Viral hepatitis is a long-known, but still not fully understood disease. In essence, this is not one disease, but several: a group of dangerous and quite common infectious and inflammatory liver diseases of a viral nature. Quite often you can find other names for these infections: Botkin’s disease; serum or transfusion hepatitis; infectious or epidemic hepatitis; infectious jaundice.

All viral hepatitis is characterized by an enlarged liver, impaired liver function, symptoms of intoxication and, often, icteric discoloration of the skin and mucous membranes. In this article we will consider the symptoms of viral hepatitis in children, as well as the treatment of this disease.

Viral hepatitis (its acute form) ranks third in frequency among infectious diseases after intestinal infections and. And the incidence among children ranges from 60% to 80% (in different regions) from the general incidence of hepatitis. The disease is recorded in isolated cases or outbreaks, but epidemics are also possible.

Viral hepatitis poses a danger not only in the acute period, but also during the transition to a chronic form, because (usually caused by viruses B and C) it is one of the most common in the world according to statistics.

Cause of viral hepatitis

Viral hepatitis A is most common among children.

The causative agent of hepatitis can be a number of viruses (currently there are 8 known, perhaps there are more): A, B, C, D, E, F, G, SEN, TTV. Each of them has the ability to infect liver cells and cause diseases that differ in the mechanism of infection, clinical manifestations, severity and outcome.

Hepatitis is most often caused by viruses A, B, C. In children, hepatitis A is the most common (75% of all cases of hepatitis in children). The remaining types of viral hepatitis (F, D, E, G, SEN, TTV) have not been studied enough.

Hepatitis viruses are extremely stable in the environment: insensitive to low and high temperatures (heating up to 60°C can be withstood for 30 minutes), drying, and the effects of many chemical substances and ultraviolet radiation. But the resistance of different hepatitis viruses varies.

The source of viruses is a sick person or a virus carrier (only with hepatitis A there are no healthy virus carriers), however, the mechanism of infection is different for different types of hepatitis.

For hepatitis A and E The mechanism of infection is fecal-oral. The virus is excreted from the patient's body in feces and urine. Through dirty hands or toys, contaminated household items, the virus enters the child's mouth. The entry gate for infection is the digestive tract.

The possible routes of transmission of hepatitis A and E are as follows:

• contact-household: using dirty hands or toys, household items the virus enters the child’s body through the mouth;
• waterborne: when water bodies are polluted with secretions, outbreaks of hepatitis may occur through waterborne infection due to poor-quality water supply systems;
• food: infection through food is possible if hygiene rules are not observed by the person preparing it;
• airborne transmission of viral hepatitis A (not recognized by all scientists).

Susceptibility to hepatitis A in children in the first year of life is minimal due to innate immunity, which disappears by the age of one year. Maximum susceptibility is in children from 2 to 10 years. The highest incidence of morbidity in children is observed from 3 to 9 years of age due to frequent violations of hygiene rules at this age.

For viral hepatitis A there is an autumn-winter seasonality, for other types of hepatitis there is no seasonality.

All other hepatitis viruses are transmitted through blood.

Hepatitis B and C viruses transmitted through even a negligible amount of infected blood. The patient becomes infectious from the end of the incubation period.

Infection of children can occur through transfusion of donor blood or blood products received from a virus-carrying donor or (which is unlikely) from a patient in the incubation period of the disease. Children can also become infected through poorly processed reusable medical instruments (dental, surgical).

Particularly dangerous as a source of infection are patients with erased, anicteric forms of hepatitis B and people with chronic hepatitis C, who may not even know about their disease - they are not isolated and continue to spread the infection.

Virus B is found not only in the blood, but also in the patient’s feces, urine, saliva, breast milk, tear fluid and other biological fluids. But infection of a child usually occurs through the blood and, in extremely rare cases, through the mother’s saliva. In rare cases, infection can occur through shared use of toothbrushes, washcloths, etc.

Children's susceptibility to virus B is very high. However, taking into account the routes of transmission of infection, the incidence of this type of hepatitis in children is only 11% of the total number of viral hepatitis. Children of infant age (perinatal cases) are more often ill, as well as children receiving treatment in the department, after organ transplantation, plasmapheresis, in oncology clinics; .

Virus C transmitted through infected blood or blood products. Its source is not only a patient with acute or chronic hepatitis, but also a healthy virus carrier.

It is possible that the fetus can be infected from a virus-carrying mother during childbirth, as well as parenterally through the use of piercing and cutting objects, including medical instruments that are poorly processed and contain a negligible amount of blood on them (during surgical operations, tooth extraction, etc.).

Teenage children can become infected this way when getting tattoos, piercings, manicures, or having their ears pierced for earrings.

During adolescence, viral hepatitis B and C can be transmitted sexually from a virus-carrying partner during unprotected contacts. Teenagers who use drugs by injection can also become infected.

There is no cross immunity between different types of hepatitis.

Symptoms of viral hepatitis

The asthenovegetative variant of hepatitis is characterized by increased fatigue and weakness of the child. He becomes irritable and whiny.

Viral hepatitis is characterized by a cyclical course of the disease. In the development of acute viral hepatitis, the following periods are distinguished:

• incubation;
• preicteric;
• icteric;
• period of convalescence (recovery).

The disease can occur in a typical or atypical way. The icteric form is typical, erased, anicteric and latent forms are atypical. The course of viral hepatitis can be mild, moderate, severe and malignant (fulminant). There are also (depending on the duration of the disease) acute, protracted and chronic forms of hepatitis.

