This liver inflammation is caused by a viral infection. The viruses responsible for the most common types of hepatitis (hepatitis A and hepatitis B) were identified some time ago. Other types of hepatitis (C, D and E) have been identified recently. These types are uncommonly associated with disease in children.
Hepatitis A is a less serious disease than hepatitis B, which can become chronic and gradually lead to liver failure. Both infections, however, can follow a rapidly progressive course, destroying the liver and resulting in death.
In 1992, the American Academy of Pediatrics began recommending routine hepatitis B immunization for all children. The vaccine, which was formerly reserved for people in high-risk groups, is given in the first few days after birth, with boosters between one and two months of age and again between six and 18 months of age.
HOW DOES HEPATITIS DEVELOP?
The hepatitis A virus commonly passes from person to person when infected fecal material contaminates food or water. Careless diaper changing and lax hand washing practices promote the spread of the disease, as does poor public sanitation. Some outbreaks of hepatitis A have been traced to consumption of contaminated shellfish. Hepatitis B is passed in infected blood and (perhaps) other body fluids, which can enter the body through the mucous membranes of the mouth and genital tract, as well as through cuts, scrapes, blood transfusions and use of contaminated needles. Hepatitis B also can be passed from an infected mother to her baby during birth or gestation.
Both viruses have a fairly long incubation period—about 25 days for hepatitis A and three months for hepatitis B. During this period, an infected person can spread the virus even though symptoms are not yet present. In addition, some people with hepatitis B infection become chronic carriers of the virus. Although they recover from the initial illness, they continue to pass the disease to others.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS HEPATITIS?
In many cases, you will know if your child has been exposed to hepatitis. If someone in the child's day care or preschool comes down with hepatitis, the teacher or school nurse will inform you and let you know what symptoms to watch for.
The initial signs and symptoms of hepatitis A—chiefly, nausea and vomiting—can come on suddenly, while hepatitis B tends to develop more gradually. Fever may occur in both infections but is more common in hepatitis A. Hepatitis B, by contrast, often causes aching joints and widespread itching, symptoms not usually associated with hepatitis A. Tenderness in the area of the liver (the upper, right portion of the abdomen) is common in both hepatitis A and hepatitis B.
The hallmark of both infections is jaundice, a yellowing of the skin and whites of the eyes caused by the buildup of bilirubin, a pigment normally excreted by the liver. Jaundice typically develops at about the time symptoms begin to fade—about five to seven days after their onset. At about the time when jaundice develops, the stools become pale and the urine darkens.
Hepatitis A may not produce jaundice in small children, so it sometimes goes undiagnosed or is mistaken for viral gastroenteritis.
IS MEDICAL ATTENTION NECESSARY?
Yes. Any time a child becomes jaundiced, a visit to the pediatrician is in order. Other symptoms of hepatitis also warrant medical investigation, especially if they last more than one or two days.
HOW CAN THE PEDIATRICIAN TELL IF MY CHILD HAS HEPATITIS?
If the usual signs and symptoms are present, the doctor may order a blood test to measure antibodies to the virus. Tests of liver function, also performed on a blood sample, also may be needed.
WHAT TREATMENTS ARE AVAILABLE?
Rest, fluids and an easily tolerated diet are the only treatments for hepatitis. If a child is severely dehydrated, he might be admitted to the hospital for administration of intravenous fluids. In most cases, complete recovery takes about a month, although some children have mild relapses a few months later.
PREVENTING HEPATITIS
• Wash all fruits and vegetables thoroughly before eating them.
• Always wash hands after changing diapers or using the bathroom.
• Always wash hands before handling food.
• Children should get a shot of gamma globulin (protective antibodies) if exposed to hepatitis.
• Have all children and other family members immunized against hepatitis B.
