Pericarditis has several different causes, however, in about 70% of paediatric patients, a specific aetiology cannot be detected and the pericarditis is considered idiopathic. Recurrences may occur in up to 15-30% of cases. The pathogenesis of recurrent disease is controversial. Infectious, autoimmune and autoinflammatory pathways have been proposed as mechanisms involved in recurrences. Therapeutic strategies are not standardised, non-steroidal anti-inflammatory drugs at high dosages being the mainstay of therapy with the possible addition of low dose colchicine to prevent recurrences. Biological agents are considered a possible new therapeutic frontiers in the care of idiopathic recurrent pericarditis.