What Do Hepatitis Symptoms Look Like in Children?

Health & Wellbeing

The C.D.C. issued an alert after clusters of severe hepatitis cases popped up among children around the globe. What signs should parents watch out for?

The Centers for Disease Control and Prevention issued an alert on Thursday to physicians nationwide notifying them of a cluster of severe and unexplained hepatitis cases in otherwise healthy young children.

Between October 2021 and February 2022, nine children between the ages of 1 and 6 in Alabama were admitted to the hospital with acute hepatitis; two required liver transplants.

Similar cases have also popped up in North Carolina, as well as in Europe. The U.K. Health Security Agency has reported more than 100 cases of sudden-onset hepatitis in children under 10 since January 2022, 10 of whom required liver transplants.

Here’s what we know about these hepatitis cases, and what symptoms parents should watch for.

Hepatitis is a broad term used to describe inflammation of the liver, an organ that carries out hundreds of essential functions every day, from aiding digestion to clearing toxins from the blood. When the liver is inflamed or damaged, it is unable to perform many of those tasks.

“Acute” hepatitis refers to inflammation that comes on relatively quickly and does not last more than six months. It can be severe and lead to liver failure, as was the case with several children in Alabama. But hepatitis can also be relatively mild. It’s not uncommon for patients — particularly children — to have liver inflammation in the course of a simple, uncomplicated viral illness, explained Dr. Alexander Weymann, director of the Liver Center at Nationwide Children’s Hospital in Columbus, Ohio.

Hepatitis symptoms are wide-ranging and overlap with many common illnesses. A child with hepatitis may experience fever (low-grade or more significant), fatigue, joint or muscle pain, loss of appetite or nausea, diarrhea and vomiting.

Children may also have abdominal pain or tenderness, particularly in the right upper abdomen, which is where the liver is located, Dr. Weymann said, and it is important to seek urgent medical attention any time a child shows sign of severe pain when their abdomen is touched. Doctors may consider other possible causes of abdominal pain, like appendicitis. Some children may have darker urine, or pale or clay-colored stools.

Jaundice, or yellowing of the skin and eyes, is a hallmark sign of hepatitis — although it is possible to have significant liver inflammation and show no signs of jaundice.

“The first change is in the eyes: The white part begins to look yellow,” Dr. Weymann said.

He noted that it can be more difficult to detect jaundice in children who have darker skin, so parents should take even subtle changes in tone seriously.

“Typically, one won’t see ‘dramatic’ jaundice until the inflammation or dysfunction of the liver has progressed quite far already,” Dr. Weymann said.

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Hepatitis can have many causes, from autoimmune disease to side effects of certain medications. Most often, it is caused by one of the five hepatitis viruses (hepatitis A, B, C, D and E). Depending on the type, viral hepatitis can spread through contact with blood and other bodily fluids or fecal matter, or by consuming raw or undercooked meats. But viral hepatitis has been ruled out in the recent pediatric clusters in the United States and abroad.

Instead, the C.D.C. suspects that the adenovirus is causing the current cases, though health officials caution that the investigation is ongoing. There are more than 50 types of adenoviruses, which tend to cause mild illness, such as colds and fevers, pink eye or vomiting and diarrhea.

In Alabama, all nine children tested positive for adenovirus. And of the five cases that were genetically sequenced, all had adenovirus type 41, which typically causes vomiting and diarrhea. A majority of the affected children in Britain, though not all, tested positive for adenovirus as well.

“It’s interesting that we’re really only seeing this in children less than 10 years, meaning that most people over 10 have immunity to adenovirus, and that may be why this hepatitis is showing up in young children,” said Dr. Jennifer Lighter, a pediatric infectious diseases specialist and hospital epidemiologist with N.Y.U. Langone Health in New York City.

But doctors and health officials have known that adenovirus infection can cause liver inflammation. That’s not new. What is unusual is for otherwise healthy young children to become so suddenly ill, which is why public health officials are spreading the word and continuing to probe other possible underlying causes.

Although health officials are not certain the adenovirus is causing the recent hepatitis clusters, parents can take steps to prevent transmission. Adenovirus spreads from person to person through respiratory droplets or through touching a surface with adenovirus on it. Children should be encouraged to wash their hands often and avoid touching their face and mouth to the extent it is possible — many of the same measures that help prevent the spread of Covid.

Parents should also remember that the C.D.C. alert is not a call for action or alarm. The overall risk of an otherwise healthy child suddenly developing severe hepatitis remains extremely low. Health officials simply want to alert pediatricians and other health care providers who may see young patients with hepatitis that they should now screen for adenovirus.

Treatment varies based on the type of hepatitis that a child has. For some types of viral hepatitis, there are drugs that can suppress or eliminate the virus, Dr. Weymann said. But for the vast majority of cases — like when a child comes in with liver inflammation and adenovirus — doctors focus on preventing or managing complications.

“That usually is sufficient, since the liver is really good at healing itself,” he added.

If you have concerns about symptoms like lethargy, pain or changes in skin or eye tone, reach out to your child’s pediatrician for an immediate evaluation, said Dr. Mobeen Rathore, chief of infectious diseases and immunology at Wolfson Children’s Hospital in Jacksonville, Fla.

“Parents notice what their kids look like all the time. That’s what we do,” Dr. Rathore said. “I don’t believe that if a child’s skin color changes that a parent is going to say, ‘Oh, that’s OK, let’s wait and see what happens tomorrow.’”

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