liver in children

Overview

The liver is a large, important organ that does many jobs, like cleaning the blood, making bile to help digest food, and storing energy. Liver problems in children happen when something stops the liver from working normally, such as an infection, a genetic condition, or a blocked bile duct.

Liver disease in children is uncommon. When it does happen, it can range from a short-term problem that goes away to a long-term condition that needs ongoing care.

It can affect babies, toddlers, school-age children, and teenagers. Some liver problems are present from birth, while others develop later in childhood.

Symptoms

Common symptoms

• Yellowing of the skin or whites of the eyes (jaundice)
• Dark urine or pale, pasty stools
• Feeling very tired or weak
• Loss of appetite or weight loss
• Swollen belly or pain in the upper right side of the tummy

Symptoms in children

• Failure to gain weight or grow properly
• Itchy skin, especially without a rash
• Delayed development or changes in learning
• Very low energy, lack of interest in play

Symptoms in older adults

• This article focuses on children, but older adults may also get liver disease from causes such as alcohol, fatty liver, or hepatitis. Many of the same symptoms apply, but the outlook and treatment can differ.

Causes

Main causes

• Viral infections like hepatitis A, B, or C
• Genetic or inherited conditions, such as cystic fibrosis or alpha-1 antitrypsin deficiency
• Blocked or narrow bile ducts (biliary atresia)
• Autoimmune diseases, where the body's immune system attacks the liver
• Some medicines, poisons, or long periods of poor nutrition

Risk factors

• Being born premature
• A family history of liver disease
• Infection during pregnancy that affects the baby
• Obesity or diabetes in older children (fatty liver disease)

When to see a doctor

See a doctor urgently if:

• If your child's jaundice is getting worse, or they have intense belly pain, repeated vomiting, or a high fever, seek medical help the same day.

Book a routine appointment if:

• If your newborn is still jaundiced after 2 weeks of age
• If your child is losing weight, eating poorly, or always tired
• If urine is dark or stools are pale for more than a day or two
• If you have any worry about your child's liver or digestion

Diagnosis

A doctor will start by asking about your child's health, doing a physical exam, and looking for signs like jaundice or an enlarged liver. If they suspect a liver problem, they will arrange simple tests and may refer your child to a paediatric liver specialist.

Tests that may be done

• Blood tests to check liver enzymes and function
• Ultrasound of the tummy to look at the liver and bile ducts
• Elastography, a scan that checks how stiff the liver is
• A liver biopsy, where a small sample of liver tissue is taken for testing (less common)
• Genetic tests if a hereditary cause is suspected

What to expect at your appointment

Most tests are painless and take only a few minutes. A biopsy is done under anaesthetic, so your child won't feel it. It's normal to feel nervous, but your care team will guide you through every step.

Treatment

Treatment depends on the cause. Some liver problems in children get better on their own with rest and good nutrition. Others need medicine to control symptoms or treat an infection. In rare cases, surgery or a liver transplant may be needed.

Self-care at home

• Give your child plenty of fluids and a balanced diet
• Make sure your child gets enough sleep and rest
• Make sure your child finishes any prescribed medicine exactly as directed
• Keep follow-up appointments even if your child feels well

Medical treatments

Doctors may use antiviral medicines for viral hepatitis, anti-inflammatory medicines for autoimmune liver disease, or medicines to manage itching and other symptoms. In babies with certain metabolic conditions, special formula or supplements may help. No specific medication names or doses are listed here — always ask your healthcare provider what's best for your child.

When is surgery considered?

Surgery is usually only considered if there is a blockage in the bile ducts (for example, biliary atresia) or if the liver fails and a transplant is needed. This is decided by a specialist team.

Living with this condition

Most children with liver disease can go to school, play, and live a normal life. They may need regular check-ups, blood tests, and a special diet. It's important that teachers and caregivers know what to watch for, such as jaundice or extreme tiredness.

Lifestyle tips

• Encourage your child to be physically active, but let them rest when they are tired
• Avoid alcohol and tobacco, especially for teenagers
• Make sure your child is up to date on vaccinations
• Wash hands regularly to avoid infections
• Do not give over-the-counter medicines without asking a pharmacist or doctor, because some medicines can affect the liver

Diet and exercise

A balanced diet is important. Depending on the liver condition, a dietitian may recommend extra calories, vitamins, or changes like less salt or fat. Exercise is usually safe, and even gentle play can help keep energy levels up. Always follow the advice of your child's care team.

Mental health and emotional wellbeing

Living with a long-term condition can feel stressful for both children and parents. It's normal to feel worried, sad, or frustrated at times. Talk to your child's doctor if you notice changes in mood, sleep, or behaviour.

Prevention

Not all liver problems can be prevented, but many can be avoided or managed better. Vaccines protect against hepatitis A and B. Avoiding alcohol, maintaining a healthy weight, and being careful with medicines also reduce risk. Some genetic conditions are picked up by newborn screening.

Vaccines

The hepatitis B vaccine is recommended for all children and helps prevent one of the main viral causes of liver disease.

Screening programmes

Some countries screen newborns for certain inherited liver and metabolic conditions. If you don't know whether your baby was screened, ask your maternity team.

Complications

If left untreated

• Cirrhosis (permanent scarring of the liver)
• Liver failure, when the liver cannot do its job
• Growth and development problems
• Bleeding from veins in the food pipe (varices)
• Impact on brain function (hepatic encephalopathy)

Long-term outlook

This sounds alarming, but the truth is most children with liver problems do very well with the right care. Many conditions are treatable, and with early diagnosis and regular follow-up, most children can grow up healthy and lead full lives. Research is always improving, and your child's team will be with you at every step.

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