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It is important to note the differences between the studies included within this letter and our study, which make them difficult to adequately compare. However, we agree that more randomized studies should be conducted and stated such in our study. First, the subjects in the studies referenced in the letter were adults. The causes of pancreatitis in adults are significantly different than the causes of pancreatitis in children. One cannot assume that because a treatment is safe for adults that it is safe for children. Our study is one of the few studies to date to evaluate early oral nutrition in pediatric acute pancreatitis. Second, the studies referenced evaluated patients with more severe acute pancreatitis. Although Vaughn et al did agree with our conclusions regarding early oral feeding in acute pancreatitis, they studied mild-to-moderate acute pancreatitis1Vaughn V.M. Shuster D. Rogers M.A.M. Mann J. Conte M.L. Saint S. et al.Early versus delayed feeding in patients with acute pancreatitis: a systematic review.Ann Intern Med. 2017; 166: 883-892Crossref PubMed Scopus (49) Google Scholar; we did not include moderate disease in our study. Qi et al concluded the safety and benefits provided by early nutrition in severe pancreatitis but did not demonstrate these outcomes in those with mild-to-moderate disease.2Qi D. Yu B. Huang J. Peng M. Meta-analysis of early enteral nutrition provided within 24 hours of admission on clinical outcomes in acute pancreatitis.JPEN J Parenter Enteral Nutr. 2018; (in press)Crossref PubMed Scopus (18) Google Scholar Mirtallo et al performed a meta-analysis and developed international consensus guidelines for nutrition therapy in acute pancreatitis3Mirtallo J.M. Forbes A. McClave S.A. Jensen G.L. Waitzberg D.L. Davies A.R. International consensus guidelines for nutrition therapy in pancreatitis.JPEN J Parenter Enteral Nutr. 2012; 36: 284-291Crossref PubMed Scopus (90) Google Scholar; they recommend early nutrition regardless of the severity of the disease. Furthermore, a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition recommends early (within 48-72 hours of presentation) oral or enteral nutrition in the management of pediatric acute pancreatitis.4Abu-El-Haija M. Kumar S. Quiros J.A. Balakrishnan K. Barth B. Bitton S. et al.Management of acute pancreatitis in the pediatric population: a clinical report from the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition Pancreas Committee.J Pediatr Gastroenterol Nutr. 2018; 66: 159-176Crossref PubMed Scopus (108) Google Scholar Our study adds to the growing body of literature supporting early oral nutrition in acute pancreatitis in children, and we agree that more meta-analyses are needed to support our conclusions. Third, we cannot compare our study with those evaluating secondary infection as we excluded patients with initial signs of local complications and did not have any patients develop these complications throughout the study. Early oral nutrition in patients with acute pancreatitis: risk assessment for children and adolescentsThe Journal of PediatricsVol. 199PreviewEllery et al determined the advantage of early oral nutrition in children with mild acute pancreatitis.1 The authors recognized that early patient-directed oral nutrition in mild acute pancreatitis showed decreased length of time nil per os status and hospitalization without obvious complications, by setting treatment team-directed nutrition as a control. I would like to comment about their study. Full-Text PDF