Hepatitis in children has many different origins or causes. A child may contract hepatitis from exposure to a viral source. The following is a list of some of the viruses associated with hepatitis:
- Hepatitis viruses. Five main types of the hepatitis virus have been identified, including hepatitis A, B, C, D and E.
- Cytomegalovirus (CMV). This virus is a part of the herpes virus family that can be transmitted from person to person.
- Epstein-Barr virus (EBV). The virus most commonly associated with infectious mononucleosis.
- Herpes simplex virus (HSV). Herpes can involve the face and skin above the waist, or the genitalia.
- Varicella zoster virus (VZV). Also known as chickenpox, a complication of VZV is hepatitis, although these very rarely cause hepatitis in children or infants.
- Enteroviruses. A group of viruses commonly seen in children such as coxsackie viruses and echoviruses.
- Rubella. Caused by the Rubivirus, rubella is a mild disease that causes a rash.
- Adenovirus. A group of viruses that commonly cause colds, tonsillitis, and ear infections in children. They can also cause diarrhea.
- Parvovirus. A virus referred to as fifth disease, which is characterized by a facial rash that is described as having a “slapped-cheek” appearance.
Autoimmune liver disease can cause hepatitis in children. The body’s immune system develops antibodies that attack the liver causing an inflammatory process that leads to hepatitis.
Other causes include Wilson disease and non-alcoholic steatohepatitis (NASH).
The following are the most common symptoms for hepatitis. However, each child may experience symptoms differently and some children may experience no symptoms at all.
Symptoms of acute (abrupt onset) hepatitis may include the following:
- Flu-like symptoms
- Not feeling well all over
- Nausea and/or vomiting
- Decreased appetite
- Abdominal pain or discomfort
- Joint pain
- Sore muscles
- Jaundice (yellow color in the skin and/or eyes)
- Clay-colored stools
- Dark urine
- Itchy red hives on skin.
Later symptoms include dark-colored urine and jaundice (yellowing of the skin, and eyes). The symptoms of hepatitis may resemble other conditions or medical problems. Always consult your child’s doctor for a diagnosis.
In addition to a complete medical history and examination by your child’s doctor, diagnostic procedures and other tests to determine the extent of the disease may include the following:
- Blood testing for the following:
– Liver enzymes, including ALT and AST to evaluate for inflammation
– Total bilirubin and direct bilirubin to evaluate for excretion
– ALP and GGT to evaluate for obstruction
– Coagulation tests, such as an international normalized ratio (INR) to evaluate for synthetic function
– Hepatitis profile
– Antibody and polymerase chain reaction (PCR) studies (to check for the type of viral hepatitis if present)
– Autoimmune markers.
- Abdominal ultrasound. This diagnostic imaging procedure allows doctors to evaluate the liver and the surrounding structures, including the gallbladder, pancreas and bile ducts and blood vessels more closely. Learn more about ultrasounds.
- Liver biopsy. A small sample of liver tissue is obtained with a special biopsy needle and examined for abnormalities. Learn more about liver biopsy.
Specific treatment for hepatitis will be determined by your child’s diagnosis and health care team based on:
- The child’s age, overall health and medical history
- Extent of the disease
- The child’s tolerance for specific medications, procedures or therapies
- Expectations for the course of the disease
- The family’s opinion or preference.
Treatment for hepatitis varies depending on the underlying cause of the disease. The goal of treatment is to alleviate symptoms and stop damage to the liver that could result in chronic scarring of the liver. Treatment may include one or more of the following:
- Antiviral medications if it is a virus
- Immune drugs if the diagnosis is an autoimmune disease
- Supportive care (healthy diet and rest)
- Medications (to help control itching)
- Maintaining adequate growth and development
- Avoiding alcohol and drugs
- Preventing the spread of the disease (if the cause is viral hepatitis)
- Interferon drug therapy (a medication referred to as a “biologic response modifier” that can affect the immune system and has virus-fighting activities)
- Frequent blood testing (to determine disease progression)
- Hospitalization (may be required in more severe cases)
- Liver transplantation (may be recommended for end-stage liver failure)
- Proactive nutritional support.
Proper hygiene is the key to preventing the spread of many diseases, including hepatitis. Other preventive measures include:
- Vaccinations. Vaccinations are available for hepatitis A and B.
- Blood transfusion. Blood transfusions are routinely screened for hepatitis B and C to reduce the risk of infection.
- Antibody preparation. If a person has been exposed to hepatitis A or B, an antibody preparation (immunoglobulin) can be administered to help protect them from contracting the disease.