Hepatitis A in Children

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KEY POINTS

• Hepatitis A is a viral infection of the liver. When your child has hepatitis, the liver is irritated (inflamed). It may be swollen and tender.
• The main treatment is rest. Recovery from hepatitis A usually takes 4 to 8 weeks. The disease rarely has lasting effects.
• Follow your child's healthcare provider's instructions for taking medicine for symptoms. Your child should not take medicines that can damage the liver.
• A vaccine is recommended for all children over 1 year of age.

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What is hepatitis A?

Hepatitis A is a viral infection of the liver. The liver is one of the largest organs and helps keep your child’s body healthy. Some of the functions of the liver include:

• It helps the body get rid of some medicines and harmful substances.
• It makes bile, which helps the body digest fats.
• It stores glucose (sugar), which the body uses for energy.
• It makes many proteins, which are the building blocks for all cells in the body.

When your child has hepatitis, the liver is irritated (inflamed). It may be swollen and tender.

What is the cause?

Hepatitis A is caused by the hepatitis A virus. The virus is spread by contact with infected bowel movements. Someone who is infected may pass the infection to others by not washing his or her hands, especially after using the bathroom. It is also possible to pass the virus around by not washing hands after changing a diaper or helping a child use the toilet. Sometimes there are outbreaks of hepatitis A at day care centers or restaurants. Your child might also get the virus from:

• Eating food handled by an infected person
• Drinking untreated water or eating food that was grown, washed, or prepared in untreated water

Your child has a higher risk for infection if your child has not had a hepatitis A vaccination and:

• Travels to a country where hepatitis A is common
• Lives or goes to school in an area that has outbreaks of hepatitis A
• Uses illegal drugs
• Is a male who has sex with males
• Has HIV/AIDS

Hepatitis A is usually contagious for 2 to 3 weeks before symptoms appear and for 2 to 3 weeks afterward. During this time, others can be infected by touching anything contaminated with bowel movements of the infected person. The disease can be spread by people, especially toddlers and preschoolers, who do not have any symptoms and may not know they carry the virus.

What are the symptoms?

Symptoms usually appear 2 to 6 weeks after your child is infected with the virus. Sometimes hepatitis A is so mild that there are no symptoms. Most young children who have the virus will not get sick at all. If they are infected, the virus is in their bowel movement and can be passed to others.

If your child has symptoms, the illness usually starts with:

• Feeling tired all the time
• Loss of appetite
• Fever
• General aching

After several days your child may have:

• Nausea and vomiting
• Belly pain, especially just below the ribs on the right side
• Joint pain
• Bowel movements that are whitish or light yellow and may be looser than normal
• Dark urine
• Yellowish skin and eyes (jaundice)

How is it diagnosed?

Your child's healthcare provider will ask about your child's medical history and symptoms and examine your child. Your provider will ask about any recent travel. Your child will have blood tests. If blood tests show that the liver is not working normally, your child may have tests to find out if a virus is causing the problems. The tests will also determine the type of virus causing the infection.

How is it treated?

The main treatment is rest. Recovery from hepatitis A usually takes 4 to 8 weeks. Your child may not have much energy for months. The disease rarely has lasting effects. It usually does not cause permanent liver damage.

Usually your child does not need to stay at the hospital for treatment. If your child loses too much fluid from vomiting or diarrhea, your child may need to go to the hospital to get IV fluids.

Because the infection is caused by a virus, antibiotic medicine will not help.

How can I take care of my child?

Follow the full course of treatment prescribed by your healthcare provider. In addition:

• Your child should avoid taking medicines that can damage the liver such as acetaminophen. Ask your child’s provider which medicines are safe for your child.
• Your child will need to get plenty of rest while healing. As the symptoms get better, your child may slowly start being more active. It’s best to avoid a lot of physical exertion until your child's healthcare provider says it's OK.
• Give your child small, high-protein, high-calorie meals, even when your child feels nauseated. Ask your provider if you are not sure which foods these are. Sipping soft drinks or juices and sucking on hard candy may help your child feel less nauseated. Your child should not drink any alcohol.
• For an older child, advise your teen to avoid sexual contact with others until your teen’s provider says it’s OK. Teach an older teenager to practice safe sex. Teach your teenager to use latex or polyurethane condoms the right way during foreplay and every time he or she has vaginal, oral, or anal sex, and to have just 1 sexual partner who is not sexually active with anyone else and who will use protection every time your teen has sex.

Ask your provider:

• How and when you will get your child’s test results
• How long it will take for your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

How can I help prevent hepatitis A?

A vaccine is recommended for all children over 1 year of age. Two shots are given 6 to 18 months apart. If your child is traveling to an area where hepatitis A is common, the hepatitis A vaccine is very important. It’s best for your child to get both shots before starting the trip. This means getting the first shot at least 7 months before the trip and then the second shot 6 months later. If you don't have that much time before your child leaves, be sure your child gets at least one shot 2 weeks or more before the trip.

Some states and counties now require proof of immunization for school or preschool entry. Ask your child’s healthcare provider if your area requires the hepatitis A vaccine.

If your child has not had hepatitis A shots and has been exposed, your child may be given the hepatitis A vaccine or may be given a shot of immune globulin. Immune globulin may not always prevent hepatitis A, but it may help to make it milder. The protection starts almost right away but lasts for just 2 to 4 months.

If your child has an active hepatitis A infection or if you think your child may have been exposed to hepatitis A, make sure your child always washes his or her hands thoroughly after using the restroom. This will help prevent spread of the disease to others.

If someone in your household has hepatitis:

• Ask your healthcare provider if others in the household need to get a hepatitis or immune globulin shot.
• Wear disposable gloves if you must have contact with the sick person's bowel movements, body fluids, clothing, towels, or bed linens. This includes bathing your child or changing your child’s diaper.
• Wash the infected person's clothing and bed linens separately from other laundry. Use hot water and a strong detergent.
• Clean toilets, diaper changing pads or surface, and other bathroom surfaces with a disinfectant. Wear gloves when you clean. If possible, it's safest to have the infected person use a different bathroom from everyone else in the household for about 1 month after they first got sick.

For more information, contact:

• American Liver Foundation
  800-465-4837
  https://liverfoundation.org/