Jaundice means the skin and the whites of the eyes turn yellow. All degrees may exist, and often it is so light as to be barely detectable. It invariably indicates liver disease. Generally speaking, liver disease (as occurring in adults) is quite rare in infants and children. The free use of alcohol is one of the major reasons why so many adults are prone to disorders of this vital organ; fortunately, infants have not yet learnt of this beverage. Some unwise mothers who imbibe freely during pregnancy give birth to severely damaged children (mentally and physically) who suffer from the so-called foetal alcohol syndrome—often the babies perish soon after birth.
Infectious hepatitis is a virus infection of the liver which can produce serious illness, but it is usually mild and recovery is common.
Jaundice of the newborn
Jaundice of the newborn, also called physiological jaundice, occurs commonly in normal babies. In fact, it is claimed that about 10 per cent of babies show this. It comes on during the first week of life, but usually not before the first 36 hours. It vanishes just as rapidly after the first week, leaving no aftermath.
The red blood cells of the body are continually being manufactured and broken down. When destroyed, they yield a product called haemoglobin, and this is disposed of by the liver. A baby’s liver is not always geared to cope with the fairly large amounts it has to dispose of in early life, so the by-products build up as a substance called bilirubin.
Other forms of jaundice
If the baby is jaundiced at birth, or if physiological jaundice persists beyond a week, the doctor will seek out other causes. It is a cardinal sign of liver disease, and the cause must be found. If large amounts of bilirubin (the material that causes the yellow discoloration) are allowed to remain in the blood, serious and permanent adverse effects are probable. A condition called kernicterus may take place. This comes from the Greek words meaning kernel (of the brain) and icterus (jaundice). Staining and damage of the vital brain centres may occur. It may cause death at worst, or it may leave the infant with permanent brain palsy, deafness and mental retardation.
A serious and fairly common cause of this in bygone days was the so-called haemolytic disease of the newborn, caused by the blood group Rh factor. It occured in some women who were Rh negative producing a Rh positive child, and whose systems had been sensitized by an Rh baby previously. With each subsequent Rh pregnancy, the condition became more severe and serious. Total blood transfusions were carried out on affected babies in an attempt to save them, and many were highly successful. However, with the ready availability of Rh immunization for these women, given within 72 hours after producing an Rh positive child, this risk has now largely vanished.
There are various other causes but these come within the orbit of obstetricians and paediatricians caring for babies when they are born. The condition is usually picked up and treated at once.
Hepatitis A (infectious hepatitis)
The more common variety is also called Hepatitis A, or viral hepatitis. It is more likely in adults, but may occur in children and infants. It is caused by a virus and is believed to be transmitted by flies which infect food, but there may be other ways of contamination as well.
It takes about two to six weeks for the germ to incubate and produce symptoms. Often it is sub-clinical, meaning no obvious symptoms occur. The child merely feels off-colour. Frequently, as the liver becomes infected, the cells swollen and the normal flow of fluids through the system affected, jaundice occurs. This may be mild, with only a staining of the whites of the eyes. Or it may be more pronounced, and the whole body becomes an obvious yellow.
It may have a rapid onset, with fevers, chills, malaise, lack of appetite, vomiting, headache, and aches and pains all over the system. Jaundice of the eyes and skin may occur; and if so, the skin often becomes very itchy, the child starts scratching and may break and abraid the surface. Sometimes the lymph glands of the body swell and become tender. These may be in the neck, under the jaw, in the armpits and groin. Often the liver and spleen also swell and are tender. The liver, in the right-hand side of the abdomen, may be felt protruding from under the rib cage. On the left-hand side is the spleen, a large organ associated with blood production.
An infection with jaundice occurring during childhood, and with the symptoms listed, is most likely infectious hepatitis. However, see the doctor for a confirming diagnosis and be guided by the doctor’s recommendations for treatment.
Treatment of hepatitis A
Most cases are mild and may be managed at home. Children prefer to stay in bed for the first few days at least, and maybe longer. It depends on how quickly they start to recover.
There are no restrictions on food intake. Giving a good nutritious diet is advisable, if the patient is inclined to take this. Fat-containing foods may be unacceptable because the patient experiences nausea. (The old idea of withholding fats for medical reasons no longer applies.) All the child’s usual foods may be given. However, from a practical side, small portions of attractively served foods along the lines of the patient’s favourites are probably the best idea. Plenty of fluids are recommended, for these help to wash toxins and debris from the system and always help in recovery of any infection.
Usually there is no medication given, for the liver would then have to cope with drugs and it is already inflamed and battling itself. Additional vitamins (especially the vitamin B series) can help strengthen the liver.
This infection is usually self-limiting, and recovery is the usual result. Most patients suffer minimum or no jaundice, but sometimes there is major and serious yellowing which may indicate a severe degree of the disease.
If one member of the family has infectious hepatitis, a good deal of protection for the other members may be gained by an injection of gamma globulin. The doctor arranges and administers this.
Hepatitis B (serum hepatitis)
Today this is better known as Hepatitis B, and it is also caused by a virus. In children it is much rarer. It is transmitted by infected blood and for this reason it occurs in persons receiving injections with needles previously used by an infected person—so is more probable in drug addicts. Hepatitis B used to occur occasionally after blood transfusions, but now, with screening tests for blood, this is unlikely in this country; the infection is more common overseas, especially with commercially bought blood. However, it is claimed that the virus can also be transmitted via breast milk and various other body fluids. It is worth noting that many cases have occurred in young people after they have been tattooed and also in girls (often children) after they have had their ears pierced; on checking, it has been found that the instruments used were not completely sterilized. Now that pre-sterilized studs are widely used for ears, the incidence has been reduced, but parents should still be careful to check that this is so if their children intend having their ears pierced.
It may take six months or more for symptoms to develop from the time of infection. The illness is serious and many deaths have occurred.
Treatment of hepatitis B
It is essential that treatment be under full medical supervision. This is best carried out in a major hospital, where clinics are geared for diagnosis and treatment of this unfortunate illness.
For any case of obvious jaundice, treatment must be under proper medical supervision. Although certain cases may be treated quite satisfactorily at home, proper diagnosis in the first place is essential. After this, it is important to be guided by the doctor’s suggestions. The advice offered in this section is to be used only as a general guide, to give some idea of the nature of therapy that will probably be recommended. The only medication, if any, to be taken is that prescribed by your doctor. Drugs given are usually minimal, and then only for the more serious forms of the disease. Parents should not self-medicate, for this could aggravate the disorder and prolong convalescence.
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