Liver diseases in children are often overlooked, largely because their early symptoms can be subtle or easily mistaken for common illnesses. Yet, these conditions can significantly impact a child’s growth, development, and overall health if left undiagnosed. From infections and genetic disorders to metabolic and autoimmune conditions, more than 100 types of liver diseases can affect children and adolescents, ranging from mild and manageable to severe and life-threatening.
Globally, the burdens of pediatric liver disease is rising. The incidence of cirrhosis among children and adolescents has increased by nearly 18 per cent over the past three decades, highlighting a growing public health concern. A 2024 study further underscores this trend, showing that infections remain the leading cause of liver disease in children, while cases of non-alcoholic fatty liver disease (NAFLD) have risen sharply over the past decade.
What makes the situation more concerning is that many of these conditions do not present clear symptoms in their early stages. As a result, they are often under-recognised or diagnosed late, delaying critical treatment and increasing the risk of complications.
This World Liver Day, we spoke to Dr Rajkali Rajendiran, Associate Consultant in Paediatric Gastroenterology, Hepatology and Transplantation at Rela Hospital, Chennai, to understand the early warning signs of liver problems in children that parents often miss, and why timely intervention can make all the difference.
Liver disease is not always about jaundice
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Dr Rajkali Rajendiran explained that while jaundice is often considered the most recognisable sign of liver disease, it is far from the only indicator. Many symptoms are subtle and non-specific, making them easy to miss.
“When we think about liver disease, the first thing that comes to mind is the yellow colour seen in jaundice. We look for yellow skin and eyes, but in reality, jaundice is not the only sign that the liver is affected,” he said.
He added that relying solely on visible yellowing can delay diagnosis, as several early warning signs may appear without it.
According to Dr Rajendiran, everyday symptoms like poor appetite or fatigue may sometimes point to something more serious. “A child who develops poor appetite, recurrent vomiting, abdominal pain, and gets tired easily should not be ignored,” he said.
He further explained that children who are not gaining adequate weight despite eating well compared to their peers may also be showing early red flags of liver dysfunction. These signs, though common, warrant closer observation when persistent.
Physical changes that need urgent attention
Certain visible changes in the body can signal that the liver is not functioning properly. Dr Rajendiran explained that abdominal swelling could be due to an enlarged liver or fluid accumulation, both of which require medical attention.
“Some children develop pale stools with dark yellow urine, which may be due to obstruction of bile flow caused by liver disease,” he noted.
He emphasised that such symptoms often indicate underlying issues that should not be overlooked or delayed.
Hidden warning signs beyond the obvious
Some symptoms are less commonly associated with liver disease but can be important indicators. “Persistent itching without a rash, which disturbs sleep or daily activities, can be a sign,” he said.
He further pointed out that frequent episodes of low blood sugar, especially in the morning after long fasting hours, may suggest a storage disorder of the liver.
In addition, swelling of the legs, easy bruising, bleeding from the mouth, or blood in stools can indicate liver injury and require immediate evaluation.
Special caution for newborns
Dr Rajendiran emphasised that newborns require extra vigilance when it comes to liver-related symptoms. “Any jaundice lasting for more than two weeks of life, along with persistent pale-coloured stools or dark yellow urine, demands immediate medical evaluation,” he said.
He added that early signs in infants are often subtle but can quickly progress if not addressed in time.
Early detection can save lives
“The key message is quite simple: liver disease in children can be silent, but it is not invisible if you know what to look for,” he said.
He urged parents not to delay seeking help. “If you see these signs, do not wait. Consult a pediatric hepatologist or gastroenterologist immediately. Your vigilance can quite literally save a child’s life,” he added.
This story is done in collaboration with First Check, which is the health journalism vertical of DataLEADS
