Pediatric Hepatitis

Hepatitis is an inflammation of the liver. It can damage and destroy liver cells.

Hepatitis in children can be caused by many things. Your child can get hepatitis by being exposed to a virus that causes it. These viruses can include:

• Hepatitis viruses. There are 5 main types of the hepatitis virus: A, B, C, D and E.
• Cytomegalovirus. This virus is a part of the herpes virus family.
• Epstein-Barr virus. The virus causes mononucleosis.
• Herpes simplex virus. Herpes can affect the face, the skin above the waist or the genitals.
• Varicella zoster virus (chickenpox). A complication of this virus is hepatitis. But this happens very rarely in children.
• Enteroviruses. This is a group of viruses often seen in children. They include coxsackieviruses and echoviruses.
• Rubella. This is a mild disease that causes a rash.
• Adenovirus. This is a group of viruses that causes colds, tonsillitis, and ear infections in children. They can also cause diarrhea.
• Parvovirus. This virus causes fifth disease. Symptoms include a slapped-cheek rash on the face.

Conditions can also cause hepatitis in children. These can include autoimmune liver disease. For this disease, your child’s immune system makes antibodies that attack the liver. This causes inflammation that leads to hepatitis. Medicines can also cause hepatitis. Any medicine that is broken down by the liver can lead to inflammation of the liver if taken for a long period of time or in large quantities. Occasionally, metabolic problems such as diabetes and obesity can lead to a fatty liver and hepatitis in children (called MASH, metabolic associated steatohepatitis).

Children who are exposed to a virus that causes hepatitis are more likely to get hepatitis.

Hepatitis A

This form of the virus is passed through fecal-oral contact. It’s spread to children in the following ways:

• Eating food made by an infected person who didn’t wash their hands well after using the bathroom
• Drinking water that is contaminated by infected feces. This is a problem in developing countries.
• Touching an infected person's feces or dirty diaper and then putting your hands near your mouth. Outbreaks may happen in child-care centers.
• International travel to areas where hepatitis A is common
• Using illegal drugs
• Blood transfusions (very rare)

Hepatitis B

Hepatitis B is spread when blood from an infected person enters another person's body. It can be spread through needlesticks and sharp instruments. It can also be spread by sharing personal items, such as razors and toothbrushes.

Babies may catch the virus during pregnancy if their mother has the virus. Children can spread it to others through household contact or through scrapes or cuts.

The following children are at risk for hepatitis B:

• Children born to mothers with hepatitis B
• Children born to mothers who have come from a country where hepatitis B is widespread. These include Southeast Asia and China.
• Children who live in long-term care facilities or who are disabled
• Children who live in households where someone is infected with the virus
• Children who have a blood-clotting problem and need blood products. This can include hemophilia.
• Children who need dialysis for kidney failure
• Teens who do high-risk activities. These include IV (intravenous) drug use and unprotected sex.

Hepatitis C

Hepatitis C passes through infected blood. It can also be passed through sexual contact. Moms can also pass it to their babies during pregnancy. The following children are at risk for hepatitis C:

• Children born to mothers who have the virus
• Children who have a blood clotting problem, such as hemophilia
• Children who need dialysis for kidney failure
• Teens who do high-risk activities. These include IV (intravenous) drug use and unprotected sex.

Hepatitis D

This type of hepatitis can only happen with hepatitis B. Hepatitis D can happen at the same time your child is infected with hepatitis B, or it can start later.

Hepatitis D can't be spread from a mom to her baby during pregnancy. This condition is rare in children born in the U.S. This is because the hepatitis B vaccine is given to babies. Hepatitis D only happens in people already infected with hepatitis B.

Hepatitis E

This form of hepatitis is like hepatitis A. It’s spread through fecal-oral contact. Hepatitis E is most common in developing countries. It’s rare in the U.S.

Symptoms can happen a bit differently in each child. Some children don’t have any symptoms.

Symptoms of sudden (acute) hepatitis may include:

• Flu-like symptoms
• Yellowing of the skin or the whites of the eyes (jaundice)
• Fever
• Nausea or vomiting
• Loss of appetite
• Not feeling well and fatigue
• Stomach pain or discomfort
• Diarrhea
• Joint pain
• Sore muscles
• Itchy red hives on the skin
• Clay-colored stools
• Dark-colored urine

The symptoms of this condition may look like symptoms of other health problems. Make sure your child sees their healthcare provider for a diagnosis.

Your child’s healthcare provider will check your child's health history. The provider will also give your child a physical exam. Your child will also need other tests.

Blood Testing

Your child’s healthcare provider may do blood tests for the following:

• Liver enzymes
• Liver function
• Antibody and polymerase chain reaction. This is to check for the type of hepatitis.
• Cellular blood counts
• Coagulation tests. These include international normalized ratio.

CT Scan

A CT scan shows detailed images of any part of the body. This test will show your child’s bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

Ultrasound

Ultrasound uses sound waves to examine parts of the body. It's very effective in examining the liver.

MRI

This test uses large magnets, radio waves, and a computer. Together, these show detailed images of organs and structures inside your child’s body.

Liver Biopsy

Your child’s healthcare provider may take out a tissue sample from your child’s liver. Then they may look at it closely under a microscope.

Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Your child’s treatment will depend on what’s causing their hepatitis. The goal of treatment is to stop damage to your child’s liver. It’s also to help ease symptoms. Your child’s treatment may include:

• Medicines. These can control itching, treat the virus, or control an autoimmune disease. 
• Supportive care. This includes eating a healthy diet and getting enough rest. Weight loss if the child is obese or overweight, and treating underlying conditions such as diabetes.
• Reducing risk. This includes not using alcohol or illegal drugs.
• Blood testing. This can tell if the disease is progressing.
• Hospital stay. This is done in severe cases.
• Liver transplant. This is done for end-stage liver failure.
• Helping to prevent the spread of viral hepatitis. This includes having good personal health (hygiene) habits, such as handwashing.
• Infants born to a mother with Hepatitis B will get the Hepatitis B vaccine and immune globulin

The main complications of hepatitis include liver failure, liver cancer or death. This is more likely with hepatitis B or C.

Work with your child’s healthcare provider to create a care plan for your child. If your child has chronic hepatitis, they will need to get plenty of rest, eat a healthy diet and take medicines as prescribed.

Call your child’s healthcare provider if your child has symptoms of hepatitis, such as jaundice. You should also call if your child is exposed to viruses that can cause the disease.