Management of pericardial diseases should consider specific issues related to the age of patients (essentially dosing issues) and gender (especially considering specific physiological conditions such as pregnancy and lactation) [1].

Pericarditis is an important cause of chest pain in children and accounts for about 5 % of all children who present with chest pain to a paediatric emergency department [2]. The aetiological spectrum has specific peculiarities since children may present more specific causes, such as bacterial, autoinflammatory diseases and especially post-pericardiotomy syndromes following surgical repair of congenital heart diseases (especially atrial septal defects) [3–5].

The same diagnostic criteria of adults apply also for pericarditis and pericardial effusions in children. However, it is typically described that children have a more marked systemic inflammatory pattern compared to adults. Fever and pleuropulmonary involvement is more commonly reported as well as elevation of markers of inflammation [5].

Unfortunately, at present, there are no RCTs in paediatric settings and thus the management of pericardial syndromes in children follows the general schemes of adults although with dose adjustments; moreover, aspirin is contraindicated in children because of the risk of Reye’s syndrome (Tables 17.1 and 17.2) [1]. Colchicine can be used in children, while corticosteroid use should be restricted more than in adults, due to their possible severe side effects (striae rubre and growth impairment), which are particularly deleterious in growing children. Corticosteroid dependence is particularly critical in these patients and biological agents (e.g. anakinra) have been first used in the paediatric setting to allow corticosteroid withdrawal [6–9]. Exercise restriction is particularly bothersome for children and their families, and the quality of life may be seriously affected especially in recurrent cases. Nevertheless, the prognosis is good and related to the underlying aetiology of pericardial syndromes [5].

The new 2015 ESC guidelines address the specific issue of the management of children with a pericardial syndrome [1]. Specific recommendations include:

The low levels of recommendations reflect the evidence based essentially on case series, retrospective reviews and experts’ opinion and reviews. Although possible, it seems wise in my view, in order to improve patient compliance and reduce possible side effects, not to prescribe higher doses of colchicine in children >5 years, but instead to consider the same doses of adults (e.g. 0.5 mg BID).

During pregnancy, it is relatively common (up to 40 % of cases) to detect a mild pericardial effusion by the third trimester. The effusion is generally asymptomatic and does not require any treatment [10–13].

Pericarditis may occur and treatment should consider possible effects of medical therapy on the foetus. Generally pericarditis is viral or idiopathic and has a good prognosis with outcomes similar to those reported in the general population. In patients with previous pericarditis, it is wise to plan pregnancy in a phase of quiescence of the disease. For the medical therapy of pericarditis, aspirin and NSAIDs (ibuprofen and indomethacin) may be prescribed during the first and second trimester. After gestational week 20, all NSAIDs (except aspirin ≤ 100 mg/day) can cause constriction of the ductus arteriosus and impair foetal renal function, and they are withdrawn in any case at gestational week 32. On this basis, low-dose corticosteroids (e.g. prednisone 0.2–0.5 mg/kg/day) represent a valid option that can be adopted for the whole duration of pregnancy (Table 17.3). In the absence of a specific indication (e.g. Familial Mediterranean Fever), colchicine is considered contraindicated during pregnancy [1, 10–15].