An acyclic, longer course of the disease is also possible, when after improvement or recovery exacerbations and relapses occur again.

Incubation period at hepatitis A can last from 7 to 50 days (more often it is 2-4 weeks); at hepatitis B– from 1 to 6 months (usually 1-1.5 months); at hepatitis C– from several days to 26 weeks (usually 7-8 weeks).

Pre-icteric period can occur in different ways:

• influenza-like, or catarrhal;
• gastric or dyspeptic;
• asthenovegetative;
• arthralgic or rheumatoid.

With the influenza-like type, the disease begins with an increase in temperature and the appearance of catarrhal manifestations of the disease (nasal congestion, cough, weakness, lack of appetite), nosebleeds. Sometimes, even when visiting a doctor, a child is diagnosed with “” during this period.

With the gastritic type in the pre-icteric period, the child is bothered by pain in the epigastric region, in the right hypochondrium, lack of appetite, weakness, and sometimes vomiting. Parents more often try to connect these phenomena with the nature or quality of food, they suspect.

With the asthenovegetative variant, weakness, drowsiness, increased fatigue, and decreased appetite are noted.

Arthralgic syndrome in the preicteric period is characterized by symptoms of intoxication expressed against the background, which may be. This variant of the pre-icteric period is more typical for viral hepatitis B.

With hepatitis A, the pre-icteric period lasts about a week, with parenteral hepatitis it is longer (up to 2-4 weeks).

Already at the end of the pre-icteric period, dark-colored urine appears.

Icteric period hepatitis is characterized by the appearance and rapid increase (over 1 or 2 days) of icteric staining of the skin and mucous membranes. First it appears on the sclera, oral mucosa, face, torso, and limbs. Subsequently, the jaundice disappears in the reverse order.

With hepatitis A, jaundice appears earlier, increases faster to a maximum level, and then disappears faster. With hepatitis B, jaundice appears after a longer pre-icteric period, and increases slowly and persists for a longer time.

The severity of jaundice depends on the severity of hepatitis, but at an early age the child may not have such a correspondence. When jaundice appears, urine becomes deeply dark in color (reminiscent of strongly brewed tea), and feces, on the contrary, become discolored and resemble white clay.

With severe jaundice, it can be disturbing. With the appearance of jaundice, the child’s well-being, as a rule, improves, and the symptoms of intoxication are significantly reduced. The size of the liver during this period is increased, and the size of the spleen often increases. Moreover, the younger the baby is, the more often the spleen enlarges. There were no changes in other organs.

In severe cases, during the icteric period, hemorrhagic manifestations are observed (small pinpoint hemorrhages on the skin); intoxication continues to increase. Symptoms of central nervous system damage are especially dangerous: anxiety or lethargy, sleep disturbance, insomnia, nightmares. Vomiting and decreased heart rate may occur.

Gradually, the jaundice disappears, the size of the liver normalizes, and the normal color of the discharge is restored.

The duration of the icteric period in a mild form is about 2 weeks, in a moderate form it is up to 1 month, in a severe form it is about 1.5 months.

A prolonged course is characterized by a longer period of jaundice (3 or more months).

The most severe form of hepatitis is fulminant (malignant), in which the liver tissue becomes necrotic, and areas of necrosis (death) can occur at any stage of the disease. The extensive necrotic areas are associated with massive antibody production and autoimmune liver damage.

This severe form of hepatitis develops mainly in children in the first year of life, which is probably due to the imperfection of the baby’s immune system and a large dose of the virus acquired in the blood.

With this form, there is an early onset and increase in symptoms of intoxication and damage to the central nervous system: lethargy during the day and restlessness at night, vomiting, significant enlargement of the liver, and loss of consciousness may occur. Older children may experience delirium. Long sleep may alternate with periods of excitement and motor restlessness. Children may scream, jump out of bed and try to run.

Subsequently, hemorrhagic manifestations occur: nosebleeds, vomit that resembles coffee grounds (stomach bleeding). Shortness of breath appears, significant, temperature rises within 38 ° C, possible. The liver is painful not only when you feel the abdomen, but also at rest.

Coma then develops. The liver quickly decreases in size, and a characteristic sickly-sweet smell of raw liver (“liver odor”) appears from the mouth. The amount of urine decreases and swelling may appear.

In a biochemical blood test for the icteric form of hepatitis, an increase in the level of bilirubin (mainly due to the direct fraction) and thymol test is noted. The level of hyperbilirubinemia is taken into account when assessing the severity of the disease. When bile flow is impaired (cholestasis), alkaline phosphatase activity and cholesterol levels increase.

But the main significance for any form of hepatitis is the increase in the activity of liver enzymes (AlAt and AsAt) or aminotransferases. Moreover, AlAt (alanine aminotransferase) increases to a greater extent. An increase in enzyme activity indicates the presence of a process of destruction of liver cells.

The activity of liver enzymes changes already in the pre-icteric period, which can be used for early diagnosis of hepatitis. This indicator is also of great importance in the diagnosis of atypical forms of the disease. Determination of enzyme activity also helps to diagnose the fulminant form of hepatitis: at first, enzymes increase sharply, and in the terminal stage they also sharply decrease as bilirubin levels increase.

The severity of hepatitis is also indicated by a decrease in prothrombin levels and an increase in ammonia in the blood. A large amount of ammonia, according to scientists, is one of the factors contributing to the development of coma, indicating a malignant form of hepatitis.

