Just because kids have youth on their side doesn’t mean they are immune to liver disease. Dr. Flora Szabo, one of our gastroenterologists, answers these 6 questions about the common causes of liver disease in kids and the warning signs.
What can cause liver disease in kids?
The causes vary quite a bit depending on age. Liver disease in infants is often the result of a metabolic, genetic, congenital or autoimmune condition. Infections can also impact the liver in young children. In older children and teenagers, metabolic dysfunction–associated steatotic liver disease (MASLD, previously called fatty liver disease) has become one of the most common chronic liver diseases, particularly in children with obesity, insulin resistance or type 2 diabetes.
What symptoms are associated with pediatric liver disease?
Liver problems are often first suspected in routine lab work and don’t always have physical symptoms. When symptoms do occur, children may experience:
- Persistent fatigue
- Poor appetite
- Nausea
More concerning signs include:
- Yellowing of the skin or eyes (jaundice)
- Dark urine
- Unusually pale or gray stools
- Persistent itching
- Poor growth
In newborns or young infants, persistent passage of pale or white stools could indicate obstruction of bile flow.
How does liver disease impact a child’s body?
The liver does much more than process food. It also:
- Helps regulate blood sugar and cholesterol
- Processes medications and toxins
- Produces proteins needed for blood clotting
- Makes bile to help absorb fats and vitamins
- Plays an important role in immunity
Chronic liver disease can therefore affect the entire body. Children can develop:
- Poor growth
- Nutritional deficiencies
- Problems absorbing fat-soluble vitamins (A, D, E and K)
- Abnormal bleeding
- Enlarged liver or spleen
- Scarring of the liver called fibrosis
- Cirrhosis
How can liver disease be treated once it’s detected?
Treatment depends on the cause, which is why establishing the correct diagnosis is so important. Evaluation may include blood tests, ultrasound or other imaging, genetic testing, and sometimes specialized tests such as elastography or liver biopsy.
Some conditions can be treated very effectively. Autoimmune hepatitis, for example, can often be controlled with medications that suppress the abnormal immune response. Wilson disease can be treated by reducing copper accumulation. Nutritional deficiencies can be corrected. Medication-related liver injury may improve after the responsible medication is discontinued.
For children with MASLD, treatment focuses primarily on improving metabolic health through nutrition, physical activity, healthy weight management and treatment of associated conditions such as diabetes, high cholesterol or high blood pressure. Some adolescents may also benefit from medications targeting obesity or diabetes.
Children with advanced or irreversible liver disease may ultimately require a liver transplant, although this represents only a small number of children with liver disease.
How does liver disease in children differ from liver disease in adults?
There is considerable overlap, but children have some important differences. Adults commonly develop liver disease from long-term metabolic disease, alcohol-related liver injury, chronic viral hepatitis and medications.
Children are much more likely to have genetic, metabolic, congenital or developmental disorders that may never occur in adults. Pediatric liver specialists also have to consider something adults don't: growth and development. Liver disease and its treatments can affect nutrition, puberty, bone development and normal growth.
At the same time, the increasing prevalence of childhood obesity means that some diseases traditionally associated with adults—particularly MASLD and type 2 diabetes—are now increasingly encountered in preteens and teens.
What else should parents know?
Perhaps the most important message is that abnormal liver tests do not necessarily mean that a child has permanent liver damage. The liver has a remarkable ability to recover, particularly when the underlying problem is identified early.
For many pediatric liver diseases, early diagnosis can substantially change the long-term outcome. The goal is not simply to normalize a laboratory number—it is to identify the cause, determine whether there is inflammation or fibrosis, treat the underlying disease and protect the child's liver for decades to come.