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 to do if your child has recently been diagnosed?

Questions to ask your pediatrician or  liver specialist

  • Have you ever treated any other patients with biliary atresia before?
  • Have blood tests been performed to look at child’s bilirubin levels?
  • What is the status of my child’s liver?
  • Does my child have liver damage?
  • Will my child need a liver transplant?
  • If transplant is an option, is my child a candidate for living donation?
  • What transplant hospitals are there in my state/UNOS region?
  • What transplant programs near me offer living donor transplant in pediatrics?
  • How do I look at outcomes at the different transplant programs?
  • Has the provider doing this procedure done this on many other patients?
  • Is there any medication that can help with the portal hypertension?
  • Is there any medication that can help with the pruritus?
  • If Pruritus has not been defined already, it’d be good to write “…help with Pruritus (itching)?”
  • Is there a special diet my child needs to follow?

What causes liver failure in children?

Liver failure can be due to many different types of disease or injury and often a cause cannot be found. Known causes of acute liver failure include:

  • Viruses
  • Inherited metabolic disorders
  • Toxins
  • Medicines
  • Immune system problems (e.g., Autoimmune hepatitis)
  • Low blood flow to the liver

Liver failure may slowly or suddenly developed and can be long term. Chronic liver failure happens mostly after cirrhosis (severe scarring of the liver) developed and can be from some of the conditions listed above. Other possible causes of chronic liver failure include:

  • Chronic hepatitis (e.g., hep c, autoimmune hepatitis, nonalcoholic steatohepatitis)
  • Inherited conditions
  • Heart problems that reduce blood supply to the liver or lead to back up blood flow to the liver
  • Diseases in the bile ducts (e.g., Biliary atresia or sclerosing cholangitis)

Symptoms of liver failure in children 

Early symptoms may include:

  • Fatigue
  • Nausea or vomiting
  • Loss of appetite
  • Abdominal pain

As liver failure progresses symptoms may include:

  • Dark urine
  • Jaundice
  • Itching all over body
  • Bruising easily or bleeding for a long time
  • Swollen abdomen from fluid build up
  • Confusion, irritability, unusual sleepiness

How is liver failure diagnosed in children?

Liver failure is diagnosed through a series of tests and observations.

  • Liver biopsy
  • Blood tests
  • Ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan

These tests will check for the following:

  • High bilirubin levels, leading to jaundice
  • High liver enzyme levels
  • Problems with blood clotting
  • Signs of encephalopathy (often temporary brain disorder caused by liver disease)

What tests are used to diagnose and monitor liver disease?

  • Liver function tests (LFTs) are carried out on blood samples in a laboratory. They are a common way of seeing how well the liver is working.
  • Liver function tests are also used to monitor a child’s liver disease over time to see if the liver is getting healthier, getting worse or staying the same. Other blood tests may also need to be done to diagnose the cause of the liver disease.

How is liver failure treated in children?

  • Children with acute liver failure (ALF) will be admitted to the hospital for close observation and treatment such close observation and management while trying to determine the cause of the liver failure. Some patients need an urgent liver transplant for acute liver failure.”
  • Chronic liver failure requires long term care by a liver specialist, and most often a regimen of medication is used to treat complications.
  • Several children diagnosed with acute liver failure and many children with chronic liver failure eventually require a liver transplant to survive.

Complications of liver failure in children

Complications may include:

  • Enlarged liver or spleen
  • Fluid buildup in the abdomen
  • Blood that does not clot normally
  • Jaundice (yellowing of the skin or eyes)
  • Bruises in the skin
  • Bleeding in the esophagus, stomach, or intestine
  • Brain problems, such as confusion or disorientation
  • Kidney problems, causing the body to not make enough urine
  • Infections

Family Story

Bakari & Ellen Sellers, pediatric liver disease advocates and parents of Sadie – a liver transplant recipient, share their family’s story.

Next Steps

  • Learn about the medications your child is taking, including:
    • The side effects
    • How often they take it and taking it on time
  • Ask about the benefits and downsides of recommended treatments.
  • Ask if there is a specific diet your child will need to follow.

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Last updated on August 16th, 2023 at 03:03 pm

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