Serological blood testing allows you to detect immunoglobulins of class M and G, which allows you to monitor the dynamics of the process. The most reliable confirmation of the diagnosis is the detection of markers of viral hepatitis in the blood, which make it possible to accurately determine the type of virus.

Highly sensitive ELISA and RIM methods (that is, enzyme immunoassay and radioimmunoassay) can detect viral antigens and antibodies to them.

Ultrasound allows you to determine not only the size of the liver and spleen, but also to identify structural changes in the liver.

Treatment

Children with viral hepatitis are treated mainly in a hospital setting. Treatment at home for older children with mild viral hepatitis A is allowed.

Comprehensive treatment is provided, including:

• bed rest;
• diet;
• symptomatic treatment (according to indications): detoxification therapy, sorbents, hepatoprotectors, vitamins, choleretic drugs, antibiotics, and other drugs);
• (for parenteral hepatitis).

In the hospital, children are housed separately depending on the type of virus to prevent cross-infection. In the acute period, strict bed rest is prescribed until the normal color of urine is restored. As laboratory parameters improve and jaundice decreases, the regimen is gradually expanded.

In case of severe intoxication, detoxification therapy is carried out - glucose solutions and saline are administered intravenously; oral administration of sorbents (Enterosgel, Filtrum, Polyphepam, activated carbon) is prescribed.

Glucocorticosteroids are used for malignant forms of hepatitis. In case of severe cytolysis (damage) of liver cells, which is confirmed by an increase in enzymes by 5 or more times, antiviral drugs are used (Interferon, Intron-A, Viferon, Roferon-A and others). Interferon inducers and immunomodulators (Cycloferon, Dekaris, Taktivin) are also prescribed.

To maintain liver cell function, hepatoprotectors are used:

• Essentiale Forte, Essentiale N - the drug contains phospholipids necessary for the restoration of liver cells.
• Preparations from milk thistle extract: Silibor, Legalon, Karsil, Mariol and others - improve the restoration of liver cells.
• LIV 52 – consists of extracts of various herbs, has a restorative effect on liver tissue.
• Pargin (contains the essential amino acid arginine), Glutargin - improve liver function.

Vitamin complexes, B vitamins, and ascorbic acid are also indicated in the treatment of hepatitis. Apilak (royal jelly) and Spirulina (contains microelements, amino acids, vitamins, nucleic acids and other biologically active substances) are used as a general strengthening treatment.

Choleretic drugs (Cholenzim, Chofitol, Flamin) are used during the recovery period. Herbal infusions can be used only with the permission of the attending physician.

Diet is very important in the treatment of hepatitis. Vegetarian soups or soups with a third broth are allowed as first courses. Meat dishes (veal, chicken, rabbit) are steamed or served boiled. Low-fat fish should also be steamed. All sausages are excluded.

Vegetable fats should be used in the diet. Food should be taken in fractional portions 4-5 times a day. Porridge, especially oatmeal (has a lipotropic effect), and potatoes are allowed as a side dish. Fermented milk products are allowed (cottage cheese is especially recommended). It is advisable to consume fresh juices, watermelons, compotes, fruit drinks, and fresh fruits.

Fried, fatty, spicy foods, seasonings, sauces, gravies, nuts, mushrooms, smoked foods, chocolate, halva, cakes, ice cream, eggs are excluded. You can cook protein omelettes. You can give your child white bread, slightly dry. Non-carbonated mineral water can be given after recovery.

The diet should be followed by the child for at least 6 months after hepatitis.

Prognosis and outcomes of viral hepatitis in children

Viral hepatitis A in children occurs in a mild to moderate form, ends in recovery, and does not develop into chronic hepatitis. While viral hepatitis B most often has a moderate and severe form, clinical and laboratory parameters return to normal no earlier than 6 months, and chronic hepatitis forms in 5% of cases.

Although hepatitis C is milder than hepatitis B, the process becomes chronic in 80% of cases. Recovery often occurs with the icteric form of the disease.

In general, the prognosis for hepatitis for children is favorable. Most cases end in recovery. Mortality rate is less than 1% (it is higher in infants). Unfavorable course (possible death) in severe forms with development of coma.

A decrease in the level of prothrombin and transaminase activity during the height of the disease indicates massive necrosis of the liver tissue - a threatening symptom.

During the height of the disease, viral hepatitis B is more dangerous, and in the long term, viral hepatitis C is more dangerous.

The long-term prognosis of viral hepatitis is influenced by many factors: the type of virus, the severity of the disease, the age of the child, the occurrence of early relapses, exacerbation of hepatitis, the addition of other infections, and compliance with the diet and regimen after discharge.

The outcomes of viral hepatitis are varied:

• Full recovery in children can occur slowly; in approximately half of the children who have recovered from the disease, residual effects are detected. One of them is post-hepatitis syndrome: the child has discomfort and complaints, but upon examination there are few objective changes. If you follow the recommended diet and regimen, they gradually disappear, but can persist for years.
• Another option for residual effects is an increase in the level of bilirubin (its free fraction) for a long time; there are no other manifestations. Although this is a manifestation of a functional disease, it usually proceeds benignly.
• The most common residual effects are pathology of the biliary tract (cholangitis, dyskinesia). It is advisable to identify such changes as early as possible, since they can progress and lead to the development of hepatocholecystitis.
• After hepatitis, other organs of the digestive tract may be affected (duodenitis, pancreatitis).
• The outcome of viral hepatitis, in addition to recovery, can be a transition to a chronic form (hepatitis lasting longer than 6 months is considered chronic) and development. This outcome most often develops with hepatitis C – in 80% of cases.

