Hepatitis C is a liver infection caused by the hepatitis C virus (HCV). If the infection becomes chronic, it can lead to liver damage over time. However, hepatitis C in children is treatable and often responds well to medication.
This article looks at hepatitis C in children. It also looks at the signs and symptoms of HCV infection and how doctors diagnose, monitor, and treat the condition.
Children may contract HCV in several ways. The most likely route of transmission depends on their age.
Babies and infants
In babies, the most common route of HCV transmission is vertical transmission, or from parent to baby. This can occur in the womb, or during birth upon contact with maternal blood.
Around 5% of pregnant people with HCV will transmit the virus to the fetus. People who have both HCV and HIV have up to four times the risk of transmitting HCV to a fetus.
Doctors typically do not treat HCV while a person is pregnant, but they can consider this on a case-by-case basis. People can discuss the risks and benefits of this with a physician.
Older children and adolescents
Older children and teens who did not previously have HCV can also contract the virus in the same ways as adults. This can occur through any exposure to blood that contains the virus.
Behaviors that increase the risk for HCV transmission
- intravenous drug use, or sharing needles with others
- tattoos and piercings using non-sterile needles
- sexual activity that leads to exposure to blood, although sexual transmission is rare
Ways HCV cannot spread
HCV does not spread through:
- casual contact, such as hugging or kissing
- sharing food or drink
- the air
There are also
If a person’s nipples become cracked or bleed, however, they should stop breastfeeding until the skin heals completely.
HCV does not always cause symptoms. Whether it does can depend on whether someone has an acute or chronic infection, among other factors. Acute infections are short-term, while chronic infections are long-term.
The symptoms of an acute HCV infection
- abdominal pain
Most children with HCV have chronic infections. In children, a chronic HCV infection is one that lasts beyond age 2.
Children with chronic HCV can remain asymptomatic until adulthood. If they do experience symptoms, they tend to be less severe than that of adults who contract the virus.
There are two tests for diagnosing HCV. The first is an antibody test. Antibodies are proteins that the immune system creates to fight viruses. If the blood contains anti-HCV antibodies, this confirms a person had HCV at some point in life.
The second test for HCV is a PCR test, which measures the concentration of the virus itself in the blood. This confirms whether someone has an active infection.
Doctors typically test babies who may have HCV after they reach 18 months old. Until this point, an antibody test may give a false positive result, as a baby may have maternal antibodies in their blood for this length of time.
In some cases, doctors may test earlier than this, once the baby reaches 3 months old. For this, doctors will use a PCR test, rather than antibody test.
Sometimes, doctors also perform a liver biopsy, where they extract and examine a small sample of liver tissue to assess liver health.
Doctors typically do not treat HCV in children until they reach at least 3 years old. Until this point, a doctor knowledgeable on pediatric HCV infections should monitor the child’s health regularly to track the impact of the virus.
Sometimes, children with HCV clear the virus spontaneously before they reach 3 years of age. This occurs in around
For children who do require treatment, doctors can prescribe direct-acting antiviral (DAA) drugs. It is important to treat chronic HCV as early as possible, as this can lower the risk of liver damage and complications later in life.
Other things children and families affected by HCV need to be aware of until treatment is finished include:
- Safety precautions: Until medications or the immune system clear HCV, a child can transmit the virus to others through their blood. To prevent transmission, children and the rest of their household need to learn how HCV spreads and how to prevent it.
- Healthy habits: People with HCV can reduce the risk of complications in later life by adopting a healthy lifestyle and diet, wherever possible. Avoiding alcohol and other substances that can harm the liver reduces the risk of liver damage.
- Immunization: People with multiple types of hepatitis have higher rates of severe liver disease. As a result, it is important that children with HCV receive immunizations against hepatitis A and B. They should also get annual vaccinations for influenza.
The medical consensus about HCV treatment protocols in children may continue to shift in response to new technologies and studies.
The long-term impact of HCV depends on how a child contracted the virus and how early they receive treatment.
Most children who have HCV from birth experience mild disease. Many will clear the virus on their own, and 80% or more will have no or minimal liver scarring by the time they reach 18 years old.
Around 20–25% of children may have more aggressive disease, and can experience liver scarring before reaching the age of 8. This is why prompt treatment is important, regardless of how severe the disease is when doctors first detect HCV.
Those who need treatment typically respond well. 90–95% of children with genotype 1 HCV will have no detectable virus in the blood after 12 weeks of DAA treatment. The treatment causes minimal side effects for most people.
Children or adolescents that acquire HCV via other routes will have a similar prognosis as adults with HCV. 80% or more will develop chronic HCV, and many develop cirrhosis decades later if they do not receive treatment.
Hepatitis C is a leading cause for liver transplants in adults, but rarely necessary in children who have HCV from birth. Without treatment, HCV spread through any route can result in a
People who give birth while they have an active HCV infection should speak with a doctor about HCV as soon as possible. Doctors can test both parents and caregivers, as well as children above a certain age, to confirm whether HCV is present. They can then create a treatment plan.
People should also seek testing for older children and adolescents who engage in behaviors that put them at increased risk for contracting HCV. This includes the use of injection drugs, sharing needles, or getting tattoos and piercings in an unhygienic environment.
Anyone with symptoms that could indicate an acute HCV infection should speak with a doctor right away.
Hepatitis C in children can be milder than in adults, if the child has had HCV from birth. Doctors typically test for HCV once a baby reaches at least 18 months old, and a child can begin treatment as early as 3 years of age.
HCV is rare in children and adolescents, but high-risk behaviors can mean some children contract HCV through exposure to blood. Early treatment can prevent the progression of the disease and lower the risk of future complications.