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Health Issues

Hepatitis means “inflammation of the liver.” This inflammation can be caused by a wide variety of toxins, drugs, and metabolic diseases, as well as infection. There are at least 5 hepatitis viruses.

  • Hepatitis A is contracted when a child eats food or drinks water that is contaminated with the virus or has close contact with a person who is infected with the virus. Hepatitis A is present in the stool as early as 1 to 2 weeks before a person develops the illness. The infection can be spread in child care settings when caregivers do not wash their hands after changing the diaper of an infected baby or from infant to infant because most very young infants do not wash their hands or have their hands washed for them. This virus also can be spread during male homosexual activity. The incubation period is 2 to 6 weeks.
  • Hepatitis B is spread through the blood and body fluids of an infected person, including through saliva or semen. (Because of the routine screening of donated blood, it is very unlikely that your child will get hepatitis B via a blood transfusion.) The virus can be spread through intimate sexual contact with an infected person or by using nonsterilized needles or syringes for drug use, tattoos, or body piercing. An infected pregnant woman can give the virus to her newborn during the delivery. Person-to-person transmission is uncommon and generally limited to long-term close contact with people with chronic hepatitis B infection. The incubation period is 2 to 5 months.
  • Hepatitis C infections are most often acquired from transfusions of contaminated blood, although your child’s risk of contracting the virus by this route is very low because of routine testing of donated blood. Sexual transmission and transmission among family members through close contact is uncommon. When hepatitis C infections occur in children and teenagers, doctors frequently can’t determine how the virus was acquired. The incubation period is 2 weeks to 6 months.
  • Hepatitis D can be contracted in ways similar to hepatitis B, including through blood, sexual contact, and the use of non-sterilized needles or syringes. Unlike the hepatitis B virus, transmission of hepatitis D from mother to newborn is uncommon. The hepatitis D virus causes hepatitis only in people who already have a hepatitis B infection.
  • Hepatitis E is rare in the United States. When it has occurred abroad, it has been associated with drinking contaminated water.

Hepatitis Viruses

Type

Transmission

Prognosis

A

Fecal-oral (stool to mouth), contaminated food and water

Expect full recovery.

B

Blood, needles, sexual

10% of older children develop chronic infection.
90% of newborns develop chronic infection.

C

Blood, needles; often unclear

Expect chronic infection.

D

Blood, needles, sexual

Makes hepatitis B infection more severe.

E

Traveler: fecal-oral, contaminated food and water

Expect recovery, although pregnant women are at risk for severe disease.

Others

A variety of viruses can affect the liver

Signs and Symptoms

Hepatitis symptoms tend to be similar from one virus type to another. Many of these symptoms are flu like, such as fever, nausea, vomiting, loss of appetite, and tiredness, sometimes with pain or tenderness of the liver in the right upper abdomen. A hepatitis infection is also associated with jaundice, a yellow discoloration of the skin and a yellowish color to the whites of the eyes. This is caused by inflammation and swelling of the liver with blockage and backup of bile (bilirubin) into the blood. This backup also usually causes the urine to turn dark orange and stools light yellow or clay colored.

However, many children infected with the hepatitis virus have few if any symptoms, meaning you might not even know that your child is sick. In fact, the younger the child, the more likely she is to be symptom free. For example, among children infected with hepatitis A, only about 30% younger than 6 years have symptoms, and most of them are mild. Symptoms are more common in older children with hepatitis A, and they tend to last for several weeks.

Children infected with the hepatitis B and C viruses are often free of symptoms or have only a very mild illness.

When to Call Your Pediatrician

If your youngster has developed any of the symptoms associated with hepatitis, including jaundice, or if she has had contact with someone who has hepatitis (eg, in a child care center), call your pediatrician.

How Is the Diagnosis Made?

If your pediatrician suspects that your child has hepatitis, your pediatrician will conduct a physical examination and take a thorough medical history to determine whether your child may be at risk of getting the infection. Your doctor may also order a simple blood test that can determine whether your child is infected with the hepatitis virus and if so, which type.

Treatment

In most cases, no specific therapy is given for acute hepatitis. The child’s own immune system will fight and overcome the infecting virus. Your pediatrician will recommend supportive care for your child, which can include rest, a well-balanced diet, and lots of fluids. Do not give your child acetaminophen without talking to your pediatrician first—there is a risk of toxicity because her liver may not be fully functioning. Your pediatrician may also want to reevaluate the dosages of any other medicines your child is taking. They may have to be adjusted because of changes in the liver’s ability to manage the current dosages.

If a child develops chronic hepatitis B or C, your pediatrician will probably send her to a specialist in gastroenterology or, in some instances, a liver specialist (hepatologist). Medicines such as interferon and ribavirin are used in adults with chronic hepatitis, but there are limited studies of these drugs in children. Your doctor may recommend enrolling your child in a study using these medicines or others.

What Is the Prognosis?

Most children with hepatitis fully recover. The mild symptoms of hepatitis A, for example, tend to resolve on their own within a month or less, and your child will be back to normal. Chronic infections are extremely rare.

Some children with acute hepatitis B, particularly those who have contracted it before 5 years of age, develop a chronic infection. These children can become lifetime carriers of the virus. In certain cases, the chronic liver infection causes progressive damage, leading to scarring (cirrhosis) and liver cancer.

Hepatitis C infections become long lasting in at least half of the children who develop this infection. In adults, chronic hepatitis leads to cirrhosis in 60% to 70% of patients, while in children this is unusual (less than 5%).

Prevention

Vaccines are available to protect children from hepatitis A and B. The hepatitis A vaccine is approved only for youngsters 2 years and older. The hepatitis A vaccines, however, are not recommended for everyone, but should be given to children living in US communities with consistently high hepatitis A rates. Other groups considered high risk, including certain travelers, should also be vaccinated for hepatitis A. When immediate protection is needed following close contact with a person with hepatitis A, your doctor may recommend an injection of immune (gamma) globulin.

The hepatitis B vaccine is part of the recommended series of immunizations given to children beginning at birth. Your child should receive a total of 3 doses of the hepatitis B vaccine.

Although there is no vaccine specifically for hepatitis D, the hepatitis B vaccine should protect against hepatitis D. Hepatitis D cannot develop unless a hepatitis B infection is already present.

To further lower your youngster’s risk of hepatitis, she should practice good hygiene and avoid contaminated food and water. Encourage your child to wash her hands before eating and after going to the bathroom. If she spends time in a child care setting, make sure the staff practices good hand washing behaviors, especially after changing diapers and when preparing and serving food to children.

Before traveling with your child to foreign countries, ask your pediatrician about the risk of exposure to hepatitis and any precautions that your family needs to take. In some cases, your pediatrician may recommend that your child receive the hepatitis A vaccine or an injection of gamma globulin, or both, before traveling abroad. General food precautions for travelers should be observed.

 

Last Updated
6/4/2013
Source
Immunizations & Infectious Diseases: An Informed Parent's Guide (Copyright © 2006 American Academy of Pediatrics)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.