After suffering from hepatitis, children are under medical supervision for 6-12 months, depending on the type of hepatitis and the severity of the course. Doctor's examinations and examinations allow timely diagnosis and treatment of complications when they are identified. Children are exempt from physical education and sports for 6 months.

Prevention

Newborns are vaccinated against hepatitis B while still in the hospital.

Measures to prevent hepatitis A do not differ from those for intestinal infections:

• compliance with personal hygiene rules;
• ensuring quality water supply;
• isolation of patients for the entire infectious period (3 weeks from the onset of jaundice, that is, about a month from the onset of the disease);
• disinfection at the source of infection.

There is also a vaccine against hepatitis A.

Measures to prevent hepatitis B and C are more complex:

• maximum use of disposable medical instruments;
• high-quality processing and sterilization of reusable instruments;
• excluding children from contact with blood and used instruments (syringes, needles, etc.);
• testing of donor blood for markers of viral hepatitis;
• testing pregnant women for markers of viral hepatitis;
• outreach to teenagers about transmission routes various types hepatitis and methods of their prevention, formation of a healthy lifestyle (prevention of drug use and unprotected sexual contacts);
• vaccination against hepatitis B (Engerix vaccine) of newborns within 12 hours after birth, then after 1 month. and at 6 months. If the mother is a carrier of the B virus, then the child (born healthy) is vaccinated after birth and then at 1 month, at 2 months. and per year. Children who did not receive the vaccine at an early age can be vaccinated at 13 years of age and then one month later and after 6 months.

Children in families with chronic hepatitis B patients or carriers of the Australian antigen, children on hemodialysis or frequently receiving blood products, children with oncological and hematological pathologies are also vaccinated.

Vaccines against other types of hepatitis have not yet been created.

Film about hepatitis C:

Summary for parents

Viral liver damage with any type of hepatitis is a serious disease that can leave marks or complications for life. Therefore, it is better to protect your child from this infection: vaccinate against hepatitis A and B and make every possible effort to create a healthy lifestyle for your beloved child.

Hepatitis in children is a group of diseases that cause an inflammatory response in the liver. They are divided into various forms: infectious, toxic, autoimmune, radiation, reactive.

Physiological jaundice of newborns belongs to a separate group. The danger of the disease is due to the fact that it may not manifest itself for some time. In this article we will talk in more detail about the types of hepatitis in children and methods of control.

Symptoms of hepatitis in children

Signs of hepatitis in children may vary depending on the form of the disease. Still, experts identify common symptoms:

• jaundice;
• change in the color of urine and feces;
• skin itching;
• nausea, vomiting;
• loss of appetite;
• diarrhea;
• abdominal pain;
• temperature increase;
• deterioration of sleep, weakness, tearfulness;
• catarrhal symptoms similar to influenza.

Viral lesion

Viral hepatitis in children still causes a lot of controversy among scientists. Regardless of the type of viral infection, such hepatitis causes enlargement of the liver, disruption of its functional activity and intoxication of the entire body.

Important! Among infectious diseases, acute viral hepatitis ranks third in prevalence.

The virus can be transmitted from the mother of the child during childbirth or even during intrauterine development. Viral hepatitis in children is divided into the following forms:

• A – infectious;
• B – serum;
• C – chronic;
• D – caused by delta virus. Occurs in people who have previously had viral inflammation of the liver;
• E – considered the most dangerous during pregnancy;
• F, G, SEN, TTV are poorly studied viruses against which vaccination has not been developed.

A

Viral hepatitis A is called the disease of dirty hands. This is the most common form, but it has a favorable prognosis. After an illness, a child develops long-term immunity. The first signs can easily be confused with a flu-like condition. The child's temperature rises, but there are no signs of a cold. Weakness, aching joints, chills, and fever also appear.

The disease begins with a general malaise

As the pathological process progresses, symptoms from the digestive tract appear: bitterness in the mouth, as well as discomfort in the epigastrium and right hypochondrium. Appetite also worsens to the point of complete disgust. The child becomes lethargic, apathetic and drowsy.

Hepatitis A is transmitted through infected urine and feces. Children may drink contaminated water or eat food that the sick person has touched with unwashed hands. In the maternity ward, infection can occur when changing diapers on a changing table on which an infected baby was previously lying.

The condition improves with the onset of the icteric period. The skin and mucous membranes acquire a yellow tint. Urine becomes beer-colored, and feces, on the contrary, become discolored. Children under one year of age are extremely susceptible to hepatitis A. The disease begins with the appearance of jaundice.

During the prodromal period, the baby has a bowel disorder, he is reluctant to eat and often regurgitates. In most cases, the disease begins with a sharp rise in temperature to 39 and even higher. The appearance of catarrhal symptoms can make early diagnosis difficult.

Important! If in kindergarten at least one child falls ill, quarantine is declared for 35 days from the date of isolation of the sick child.

Despite the fact that hepatitis A is not considered dangerous compared to other forms of the disease, the lack of timely medical care can lead to the development of dangerous consequences - liver failure and even death.

