KidsMD Health Topics

Fatty liver

  • Your child’s doctor may suspect NAFLD if your child is overweight or obese and routine blood tests suggest that the levels of certain liver enzymes are higher than normal. The diagnosis can sometimes be confirmed by ultrasound or other imaging techniques, which can show whether and how much fat has built up in the liver. Because certain medications, viral or autoimmune hepatitis, metabolic disease, and congenital liver disease can also cause fat to build up in the liver, it is important to rule these other causes out before diagnosing a child with NAFLD.

    Currently the only way to tell the difference between NAFLD and NASH is with a liver biopsy. If the biopsy shows fatty accumulation, inflammation, and scarring, then a diagnosis of NASH can be made.

    For details, see Tests.

    How do you treat NAFLD?


    • Controlling your child’s weight, especially through health eating and regular exercise
    • Controlling cholesterol and triglyceride levels

    Regular visits to a doctor who specializes in liver disease and conversations with your doctor about liver health are important parts of the treatment process. In addition, if your child has diabetes, tight blood sugar control can also help. Some studies suggest that vitamin E may provide some benefit.

    The same recommendations apply to both NAFLD and NASH. Remember, though, that in many cases the goal of treatment for both conditions is management, not cure.

    For details, see Treatment & care.

    How can NAFLD affect my child in the long term?

    If NAFLD advances to NASH, the liver may start to scar. Scar tissue (also called fibrosis) can replace the liver’s healthy, soft tissue, causing cirrhosis and preventing the organ from working properly. If not brought under control, cirrhosis can lead to complications including portal hypertension or hepatopulmonary syndrome, as well as liver failure or liver cancer. All of these are serious but preventable conditions, as long as the buildup of fat in the liver and the process of scarring can be slowed or stopped.

    Because NAFLD is a chronic condition, your child may have to seek care for it for the rest of his or her life. The Center for Childhood Liver Disease can help you and your child plan for the eventual transition from pediatric to adult care.

    Questions to ask your doctor

    If your child has been diagnosed with NAFLD, you and your family will play an essential role in his or her care. It’s important that you share your observations and ideas with your child’s treating physician, and that you have all the information you need to fully understand the treatment team’s explanations and recommendations.

    It’s often very helpful to jot down your thoughts and questions ahead of time and bring them with you, along with a notebook, to your child’s appointment. That way, you’ll have all of your questions in front of you when you meet with your child’s treating clinician and can make notes to take home with you.


    Boston Children's Hospital
    300 Longwood Avenue
    Fegan 5
    Boston MA 02115

     fax: 617-730-0716

  • Tests

    The first step in treating your child is forming an accurate and complete diagnosis. Your child’s doctor will usually make a diagnosis of NAFLD based on a combination of medical history, physical examination, and blood tests. In particular, children who are obese and have higher-than-normal levels of certain liver enzymes on routine blood tests are likely to have NAFLD. Your doctor may order an ultrasound (a painless, non-invasive imaging technique that uses high-frequency sound) to confirm the diagnosis.

    In some cases, your doctor may order a liver biopsy to see the extent of fat buildup and scarring, if any, in your child’s liver, which will tell whether your child has simple NAFLD or NASH.

    Because NAFLD can progress to more serious conditions, once they make a diagnosis of NAFLD our doctors will monitor your child’s liver by several means, including periodic:

    • Blood tests, to check how well your child’s liver is working.
    • Ultrasounds.
    • Physical exams.

    In this way, your doctor will be able to tell whether your child’s treatment is working and also watch for potential signs of worsening.

  • At Boston Children's Hospital, we take a multidisciplinary approach to the care of children with NAFLD. Our Center for Childhood Liver Disease is one of the few centers with a dedicated team of specialists who are board-certified in pediatric hepatology.

    There is no simple cure for NAFLD, so our focus is to prevent the disease from getting worse by:

    • Encouraging healthy eating and weight loss.
    • Controlling cholesterol and triglyceride levels, if necessary.
    • If your child has diabetes, maintaining tight control of blood sugar levels.
    • Monitoring for complications. NAFLD can lead to the more severe NASH, which in turn can progress to cirrhosis. Our doctors will keep a close eye on your child to catch any complications early. For details, see Tests.

    Some early studies suggest that vitamin E, an antioxidant, may have some benefit. However, it should not be seen as a substitute for weight loss, healthy eating, and physical activity.

    Other specialists in the hospital can also help manage your child's NAFLD. Dietitians in our Nutrition Department can work with you and your child to develop an appropriate diet plan that is specific to his likes and needs. Our doctors may refer your child to a specialist in the Preventive Cardiology Clinic's lipid program for help with cholesterol or triglyceride levels. Under certain circumstances we may also recommend discussing surgical options for weight loss with the hospital's Adolescent Bariatric Surgery Program.

  • Research & Innovation

    For reasons that are not clear, children with neuropsychiatric disorders have a higher risk of having NAFLD. Christine Lee, MD, is trying to understand the basis of this link in an effort to understand this relationship and perhaps find a way to prevent NAFLD in these children. This may, in turn, highlight mechanisms for the treatment of NAFLD overall.

    Nirav Desai, MD, another member of the Department of Gastroenterology and Nutrition, will soon start to study the relationship between high serum lipids (fat), the use of medications called “statins,” and NAFLD.

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