Children and HBV

Hepatitis B does not usually affect a child’s normal growth and development. Most children with chronic hepatitis B infections will enjoy long and healthy lives. Unlike other chronic medical conditions, there are generally no physical disabilities associated with hepatitis B, nor are there usually any physical restrictions for these children.

As a parent, you can take comfort from the fact that every child presents unique challenges. Therefore, your child with hepatitis B is just like any other child. The challenges of raising a child with hepatitis B are manageable if you are well informed and use common sense.

Adoption

The key to successful adoption of a child with hepatitis B is to be prepared with accurate information about the disease, and to protect yourself and other members of your household with the hepatitis B vaccine prior to the child's arrival.

International and Domestic Adoption           

Many people wish to adopt children from countries where hepatitis B infections are common: Asia, South America, Eastern Europe, and some parts of Africa. Children from these regions are often infected with the virus from their birth mothers who have hepatitis B and unknowingly pass the disease on to their children during delivery. In addition, many of these countries re-use needles for medications or blood tests, a practice that places children at risk if they have not already been infected at birth.

Domestic adoptions also present some risk to potential adoptive families. Children born to women in high-risk groups (e.g. illicit drug users, multiple sexual partners, etc.) could have been infected with hepatitis B at birth. In addition, children from group homes are at increased risk for hepatitis B infection.

Hepatitis B Testing

Your agency should be able to tell you if a child has been tested for hepatitis B. With an international adoption, it is advised that you do not request that your child be tested since the blood test itself could be a source of infection.

Reassurance for Adoptive Parents

Finding out that the child you wish to adopt has chronic hepatitis B can be upsetting, but should not be cause for alarm or stopping an adoption. We hope that a hepatitis B diagnosis will not change your decision to adopt a child. You can be reassured that most children will enjoy a long and healthy life. Hepatitis B does not usually affect a child's normal growth and development, and there are generally no physical disabilities or restrictions associated with this diagnosis.

Advice for Parents

Parents face a whole host of issues when making the decision to raise children. A child with hepatitis B presents new challenges, but they are manageable if you are well informed and use common sense.

The Hepatitis B Foundation has compiled a list of useful guidelines that may be helpful. Since each family is unique, and each community is different, please adjust your decisions accordingly.

Avoid the Spread of Hepatitis B

All parents, siblings, and other household members should be vaccinated. Extended family members, childcare providers, family, friends, and others should consider vaccination if they have, frequent and close contact with your child.

Know the Facts

If people are unfamiliar with hepatitis B, there is a possibility they will become alarmed when told your child has chronic hepatitis B. The key to reducing people's anxiety is to give them clear, simple facts.

§  Hepatitis B is not transmitted casually. It cannot be spread through the sharing of toys, sneezing, coughing, spitting, or hugging.

§  Hepatitis B is spread through blood and infected bodily fluids. Therefore, it could be spread through bites and scratches that result in broken skin.

§  Inform people that there is a safe hepatitis B vaccine and that the American Academy of Pediatrics recommends that all infants and children up to age 18 years be vaccinated. 

Know the Risk

In making the decision about telling others, be sure to consider whether your child is at high or low risk for exposing others to his or her blood (e.g. consider age, frequency of accidents, nosebleeds, biting, etc.). Consider the degree of risk a person has for exposure (frequent vs. occasional contact), and whether a person or child may have already been vaccinated.

Although there is no specific law that addresses hepatitis B, the Americans with Disabilities Act (1991) is a federal law that may protect children and adults with hepatitis B from discrimination.

Telling Others

Use common sense in deciding who you should tell about your child's hepatitis B. Once you tell, you can't take it back. So take your time and choose wisely as you decide who can be trusted with this information.

Fortunately, most children are now vaccinated against hepatitis B, so the risk of your child infecting others is reduced. Most states also require the hepatitis B vaccine for school entry. Although you do not necessarily have a "duty" to inform people of your child's hepatitis B, there may be situations where it is wise to disclose your child's diagnosis.

If possible, give literature to reinforce your facts. The Hepatitis B Foundation publishes free educational literature that you can request to give other parents, teachers, or school nurses.

What Should You Say?

Know your facts, use simple explanations, and remain calm. Emphasize that your child is healthy and poses no risk if blood accidents are handled carefully. Remind people (and health care providers) that blood is a two-way street. Other children may have unknown infections that can be spread to your child, therefore, the blood of all children should be handled carefully.

In addition, the hepatitis B vaccine is recommended for all infants and children up to 18 years. Therefore, most children should already be vaccinated and protected against hepatitis B.

Universal Precautions

The Centers for Disease Control (CDC) recommends that everyone use "universal precautions" for any accident. This means that the blood and bodily fluids of all adults and children should be treated as if it is potentially infectious.

Universal precautions (or "standard precautions") should be followed for ALL accidents, not just the blood of those with known chronic hepatitis B infection.

Cleaning Up Blood Spills

Avoid direct contact with blood, vomit, diarrhea and other bodily secretions, and ensure that others will not come into contact with them either.

§Clean all spills with a diluted solution of bleach (mix one part fresh household bleach with nine parts water).

§Discard cleaning materials into a plastic bag and tie securely. Dispose of properly in the garbage can.

§Wash your hands thoroughly with soap and warm water.

PKIDs Pediatric Hepatitis Report

Additional information for parents can be found in the Pediatric Hepatitis Report, which is the first-ever, comprehensive resource about children living with hepatitis B and C. Information about hepatitis B, from transmission to diagnosis, to treatment and civil rights protections is included in this excellent publication. It is published by the national non-profit PKIDs (Parents of Kids with Infectious Diseases).

Approved Drugs for Children

Chronic hepatitis B is normally a mild disease in children and teens. Most children can expect to live full, healthy lives unmarked by visible symptoms. In some children, however, the virus can cause serious liver damage. These children will need medical intervention and treatment.

ALL children with chronic hepatitis B should be seen regularly by a pediatric liver specialist or knowledgeable doctor whether they are on treatment or not. Visits may be every six months or once a year, depending on your child's situation. A physical exam, blood tests, and possible ultrasounds of the liver are part of the usual visit.

Approved Treatments

There are currently two approved treatment options available in the United States for children with chronic hepatitis B.

Interferon alpha (Intron A) is an injection usually given three times a week for 6 months to a year. Children generally experience fewer side effects than adults, but they can include flu-like symptoms.

Lamivudine (Epivir-HBV, Zeffix, Heptodin) is a pill that is taken once a day for at least one year or more. There are almost no side effects.

Not every child (or adult) with chronic hepatitis B needs to be treated. A pediatric liver specialist should evaluate your child to see if she or he is a candidate for treatment based on a physical exam, blood tests, and other test results. Treatment appears to be of greatest benefit to those who show signs of active liver disease.

Disclosing Your Child's Diagnosis

If you decide to disclose your child's hepatitis B, remain calm, provide literature to reinforce the facts, and give the school a letter from your child's doctor stating that s/he is healthy and poses no risk to the other children if appropriate precautions are maintained. Most states require hepatitis B vaccination prior to school entry, so this reduces any potential risk to other students.

We recommend the following when disclosing your child's hepatitis B to school officials:

§ Stress the importance of confidentiality and universal precautions to protect your child from social discrimination.

§ Remind school officials that hepatitis B is transmitted through exposure to blood; it is not transmitted casually.

§ Explain that hepatitis B is not the only blood-borne disease that puts children at risk.

§ Consider saying "Treat my child as you should treat every child — with care. You know what risk my child poses, but you don't know the risk that other children might present."