Vaccination is best protection from hepatitis A

Prevention of the disease is one of the priorities in pediatrics. Doctors unanimously say that the best prevention of Botkin’s disease is vaccination. Currently, vaccination against hepatitis A is considered a guaranteed and only method of protection. However, vaccination is not mandatory for all children; it is recommended in case of an immediate threat of infection.

Consider these situations:

• before a holiday at sea or a trip to hot countries, vaccination is done two weeks in advance;
• if the child has been in contact with a sick person, then vaccination is carried out within ten days;
• when diagnosing hemophilia and serious liver pathologies.

Before vaccination, the child is checked for antibodies to the virus. The indication for vaccination is the absence of these antibodies in the body. Their presence indicates either that the child has already been ill or has already been vaccinated. It is impossible to get Botkin's disease twice, as immunity is developed for life.

Where is the vaccination given? The vaccine is administered intramuscularly, usually in the upper arm. Parents should be prepared for the fact that side effects may occur, namely:

• nausea, vomiting;
• diarrhea;
• allergy;
• restlessness, moodiness;
• the injection site may become red, hard, and itchy. In this case, there is no need to lubricate or tape the skin. If you wet the graft, nothing will happen;
• temperature increase. Doctors allow you to give an antipyretic if the temperature reaches 38 degrees.

Vaccination against hepatitis A has a number of limitations. Let's consider the main contraindications: intolerance to the components included in the vaccine, bronchial asthma, acute pathological processes in the body.

IN

Symptoms of hepatitis B occur in three stages:

• Premonitory. Fever, headache, joint pain, abdominal pain, nausea, vomiting.
• Jaundice. Jaundice is rare, but if it begins, it has a pronounced character. Children may experience bleeding gums or even nosebleeds.
• Get well. This period lasts up to three months. The liver is enlarged, and damage to the bile ducts and pancreas is observed.

A child can become infected in the womb

Infection occurs through sperm or blood during blood transfusion (transfusion). Intrauterine infection is possible, and the baby can also become infected while passing through the birth canal. Teenagers can become infected through unprotected sex.

Persistent viral infection long time can persist in biological fluids. In the acute period, the following symptoms appear: an attack of nausea, vomiting, change in taste in the mouth, bloating, pain in the upper abdomen, loss of appetite, jaundice.

The risks of infection are very high; we can say that the spread of infection is becoming epidemic. The disease can become chronic and lead to disability or even death. The following children are at risk:

• the mother was diagnosed with serum hepatitis;
• a woman became infected with a viral infection after 24 weeks of pregnancy;
• the woman was not examined for hepatitis at all during pregnancy;
• drug addict parents;
• relatives with hepatitis B.

Important! Vaccination against hepatitis B is done in the first days of life. Vaccination does not provide a 100% guarantee that a child will not become infected. But the likelihood of this is negligible.

Even if the baby gets sick, the illness will be mild and the recovery process will come much faster. Due to the fact that serum hepatitis is a rather dangerous disease, there are three vaccination schemes:

• Standard. How many vaccinations will need to be given? First, the vaccination is given in the first days of life, then after a month and, finally, the third - after six months.
• Fast. It is prescribed when there is a high risk of infection. Immunity is formed instantly. The first vaccination is given in the first days of life, then a month later, two months later and a year later. It turns out that you will need to give four injections.
• Emergency. It is used before urgent surgery. You will need 4 vaccinations: on the first day of life, after a week, after 21 days and after a year.

Vaccination cannot be carried out in the following cases: allergy to baker's yeast, diathesis, infectious processes, autoimmune diseases, meningitis, increased reaction to a previous vaccination.

WITH

The disease is transmitted through infected blood. The use of disposable syringes and testing of donor blood before transfusion reduced the risk of viral transmission. The disease can occur in children with subtle symptoms: mild jaundice and general malaise.

Chronic hepatitis can cause serious liver damage and death

The greatest danger is posed by virus carriage, in which there are no external manifestations, but the infection has a devastating effect on the liver. It’s not for nothing that hepatitis C is called the “gentle killer.”

And this is not only because he does not show himself for a long time. The patient’s tests may return to normal, but this is only an imaginary recovery. This period can last several months, and then the infection begins to attack the organ again.

D

The source of the delta virus is patients, virus carriers and those who have antibodies. Children under six years of age are at risk. You can become infected in the following cases:

• use of non-sterile reusable medical instruments;
• during transfusion of infected blood;
• from mother to child;
• when blood gets on wounds or mucous membranes.

Important! There is no vaccination against hepatitis D! The virus promotes malignancy of healthy cells.

The delta virus is not able to develop separately from hepatitis B. Carriage of two viruses causes superinfection, which further complicates the process. According to research, cirrhosis occurs twice as quickly when attacked by the delta virus compared to other forms of viral hepatitis.

To date, there are no antiviral agents that would affect the delta virus. Interferon alpha causes a therapeutic effect in only twenty percent of cases, but when the drug is discontinued, the disease returns again.

Delta virus causes cancerous degeneration of liver cells

E

The disease is common in countries with hot climates. According to the mechanism of development and epidemiology, hepatitis E is similar to Botkin’s disease, but scientists have not found any microbiological similarities. The viral infection is killed by freezing, as well as exposure to chlorine and iodine. The main route of transmission of infection is fecal-oral.

In its manifestations, the disease is similar to hepatitis A. The disease provokes acute liver failure and is considered a transient type of viral hepatitis. As with the delta virus, there is currently no specific treatment against hepatitis E. However, patients receive therapy with interferon and ribavirin. Children's hepatitis develops less frequently than in adults, but it is much more severe.

