Cause
This inflammation of the liver is usually caused by infection with one of three hepatitis viruses: hepatitis A virus (HAV), hepatitis B virus (HBV), or hepatitis C virus (HCV). Viral hepatitis can also occur with cytomegalovirus (CMV), Epstein-Barr virus (the virus that causes infectious mononucleosis), and other viral infections.
Symptoms
In the early stages of the illness, flulike symptoms are common in hepatitis A and hepatitis B and less frequent (less than 25 percent of cases) in hepatitis C. Symptoms may be very mild or may not occur in many children. These may include fever, malaise, muscle aches, loss of appetite, nausea, vomiting, and diarrhea. Jaundice (yellowing of the skin and whites of the eyes) may or may not occur in children with these infections. Tenderness over the swollen, inflamed liver (right upper abdomen) or swollen spleen (left upper abdomen) may be present. The urine may become dark (“tea-colored”), and the stools may become white or “clay-colored.”
How It Spreads
Hepatitis A infection occurs when a person touches or eats anything that has been contaminated with HAV-infected stool, such as water, milk, and foods (especially shellfish from sewage-contaminated waters). It spreads easily in overcrowded or unsanitary conditions and among young children who may not be suspected of having the illness because of mild or absent symptoms. Hepatitis B spreads through infected body fluids including blood, saliva, semen, vaginal fluids, breast milk, and urine.
Infected infants usually have acquired the virus during the birth process from their HBV-carrier mothers. Hepatitis C usually spreads to children through transfused blood products, particularly with repeated blood product exposure as with chronic hemodialysis in a child with kidney failure. The virus may be passed from mother to infant, especially if the mother is also infected with HIV.
Incubation Period
The incubation period for hepatitis A is 2 to 6 weeks; for hepatitis B, it’s one to five months; for hepatitis C, it’s 2 to 26 weeks.
How Long Symptoms Last
Almost all previously healthy children with hepatitis A infection will recover fully within a few weeks or months. If symptoms develop with hepatitis B infection, they usually subside within six to eight weeks, but chronic infection with the virus can occur and can lead to liver damage and liver cancer.
Chronic infection with the virus is particularly common (70 to 90 percent) in infants who acquire the infection from their mothers at birth and are not treated. Children with hepatitis C usually have no symptoms but are at risk for future liver damage due to chronic infection with the virus.
When to Call Your Child’s Doctor
Your child’s doctor should be called for any child who develops jaundice or the other symptoms of hepatitis described earlier or whobecomes very drowsy or confused. Also contact the doctor if your child has had contact with others with viral hepatitis or if your child will be traveling to an area where hepatitis infection is common.
How the Diagnosis Is Made
The doctor suspects the diagnosis based on the child’s symptoms; inflammation of the liver and infection with a specific hepatitis virus can be detected by blood tests.
Treatment
Children with hepatitis who develop symptoms typically need no specific treatment other than specific supportive care—plenty of rest and adequate fluid intake to prevent dehydration. In a child with a poor appetite due to hepatitis, offering smaller, more frequent meals and fluidsthat are high in calories (like milk shakes) may help ensure that the child receives adequate nutrition while recovering. Some children whose symptoms are more severe may require hospitalization to receive IV fluids and other treatment.
Prevention
The risk of exposure to hepatitis A can be reduced by following good hygiene—including hand washing—and avoiding crowded, unsanitary living conditions or drinking or swimming in contaminated water. Shellfish from sewage contaminated waters should not be eaten. If someone in the household develops hepatitis, antiseptic cleansers should be used to clean any toilet, sink, potty chair, or bedpan used by that person.
A hepatitis A vaccine is available, and it is recommended for children traveling to areas of the world where the risk of exposure to the virus is high. The staffs of child-care facilities, family members of infected persons, and sexual partners of someone with the infection are also candidates to receive the vaccine. Giving immune globulin within one to two weeks after exposure to the virus can prevent illness from developing in 80 to 90 percent of individuals.
Hepatitis B infection from transfusions is very rare in the United States today because blood products are screened for the presence of the virus. Hepatitis B vaccine is now recommended for routine immunization of all infants and for adolescents who didn’t receive the vaccine in infancy. Hepatitis B infection in infants and young children is usually the result of transmission of the disease at birth by an infected mother who carries the virus.
Pregnant women should be screened for the virus, and if a woman is found to be a carrier, her infant should be given a dose of hepatitis B immune globulin (HBIG) at birth, followed by the recommended doses of the vaccine. In the United States, blood and plasma donors are screened for HCV infection. At present, there is no vaccine for the prevention of hepatitis C.
Complications
Although children with HAV infection almost always recover fully without specific treatment, children with chronic HBV and HCV infections are at increased risk for the development of liver damage (cirrhosis), liver failure, and liver cancer as they get older. It is important that these individuals be followed medically for signs of these complications. New drugs, such as interferon alpha, may be helpful in some cases, and patients who develop liver failure may receive liver transplants.