The usefulness of sonography in evaluating the pancreas in infants and children is well known. Its usefulness is due to the optimal sonic window provided by the relative lack of fat tissue and the large left hepatic lobe in children. A wide spectrum of pancreatic pathologic conditions can be identified sonographically in children, including congenital abnormalities; inflammatory, cystic, pseudocystic, and neoplastic lesions in usual and unusual manifestations; rare processes such as nesidioblastosis and Schwachman-Diamond syndrome; and pancreatic involvement in systemic disease. Multiple pathologic processes can affect the pancreas focally or diffusely, making diagnosis difficult in some instances, since the pancreatic response is limited to changes in echogenicity and size independent of the cause. Sonography is rapid, accurate, and noninvasive and does not require patient sedation. It is the modality of choice for evaluating suspected pancreatic disease, since it allows not only direct visualization of the pancreas but also evaluation of adjacent organs.