Rare forms

Let's look at more rare forms of hepatitis. First, let's discuss the cytomegalovirus type.

Digital computer

According to statistics, about eighty percent of the world's inhabitants are carriers of this virus. Once the infection enters the body, it remains there forever and manifests itself when the immune system is weakened. The disease is transmitted by airborne droplets, contact, sexual contact and blood transfusions.

The virus is able to penetrate the placental barrier. Infection is especially dangerous in the first trimester of pregnancy. Treatment of the disease includes reducing the activity of the virus and restoring liver function. For this purpose, antiviral agents are used. In case of immunodeficiency, these drugs are used for life.

Autoimmune

The development of the disease is associated with a disorder of the immune response. The body fights its own cells. The disease can be triggered by a viral infection, as well as by taking certain immune medications. There is even a genetic predisposition to this type of viral infection. According to statistics, autoimmune hepatitis occurs in children from two to fourteen years of age.

The autoimmune process usually occurs in children after two years of age

Acute process characterized by the appearance of the following symptoms:

• abdominal pain on the right side;
• temperature increase;
• dilation of small vessels on the face, arms and neck;
• palms become bright red;
• During adolescence, girls may stop menstruating;
• boys may experience painful enlargement of the mammary glands;
• jaundice appears in later stages.

Toxic

Occurs as a result of toxic substances entering the child's body. These could be toxins from drugs, poisonous mushrooms or household chemicals. And most often, toxic hepatitis appears from parental neglect. The process develops quite rapidly, so you should react to the first signs in time.

Toxic damage manifests itself as follows: enlargement of the liver and spleen, pain in the area of ​​the right hypochondrium, nausea and vomiting, fever, bleeding, dilatation of small vessels, jaundice.

Toxic damage can be caused by drugs, mushrooms, household chemicals and other

Reactive

Occurs against the background of organ dysfunction. The following factors can provoke the appearance of reactive changes:

• endocrine disorders;
• pulmonary diseases;
• dermatitis;
• infectious processes;
• neurological diseases.

The disease can be asymptomatic and is detected purely by chance at an appointment with a pediatrician. Unlike viral forms, reactive hepatitis does not cause serious disorders and is not characterized by a chronic process.

Chronic

A chronic process is said to occur if the disease lasts more than six months. In the absence of treatment and adherence to a diet, it is fraught with the development of cirrhosis of the liver. Viruses, drugs, toxic substances - all this and much more can lead to chronic hepatitis.

The disease manifests itself as follows:

• jaundice;
• disturbances in the gastrointestinal tract;
• discomfort in the right hypochondrium;
• spider veins;
• tendency to bleed.

How does the disease progress in newborns?

Infant infection most often occurs through the blood. Infection can also occur during intrauterine development. Hepatitis in newborns has a number of features:

• congenital hepatitis may already be at a subacute or even chronic stage;
• the disease often occurs in the form of a mixed viral-microbial infection;
• the pre-icteric period is often absent;
• the disease begins with a sharp rise in temperature;
• due to catarrhal symptoms, it is easy to miss the disease, writing it off as the flu;
• the icteric period lasts a month or even more;
• the liver is sharply enlarged.

Important! Hepatitis in newborns differs in severity.

It is worth highlighting physiological jaundice of newborns. In this case, the skin also acquires yellow, but the reason for this is physiological processes, and not an attack of a viral infection. The process begins on the second day and reaches its peak on the fifth to seventh day of life, after which it declines.

At the same time, the general condition is not disturbed, the color of urine and feces is normal. Physiological jaundice is associated with the baby’s adaptation to new living conditions. As you get used to it, the yellowness of the skin goes away. The condition does not require treatment.

Physiological jaundice of newborns and hepatitis are two different things. In the first case, the size of the liver does not change and the general condition is not disturbed

Features of treatment

It should be noted right away that each type of hepatitis has its own treatment characteristics. Although there is no single treatment program, there are general principles, which we will consider:

• bed rest. The child should not get out of bed, at least until the urine color normalizes;
• therapeutic nutrition. The diet should be enriched with vegetable fats, proteins, easily digestible carbohydrates, and fermented milk products. Fried, fatty, spicy foods are strictly prohibited;
• vitamins. It is better to give preference to non-pharmacies chemicals, and natural vitamins contained in vegetables, fruits, juices;
• symptomatic treatment may include the use of sorbents, hepatoprotectors, antibiotics, corticosteroids and other agents;
• choleretic drugs are prescribed for absolutely any form of hepatitis, but only during the recovery period!

Children with viral hepatitis are hospitalized in a hospital. In the hospital, children are housed separately to avoid cross-infection. Home treatment is allowed for mild Botkin's disease in older children.

So, no matter what the reasons for hepatitis in children, you should always remember that the appearance of jaundice is an important diagnostic criterion that will help make a timely diagnosis. This symptom should not be ignored, and if it appears, you should immediately seek the help of a specialist.

Don't forget about preventative measures. Vaccination will help prevent certain types of viral hepatitis. Early diagnosis and strict adherence to medical recommendations are the key to your baby’s health!

Hepatitis A in children is one of the forms viral diseases liver tissue, also known as infectious hepatitis. It is a highly contagious disease due to its ability to spread through personal contact. It is a milder liver disease than hepatitis B. The disease very often occurs with absolutely no external symptoms or deterioration in health, especially in children. Hepatitis A does not cause liver failure or chronic liver disease. Once the infection is completely sanitized, all symptoms disappear and no destructive consequences remain.

