Hepatitis B - children

HBV is found in the blood or body fluids (semen, tears, or saliva) of an infected person. The virus is not present in the stool (feces).

A child can get HBV through contact with the blood or body fluids of a person who has the virus. Exposure can occur from:

• A mother with HBV at the time of birth. It does not appear that HBV is passed to the fetus while still in the mother's womb.
• A bite from an infected person that breaks the skin.
• Blood, saliva, or any other body fluid from an infected person that may touch a break or opening in a child's skin, eyes, or mouth.
• Sharing personal items, such as a toothbrush, with someone who has the virus.
• Being stuck with a needle after use by an HBV-infected person.

A child cannot get hepatitis B from hugging, kissing, coughing, or sneezing. Breastfeeding by a mother with hepatitis B is safe if the child is treated properly at the time of birth.

People who are not vaccinated can get HBV during unprotected sex or drug use.

Most children with hepatitis B have none or only a few symptoms. Children younger than 5 years rarely have symptoms of hepatitis B. Older children may develop symptoms 3 to 4 months after the virus enters the body. The main symptoms of a new or recent infection are:

• Appetite loss
• Fatigue
• Low fever
• Muscle and joint pain
• Nausea and vomiting
• Yellow skin and eyes (jaundice)
• Dark urine

If the body is able to fight HBV, the symptoms end in a few weeks to 6 months. This is called acute hepatitis B. Acute hepatitis B does not cause any lasting problems.

Your child's health care provider will perform blood tests called the hepatitis viral panel. These tests can help diagnose:

• A new infection (acute hepatitis B)
• A chronic or long-term infection (chronic hepatitis B)
• An infection that occurred in the past, but is no longer present

The following tests detect liver damage and the risk for liver cancer from chronic hepatitis B:

• Albumin level
• Liver function tests
• Prothrombin time
• Liver biopsy
• Abdominal ultrasound
• Liver cancer tumor markers such as alpha fetoprotein

The provider will also check the viral load of HBV in the blood. This test shows how well your child's treatment for chronic hepatitis B is working.

Acute hepatitis B does not need any special treatment. Your child's immune system will fight the disease. If there is no sign of the HBV infection after 6 months, then your child has recovered fully. However, while the virus is present, your child can pass the virus to others. You should take steps to help prevent the disease from spreading.

Chronic hepatitis B needs treatment. The goal of treatment is to relieve any symptoms, prevent the disease from spreading, and help prevent liver disease. Make sure that your child:

• Gets plenty of rest
• Drinks lots of fluids
• Eats healthy foods

Your child's provider also may recommend antiviral medicines. The medicines decrease or remove HBV from the blood:

• Interferon alpha-2b (Intron A) can be given to children age 1 year and older.
• Lamivudine (Epivir) and entecavir (Baraclude) are used in children age 2 years and older.
• Tenofovir (Viread) is given to children age 12 years and older.

It is not always clear what medicines should be given. Children with chronic hepatitis B may get these medicines when:

• Liver function quickly gets worse
• The liver shows signs of long-term damage
• HBV level is high in the blood

Many children are able to rid their body of the HBV and do not have a long-term infection.

However, some children never get rid of HBV. This is called chronic hepatitis B infection.

• Younger children are more prone to chronic hepatitis B.
• These children do not feel sick, and lead a relatively healthy life. However, over time, they may develop symptoms of long-term (chronic) liver damage.

Almost all newborns and about half of children who get hepatitis B develop the long-term (chronic) condition. A positive blood test after 6 months confirms chronic hepatitis B. The disease will not affect your child's growth and development. Regular monitoring plays an important role in managing the disease in children.

You should also help your child learn how to avoid spreading the disease now and into adulthood.

The possible complications of hepatitis B include:

• Liver damage
• Liver cirrhosis
• Liver cancer

These complications generally occur during adulthood.

Contact your child's provider if:

• Your child has symptoms of hepatitis B
• Hepatitis B symptoms do not go away
• New symptoms develop
• Your child belongs to a high-risk group for hepatitis B and has not had the HBV vaccine

If a pregnant woman has acute or chronic hepatitis B, these steps are taken to prevent the virus from being transmitted to a baby at birth:

• Newborn babies should receive their first hepatitis B vaccine and one dose of immunoglobulin (IG) within 12 hours.
• The baby should complete all hepatitis B vaccines as recommended during the first 6 months.
• Some pregnant women may receive drugs to lower the level of HBV in their blood.

To prevent hepatitis B infection:

• Children should get the first dose of hepatitis B vaccine at birth. They should have all 3 shots in the series by age 6 months.
• Children who have not had the vaccine should get "catch-up" doses.
• Children should avoid contact with blood and body fluids.
• Children should not share toothbrushes or any other items that may be infected.
• All women should be screened for HBV during pregnancy.
• Mothers with an HBV infection can breastfeed their child after immunization.

Silent infection - HBV children; Antivirals - hepatitis B children; HBV children; Pregnancy - hepatitis B children; Maternal transmission - hepatitis B children

Centers for Disease Control and Prevention website. Vaccine information statements (VISs): hepatitis B VIS (interim). www.cdc.gov/vaccines/hcp/vis/vis-statements/hep-b.html. Updated May 12, 2023. Accessed February 27, 2024.

Centers for Disease Control and Prevention website. Vaccine information statements: your child's first vaccines (interim). www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.html. Updated July 24, 2023. Accessed February 27, 2024.

Pham YH, Leung DH. Hepatitis B and D viruses. In: Cherry J, Harrison GJ, Kaplan SL, Steinbach WJ, Hotez PJ, eds. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier; 2019:chap 157.

Rogers ME, Balistreri WF. Viral hepatitis. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 406.

Terrault NA, Lok ASF, McMahon BJ. Update on prevention, diagnosis, and treatment of chronic hepatitis B: AASLD 2018 hepatitis B guidance. Hepatology. 2018;67(4):1560-1599. PMID: 29405329 pubmed.ncbi.nlm.nih.gov/29405329/.

Wodi AP, Murthy N, McNally VV, Daley MF, Cineas S. Advisory Committee on Immunization Practices recommended immunization schedule for children and adolescents aged 18 years or younger - United States, 2024. MMWR Morb Mortal Wkly Rep. 2024;73(1):6-10. PMID: 38206855 pubmed.ncbi.nlm.nih.gov/38206855/.

Updated by: Charles I. Schwartz, MD, FAAP, Clinical Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, General Pediatrician at PennCare for Kids, Phoenixville, PA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.