%). Preoperative computed tomography was performed in 12 patients (48%); radiological AAST grading was not retrievable in 13 (52%). Immediate surgery was performed in 13 patients (52%), predominantly driven by associated intra-abdominal injuries rather than the pancreatic injury itself. Non-operative management was initially attempted in 9 patients (36%), with a 56% success rate; failures (44%) were related to clinical deterioration and progression of peripancreatic collections. Clinically relevant postoperative pancreatic fistula (ISGPS Grade B) occurred in 3 of 13 operated patients (23%), with a mean closure time of 55.6 days (range 18–110); no Grade A or Grade C fistulas were recorded. Other complications included post-traumatic pancreatitis (24%), pancreatic pseudocyst (8%), and organ/space surgical site infection (8%); most were Clavien–Dindo Grade IIIa. No in-hospital or 30-day deaths occurred.</p> Conclusions <p>In this Latin American dual-centre cohort, non-operative management was feasible in hemodynamically stable children, while operative management was largely dictated by associated injuries rather than pancreatic injury itself. Clinically relevant POPF was the dominant driver of morbidity. Accurate grading, ductal assessment, and standardised outcome reporting (ISGPS, Clavien–Dindo) are essential to guide management and benchmark results.</p>