It should be taken into account that relapses of the disease often occur in medical practice. Their symptoms appear mainly 1 month after the sick child has completely healed.

Routes of transmission of hepatitis A virus

From the onset of the disease, the hepatitis A virus is found in large quantities in the stool (feces) of persons infected with this pathogen. It is usually spread from person to person when objects or particles of substances contaminated with fecal fragments from an infected person enter the mouth. This route of transmission is called the fecal-oral route. Thus, it spreads more easily in areas where there are poor sanitation conditions or where personal hygiene is not observed. Most viral hepatitis infections occur in children as a result of contact with another family member who is infected with the disease. Transmission of the virus through blood is possible, but extremely rare.

Common routes of transmission of hepatitis:

• consuming food that has been produced by a person who has come into contact with contaminated excrement;
• through drinking water contaminated with infected feces (the problem is more common in areas with poor sewage treatment facilities);
• contact with the stool of an infected person, which can occur due to poor hand washing;
• overcrowding of children in children's institutions; kindergartens in which there are children who are not potty trained are especially susceptible to the spread of infection.

Hepatitis A has a uniform distribution in children throughout the world and is endemic in most countries. However, the incidence is declining in developed countries. There is a very high risk of infection and morbidity in developing countries and rural areas. For example, in rural South Africa, the infection rate is 100 percent.

According to the Medical Centers for Disease Control, hepatitis affects up to 200,000 young Russians every year. The highest incidence of viral hepatitis A is observed among children aged 5 to 14 years. Almost 30% of reported infections occur in children under 15 years of age, mainly because they are often in close contact with other children at school and daycare. About 15 percent of registered cases of disease are recorded among children and staff in kindergartens.

In our country, hepatitis among children is most common in the central regions and the Volga Federal District. To a lesser extent, the virus is found in Siberia and Far East. There is a high probability of infection in the southern regions and regions of the North Caucasus.

Symptoms of hepatitis A in children

Hepatitis A is caused by an enterovirus that was identified in 1973. It has an incubation period of three to five weeks. After penetration into the body through the oral cavity and intestines, it multiplies in the gastrointestinal tract and spreads to the liver parenchyma, where its vital activity and further reproduction. Hepatitis A virus is shed in a child's stool for two weeks before the onset of clinical symptoms.

People with hepatitis A may not have any signs or symptoms of the disease. A full-fledged clinical picture often develops in elderly or weakened people. Symptoms are nonspecific in many cases and usually include fever, fatigue, loss of appetite, nausea, abdominal discomfort, dark urine, and (yellowing of the skin and eyes). Viral hepatitis A produces symptoms in children after the end of the incubation period. In some cases, the clinical picture may develop 6 months after infection.

What signs of hepatitis A require immediate medical attention?

Parents should consult a doctor immediately if they experience at least one of the following symptoms:

• the child shows changes in his behavior, becomes absent-minded, has difficulty waking up in the morning, becomes lethargic or irritable;
• the child begins to drink a lot of fluids;
• the sclera of the eyes and skin of the child are yellow;
• the child has signs of dehydration, such as no urine for eight hours or dry mouth;
• the child begins to look very bad;
• appetite is impaired;
• the child's urine turns red;
• vomiting and refusal to eat are periodically observed;
• The baby complains of itchy skin.

Diagnosis and testing for hepatitis A

To establish an accurate diagnosis of viral hepatitis type A in children, a combination of medical history, clinical symptoms and specific tests is required.

Biochemical tests for hepatitis A, which include elevated liver tests and transaminases, allow one to suspect the disease. There is also a special blood test that allows you to determine antibodies to the hepatitis virus in a child’s blood. According to laboratory data, the diagnosis is finally established and the patient is sent to the infectious diseases department. Complete isolation from other children is necessary to prevent transmission of infection to others.

It is not always possible to establish a diagnosis based on complaints and clinical symptoms due to the blurred picture of the manifestation of the disease in children. Yellowness of the sclera and skin can be caused by mechanical reasons. Redness of urine can also be observed when the baby's diet changes. For example, red urine may be associated with eating beets.

Definition, types, etiology, epidemiology, pathogenesis, clinical picture, outcomes, laboratory diagnostics, treatment, care, prevention, measures in the outbreak

Viral hepatitis (VH) is a group of diseases characterized by liver damage, general toxic syndrome, hepatosplenomegaly and often jaundice.

There are at least seven independent forms of the disease. From an epidemiological point of view, they form two main groups of hepatitis - with a fecal-oral transmission mechanism (A, E) and parenteral (B, C, D, G). However, some hepatitis still remains etiologically unrecognized.

Etiology. The causative agents of hepatitis belong to different families of viruses and are characterized by resistance to high and low temperatures, as well as to the action of many disinfectants.

Pathogenesis. With hepatitis A and E, the pathogen enters the blood from the intestines, causing the development of a general toxic syndrome in the initial period of the disease. Penetrating through the portal vein system into the liver, viruses have a direct damaging effect on liver cells, resulting in their necrosis. The breakdown of necrotic hepatocytes leads to the release of protein complexes that act as autoantigens.

