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Pediatric non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)
Changing what children eat and how they exercise can reverse non-alcoholic fatty liver disease (NAFLD). Children’s Health℠ has special expertise in finding ways to help kids make these lifestyle changes long-term.
What is pediatric non-alcoholic fatty liver disease (NAFLD)?
Non-Alcoholic Fatty Liver Disease (NAFLD) is the most common cause of chronic liver disease in children the United States, affecting millions. It is a condition in which fat builds up in the liver, and – if untreated – it can lead to serious liver problems like cirrhosis (scarring of the liver) and cancer during adulthood.
Risk factors
- Pediatric NAFLD is common in the United States, affecting 10% of children.
- Obese children are at the greatest risk for developing fatty liver disease, but having type-2 diabetes or pre-diabetes, insulin resistance, or high cholesterol also increase a child’s risk.
- The disease has been found in adolescents, as well as young children. In some cases, it runs in families.
What is non-alcoholic steatohepatitis (NASH)?
Over time, the extra fat can cause inflammation and scarring of the liver. When that happens, the disease becomes known as non-alcoholic steatohepatitis (NASH). The exact cause of NAFLD and NASH is unknown.
What are the signs and symptoms of pediatric non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH)?
- Fatigue
- Loss of appetite
- Pain in the upper right part of the abdomen
- Weakness
- Weight loss
How is pediatric non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) diagnosed?
There are several tests to diagnose NAFLD and NASH in children. A doctor will go over your child's medical history and perform a physical exam. Doctors usually discover fatty liver disease through abnormal results in routine blood tests or by discovering an enlarged liver during routine examination.
Your healthcare provider may also perform one or more of the following tests:
- Blood tests
- Ultrasound
- CT scan
- MRI
- Liver biopsy
Not every child needs all these tests. Your physician will discuss with you exactly what the next steps are.
How is pediatric non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) treated?
There is no medication for NAFLD, but healthy lifestyle choices can stop the disease and even reverse it.
At Children's Health, helping children overcome NAFLD starts with:
- An accurate diagnosis, enabled by comprehensive blood tests, advanced imaging technology and (if needed) innovative biopsy techniques.
- A team approach that brings together GI specialists, dietitians and a psychologist
Children can stop or reverse NAFLD by eating healthier and exercising more. Our dietitians know how to teach your child how to crave less sugar and choose healthier foods. We can also teach your child which foods will give them the best fuel to succeed at school. Together, we’ll come up with a plan that involves fewer calories, less sugar and less fat – and plenty of physical activity.
Pediatric non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) doctors and providers
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Amal Aqul, MD Pediatric Hepatologist -
Jorge Bezerra, MD Pediatric Hepatologist -
Lauren Lazar, MD Pediatric Gastroenterologist -
Claudia Phen, MD Pediatric Gastroenterologist -
Charina Ramirez, MD Pediatric Gastroenterologist -
Norberto Rodriguez-Baez, MD Pediatric Hepatologist -
Isabel Rojas Santamaria, MD Pediatric Gastroenterologist -
Meghana Sathe, MD Pediatric Gastroenterologist
Frequently Asked Questions
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What can my child expect during the treatment process for non-alcoholic fatty liver disease (NAFLD)?
Before treatment begins, we start with a quick blood test to look for high levels of an enzyme called alanine aminotransferase (ALT). This test can reveal whether a child’s liver has been damaged. Children might need additional tests to look for extra liver fat and to rule out other conditions.
If a child needs a liver biopsy, we offer a type of biopsy that uses no incisions. This technique, called endoscopic ultrasound-guided biopsy, is easier on kids and helps them recover faster.
During the biopsy, your child’s doctor will get a small sample of liver tissue to examine. This biopsy takes less than an hour, and your child won’t be in pain because they’ll be under anesthesia the whole time.
From there, gastrointestinal specialists, dietitians and a psychologist will work together to create a personalized treatment plan that helps your child change their lifestyle, lose weight and reduce liver fat. We see most children for follow-up visits every three or four months, to check their progress and help them stay on track. These visits can continue for a year or longer, depending on how severe each child’s NAFLD is.