Liver Failure in Children
Liver failure happens when the liver becomes so sick and damaged that it stops working, either partly or completely. Although this is rare, liver failure can happen even in children.
What Is Liver Failure in Children?
The liver is the largest organ inside the abdomen (belly). It has many important jobs. Some of them have to do with filtering toxic or harmful chemicals out of the blood, with using medicines and with processing other foreign substances. The liver also helps to digest food. It stores and releases energy and makes proteins to build the body’s cells and tissues and to allow the blood to clot.
Liver failure happens when the liver becomes so sick and damaged that it stops working, either partly or completely. Although this is rare, liver failure can happen even in children. Many of them recover well, but others become extremely ill, and some may need a liver transplant to survive.
There are two main types of liver failure in children:
- Acute liver failure. This type comes on suddenly. It occurs in children with no known prior liver disease.
- Chronic liver failure. This type occurs when a long-lasting liver disease becomes much worse, either slowly or suddenly.
What Causes Liver Failure in Children?
Liver failure can happen to children of any age. The liver can fail due to many different types of injury or disease. Often, a cause cannot even be found. Some known causes of acute (sudden) liver failure include:
- Viruses, such as herpes (HSV), Epstein-Barr virus (EBV), cytomegalovirus (CMV) or hepatitis A, B and E. There are many other viruses that can cause acute liver failure, including probably some that have not been discovered or described yet.
- Inherited metabolic disorders, such as galactosemia, tyrosinemia, hereditary fructose intolerance (HFI), Wilson disease (too much copper in parts of the body) and mitochondrial diseases
- Toxins, such as certain wild mushrooms, rat poison, insect killer, weed killer and some solvents or cleaners.
- Certain medicines, such as erythromycin, valproic acid or too much acetaminophen
- Immune system problems, such as [autoimmune hepatitis]
- Low blood flow to the liver, such as in heart failure, shock or a blocked blood vessel
Chronic (slowly developing, long-term) liver failure mostly happens after a child has developed cirrhosis (severe scarring of the liver), for example from some of the diseases listed above. Other possible causes include:
- Chronic hepatitis, such as hepatitis C, autoimmune hepatitis, nonalcoholic steatohepatitis (a severe form of fatty liver disease)
- Inherited conditions, such as hemochromatosis (too much iron in the body), alpha-1 antitrypsin deficiency or cystic fibrosis (inherited diseases that also affect the lungs)
- Heart problems that reduce blood supply to the liver or lead to a backup of blood flow in the liver
- Diseases of the bile ducts, such as biliary atresia (blocked or incompletely formed bile ducts in babies) or sclerosing cholangitis (chronic inflammation of the bile ducts)
What Are the Symptoms of Liver Failure in a Child?
At first, symptoms of liver failure can look like other common childhood illnesses, such as the flu. Early symptoms may include:
- Fatigue (feeling tired all the time)
- Nausea or vomiting
- Loss of appetite
- Abdominal (belly) pain
As liver failure gets worse, symptoms may include:
- Dark urine
- Jaundice (yellowish skin and eyes)
- Itching all over the body
- Bruising easily or bleeding for a long time
- Swollen abdomen from fluid building up (ascites)
- Brain problems, such as confusion, irritability, unusual sleepiness during the day or sleeplessness at night (encephalopathy)
How Is Liver Failure Diagnosed in a Child?
Without special tests, liver failure can be hard to diagnose in the early stages. This is because the symptoms are similar to many other illnesses. As more symptoms appear, tests will be done to check for:
- High bilirubin levels, leading to jaundice
- High liver enzyme levels
- Problems with blood clotting
- Signs of encephalopathy (brain damage)
How Is Liver Failure Treated in a Child?
The right treatment for liver failure in a child depends on the cause. Options may include:
- Watching and waiting: Although a child with acute liver failure will always be admitted to the hospital for very close observation and supportive treatment (such as IV fluids and medicine against nausea or belly pain), sometimes this condition does get better on its own. This can happen, for example, if it is caused by certain viruses.
- Medicines: Some types of acute liver failure can be treated with medicines, for example if it is caused by heart problems or toxins. Liver failure due to an acetaminophen overdose can be treated with a special drug (an antidote). Chronic liver failure always requires long-term care by a liver specialist who may prescribe various medications to treat or prevent complications – vitamins, antibiotics, diuretics (water pills), drugs to lower blood pressure or medicines to help against sleepiness or confusion (encephalopathy).
- Liver transplant: About half of all children with acute liver failure, and many children with chronic liver failure, must eventually have a liver transplant to survive. A liver transplant is a very complex operation. The sick liver is removed and replaced with a new one. The new organ (the transplanted graft) may be a whole liver or part of a liver from a deceased donor. Especially in younger children it is sometimes possible to use part of a liver from a compatible living donor who is old and big enough, generally healthy, and has the same blood group. However, not every liver transplant center performs such living donor transplants. After a liver transplant, many special medicines must be taken; some are anti-rejection drugs that let the body adjust to the new organ, others prevent complications (infections, blood clots, high blood pressure, stomach problems).
What Are the Complications of Liver Failure in a Child?
Liver failure may cause complications, including:
- Enlarged liver or spleen
- Fluid buildup in the abdomen (ascites)
- Blood that does not clot normally
- Jaundice (yellow color of the eyes or skin)
- Bruises or tiny spots (petechiae) in the skin
- Bleeding in the esophagus (food pipe), stomach or intestine (gut)
- Brain problems, such as confusion or disorientation (encephalopathy)
- Kidney problems, causing the body to not make enough urine
- Infections
When Should I Call My Child’s Health Care Provider?
Liver failure in a child is always serious and can sometimes get worse very quickly. Any child with symptoms concerning for liver failure, with liver failure that has been newly diagnosed by another provider, or with known chronic liver failure and new symptoms needs immediate, urgent attention by a pediatric liver specialist. Call your child’s health care provider right away if symptoms get worse or new symptoms show up.
Key Points About Liver Failure in Children
- Liver failure is a rare and possibly life-threatening condition in children.
- Liver failure happens when the liver becomes so sick that it stops working.
- Liver failure can be due to many different types of injury or disease.
- Liver failure may come on suddenly (acute) or be a long-lasting disease (chronic).
- Some cases of liver failure get better without treatment.
- Some types of liver failure can be treated with medicine.
- Some children with liver failure will need a liver transplant.
Next Steps
If your child has been diagnosed with liver failure, your best source of information is your child’s health care provider. He or she will work with you to give your child the best chance of recovery. Some helpful things you can do include:
- Learn all you can about recommended treatments. Ask about the benefits and the downsides.
- Make sure your child takes all prescribed medicines on time.
- Find out about any side effects of your child’s medicines.
- Do not give any medicines/drugs, home remedies, herbs or supplements that have not been specifically prescribed for your child without first talking to his or her medical provider.
- Keep all follow-up appointments with your child’s health care provider.
- Ask if there is any specific diet recommended for your child.
- Ask what forms of physical exercise are safe for your child to do and find out if there any activities your child should avoid.
- Call you child’s provider immediately with any concerning changes you have noticed in how your child looks, feels or behaves.
