Hepatitis B in Children: Symptoms and Treatment

What Is Hepatitis B?

Hepatitis B (HBV) is a liver disease caused by the hepatitis B virus. Most hepatitis B infections clear up within one to two months without treatment. When the infection lasts more than six months, it can develop into chronic hepatitis B, which can lead to chronic inflammation of the liver, cirrhosis (scarring of the liver), liver cancer, and/or liver failure.

The hepatitis B virus is spread through contact with body fluids of an infected person, such as blood, semen, vaginal fluids, and saliva. Unlike the hepatitis A virus, hepatitis B virus is not spread through contaminated food or water. Hepatitis B can be passed on through sexual contact or needle-sharing/accidental needle sticks, but children with hepatitis B more likely contracted it through:

  • Being born to a mother who has hepatitis B (It is very important that all pregnant women get a blood test for hepatitis B early in their pregnancy, since a woman who has hepatitis B can spread the virus to her baby during birth.)
  • Living in the same house with someone who is infected with hepatitis B, and sharing items such as toothbrushes or razorblades
  • Receiving multiple transfusions of blood or blood products, as hemophiliacs do (risk is greatly reduced with careful blood screening)
  • Being bitten so that the skin is broken by someone whose saliva contains the hepatitis B virus
  • Being a hemodialysis patient

Hepatitis B Symptoms in Infants and Children

The hepatitis B virus mainly affects the liver, and enters the liver cells (called hepatocytes) when in the body. Reproduction of the virus causes death of these cells. The sudden death of a large number of liver cells can cause liver damage or even liver failure.

In most children with hepatitis B, this does not happen. Instead, the virus multiplies slowly and persists in the body, causing slow but progressive liver damage. This state is known as the chronic carrier state; even though the person has hepatitis B in his or her liver and blood, there are no signs of disease. A chronic carrier can still pass the disease on to others, even if he or she has no symptoms. Most children who acquire the infection at birth or soon after become chronic carriers. In contrast, adults who get the infection have an acute illness, followed by clearance of the virus.

Symptoms usually appear within 25 to 180 days following exposure to HBV. The most common symptoms are:

  • Yellowing skin and eyes (jaundice)
  • Fatigue that lasts for weeks or even months
  • Abdominal pain in the area of the liver (upper right side)
  • Loss of appetite
  • Nausea
  • Vomiting
  • Joint pain
  • Low-grade fever
  • Dark urine and light-colored stool
  • Widespread itching
  • Rash

Hepatitis B Diagnosis

The doctor will ask about your child's symptoms and medical history, and perform a physical exam. Hepatitis B is diagnosed with blood tests, which are also used to monitor its effects on the liver. For chronic cases, a liver biopsy may be needed. A biopsy is the removal of a sample of liver tissue for testing.

Hepatitis B Treatment

Hepatitis B symptoms can usually be treated with medication. Patients with uncomplicated cases can expect to recover completely. Patients with chronic hepatitis B are treated with medication to reduce the activity of the virus and prevent liver failure. Medications include:

  • Interferon alfa-2b (Intron A) injection
  • Lamivudine (Epivir-HBV) oral medication

Cronic hepatitis B patients should avoid anything that can further injure the liver, such as alcohol, certain medications, dietary supplements, and herbs (discuss these substances with your child's doctor).

In rare cases where the liver damage caused by hepatitis B is life-threatening, a liver transplant may be needed.

Hepatitis B Prevention and Vaccinations

It is important for children to receive hepatitis B vaccinations. This consists of three injections over a six-month period. Protection is not complete without all three injections.

If you are pregnant, have a blood test for hepatitis B. If you are diagnosed as positive, you should be sure that your baby gets a shot called H-B-I-G and the first dose of hepatitis B vaccine within 12 hours of birth. Your baby should get the second dose of hepatitis B vaccine at one to two months old and the third dose at six moths old. Your baby should also get a blood test at nine to 15 months old to be sure he or she is protected.

Learn about other Liver Disease States.