Hepatitis in Children: Symptoms, Causes, Diagnosis, Treatment

Hepatitis is a general umbrella term used to describe inflammation of the liver. Inflammation of the liver can be caused by many reasons, including viruses (viral hepatitis), drugs, chemicals, genetic disorders, alcohol, or even due to an overactive immune system that attacks the liver (autoimmune hepatitis). Depending on the cause of hepatitis, it can either be chronic, which is a long-term condition that produces less obvious symptoms but causes progressive liver damage, or acute hepatitis, which flares up suddenly and then goes away.

Worldwide, the Centers for Disease Control and Prevention has been looking at hundreds of causes of hepatitis. In May 2022, at least 228 cases of hepatitis in children were detected in a mysterious outbreak of hepatitis globally.⁽¹⁾ The cases detected in the US led to hospitalization for most of the children, five deaths, and multiple liver transplants.

It should be noted that hepatitis is not a common disease in children, and according to the World Health Organization (WHO) reported that children affected by hepatitis range from the age group of one month to 16 years.⁽²⁾ As per experts, this is a worrying trend because there is still no clear cause that has been identified as causing hepatitis in children.

While more research is still needed, here are some of the main signs and symptoms of hepatitis in children, its causes, and treatment option.

The term hepatitis means inflammation of the liver. This can be caused due to a number of reasons, including viruses, certain medications, toxins, alcohol use, and certain medical conditions as well.

There are many ways in which you can get hepatitis, including:

Toxic hepatitis, which is caused by drinking a lot of alcohol, taking certain medicines or illegal drugs, or being exposed to certain chemicals or poisons.

Viral hepatitis, which is the most common form of hepatitis in most countries. The common hepatitis viruses include hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV).⁽³⁾ Though these viruses differ from one another, the one thing in common between them is that they cause infection and inflammation of the liver.

The starting symptoms of hepatitis in children can be vague and confusing. They can also be attributed to a variety of other things. These symptoms may include nausea, vomiting, loss of appetite and fever. As hepatitis progresses, other symptoms start showing up, including light-colored stool and dark urine. Some of the more serious symptoms include jaundice, which is the yellowing of the whites of the eyes and skin.

As hepatitis progresses, the inflammation of the liver gets more severe, and then you start to see the more unique symptoms of the disease. This includes a yellowish color on the skin and the whites of the eyes turning yellow. It is usually also accompanied by dark urine and light-colored stools. It is important to remember that the symptoms of hepatitis are typically vague until the inflammation progresses and the symptoms get more severe.^{(4, 5, 6, 7)}

In children, hepatitis A is the most common form of hepatitis to develop. The hepatitis A virus lives in the feces of people who have been infected. This is why it is very important to ensure that your children make a habit of washing their hands after going to the bathroom and before eating. It is also possible for fruits, vegetables, and even shellfish like lobster and shrimp to carry the hepatitis virus if they were harvested in unsanitary conditions or in contaminated water. Hepatitis A, though, tends to affect people only for a short time, and once they recover, the virus does not re-infect the person.⁽⁸⁾

While hepatitis causes only short-term illness that clears up completely, hepatitis B and C can transform into severe long-term diseases in some people. Teenagers and young adults are at the greatest risk of contracting these hepatitis viruses.

Hepatitis B and C are known to be contagious, and they can get passed from one person to another in the same ways that HIV does – that is, through direct contact with infected bodily fluids. Hepatitis B and C are passed on even more easily through needles and fluids as compared to HIV. It can also happen through sexual intercourse and by sharing needles to inject illegal drugs that have been contaminated with infected blood. It is important to know that even if the infected person does not show any symptoms, they are still able to pass on the virus to others.^{(9, 10)}

In some cases, mothers who are infected with hepatitis B or C can pass on the virus to their babies at the time of birth. Hepatitis B and C also get passed in some unexpected ways, such as getting a manicure or pedicure with dirty nail clippers or other unsanitary instruments. You can also get hepatitis B or C while getting a tattoo with a contaminated needle.

Parents do not need to be overly concerned about their children contracting hepatitis. However, if your child is unable to keep any fluids down or you find that any flu-like or cold symptoms are not getting better, you should contact their pediatrician. Parents also need to let their pediatrician know at the earliest if they spot signs of light-colored stool, dark urine, or jaundice.⁽¹¹⁾

Some children with hepatitis may show no symptoms of having the disease. Others may also experience some other symptoms, apart from light-colored stool and dark brown urine, like:

• Belly pain, especially on the upper right hand side of the abdomen
• Flu-like symptoms, including feeling hot, vomiting, cold, etc.
• Feeling excessively fatigued
• Loss of appetite for several days
• Unexplained weight loss

If a doctor suspects that your child may have some form of hepatitis, they will begin the diagnosis by asking questions like the following:

• Has the child been around anyone who works in childcare or healthcare?
• Does any of the family members have hepatitis?
• Did the child undergo a blood transfusion as a baby?
• Did the child come in contact with the bodily fluids of someone who is or has been infected?
• Did the child get a tattoo with a dirty needle?
• Did the child inject themselves with a dirty needle?
• Could the child have eaten food that was contaminated with hepatitis A?

The doctor will also order a blood test to check if the child has hepatitis and, if yes, then which type of hepatitis. Only then will the appropriate treatment be started.

A child with hepatitis needs to drink plenty of fluids, eat nutritious food, and also get an ample amount of rest. The family members may also need to get hepatitis vaccines if they have not already gotten them. To prevent infection, children should be vaccinated against hepatitis A and B. There are no vaccines available against hepatitis C or the more rare types of hepatitis D and E. It is important to note that there is no cure for hepatitis.⁽¹²⁾

Treatment for hepatitis focuses on preventing further damage to the liver while trying to also reverse any existing damage if possible and provide relief from the symptoms. Most cases of acute hepatitis tend to resolve with time. In cases of autoimmune hepatitis, though, the child may need to take certain medications to help keep the overactive immune system under control and prevent further attacks and damage to the liver.⁽¹³⁾

At a later stage, your child will need to get some follow-up blood tests. Usually, these blood tests indicate that the child no longer has hepatitis. Sometimes, though, the blood tests may show that the person is now a carrier of hepatitis, but they may not have the active symptoms of hepatitis anymore. However, they can still pass on the infection to other people.⁽¹⁴⁾

Sometimes blood tests may continue to show that certain people may still have hepatitis B or C, which indicates that they now have chronic or long-lasting hepatitis. In this case, they need to continue having a healthy diet and take good care of themselves by taking rest, getting enough sleep, and having regular visits with their doctor. In some cases, people might need special medication to maintain their chronic hepatitis.

Since the cause of hepatitis is still not clearly known, it becomes difficult to determine how to prevent this disease. However, medical experts believe that if hepatitis is caused by adenovirus, then typical cold and flu prevention is the most helpful strategy to follow. Practicing good hand hygiene, staying away from anyone who you know has hepatitis or someone who could be ill, avoiding getting tattoos from suspicious parlors, and maintaining proper hygiene in other areas of life as well can help your child stay protected from hepatitis.

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