The pathogenesis of hepatitis B has a number of differences: the pathogen, as a rule, is introduced into the body by the parenteral route, which ensures its direct hematogenous introduction into the liver. Another significant difference is the mechanism of damage to hepatocytes. The hepatitis B virus does not have a direct damaging effect on liver cells. A decisive role in the development of the disease is played by immunological reactions leading to liver damage. The hepatitis B virus has the ability to persist for a long time, many years, and often lifelong in hepatocytes.

The mechanisms of development of hepatitis E, C, D and G have not been fully studied. It is known that the causative agent of hepatitis D has a direct damaging effect on liver cells.

Viral hepatitis C with fecal-oral transmission

Viral hepatitis A. Epidemiology. The source of infection is patients and convalescents who excrete the virus in their feces. Patients in the pre-icteric period, as well as with anicteric and subclinical forms of the disease are of greatest epidemiological importance. The virus is transmitted through contaminated water, food products and through contact and everyday life. Hepatitis A is considered primarily a “childhood infection”, in which the main contingent consists of primary school students. In the first year of life, the disease practically does not occur. Hepatitis A is characterized by epidemiological signs of intestinal infection. The incidence may be limited to sporadic cases, but epidemic outbreaks are also possible. Hepatitis has a clear seasonality, with the peak incidence observed in the fall (October, November).

Clinical painting. The incubation period ranges from 10 to 50 days, but usually does not exceed a month. The disease begins acutely. Body temperature rises to 38-39 °C, nausea, persistent infrequent vomiting, unstable stools, a feeling of heaviness and pain in the right hypochondrium appear. Sometimes catarrhal symptoms from the upper respiratory tract are observed. Signs of general intoxication gradually increase. The liver enlarges, it becomes dense and painful on palpation. By the end preicteric period Dark colored urine and discolored feces appear. At this time, a new short-term rise in temperature is often observed. The duration of the pre-icteric period is on average 5-7 days.

Icteric period characterized by the appearance of jaundice with a gradual increase in its intensity. First, the sclera and mucous membranes are stained, primarily the soft palate. As the jaundice intensifies, the color spreads to the skin of the face, torso and limbs. The liver is enlarged. In young children, the spleen enlarges. With the appearance of jaundice in mild forms of the disease, the child’s well-being improves, intoxication and dyspeptic symptoms decrease. The icteric period usually lasts 7-15 days.

Period convalescence long-term, usually more protracted in young children, lasts on average three months and is characterized by the gradual disappearance of clinical and laboratory manifestations of the disease.

The main features of hepatitis A are the predominantly mild course of the disease and the almost complete absence of a threat of chronicity of the process.

Viral hepatitis E. Hepatitis E is more common in tropical and hot countries. Young and middle-aged individuals are usually affected. Children under 15 years of age rarely get sick; their infection is latent. The incubation period and clinical manifestations of the disease are close to those of hepatitis A. A feature of the infection is increased sensitivity to the virus in pregnant women with high mortality, especially in the 3rd trimester.

Viral hepatitis with parenteral transmission mechanism

Viral hepatitis IN. Epidemiology. The hepatitis B virus is transmitted parenterally through violation of the integrity of the skin or transfusion of blood and its preparations. The infection is realized different ways: 1) during medical procedures: blood transfusions, hemodialysis, injections, instrumental diagnostics, dental interventions; 2) household infection is possible: when applying tattoos, performing cosmetic procedures (manicure, pedicure, shaving, etc.), using shared toiletries - toothbrushes, washcloths, razors; 3) during sexual intercourse through microtraumas of the mucous membrane or infected sperm (vaginal secretion); 4) transplacental transmission of the virus from pregnant women to the fetus is possible, but infection more often occurs during childbirth and in the neonatal period (through microtrauma of the skin during breastfeeding and breast milk).

The high incidence of hepatitis is determined by the widespread circulation of the virus; a large number of carriers who remain unrecognized for a long time, often for life; high sensitivity to the pathogen, allowing the possibility of infection with insignificant doses of the virus (10" 7 ml of infected blood is enough for infection); high concentration of the virus in the blood and its presence in semen and other biological fluids; high resistance of the pathogen in the external environment, to disinfectants and methods sterilization; many ways of transmission of infection.

Clinical painting. Contact with the virus usually leads to an asymptomatic course of the disease. Some infected people develop acute hepatitis. The incubation period lasts from 6 weeks to 6 months. The disease begins gradually without a clearly defined onset. Preicteric period long. Dyspeptic and asthenovegetative symptoms are more pronounced and occur more often than with hepatitis A. From the first days of the disease, the liver enlarges and becomes significantly denser. Extrahepatic manifestations of the disease often develop: polymorphic rash, pain in muscles, bones and joints. In severe and moderate forms, signs of hemorrhagic syndrome are revealed. In the icteric period, intoxication and dyspeptic symptoms, unlike hepatitis A, increase. Jaundice is long lasting and reaches great intensity. The spleen may become enlarged.

Hepatitis B, unlike hepatitis A, is characterized by a moderate to severe course, and chronic forms of the disease often develop. The peculiarity of the chronicity of the process is that it occurs mainly in mild forms of the disease.

Peculiarities currents hepatitis A at children breast age. The disease often begins acutely with increased body temperature, lethargy, drowsiness, breast refusal, regurgitation and vomiting. The duration of the pre-icteric period is shortened, and dark, diaper-staining urine and discolored feces appear early. The jaundice of the sclera and skin is usually milder than in sick older children. There is often a discrepancy between the severity of the disease and the intensity of jaundice. Hepatolienal syndrome is more pronounced. More often than in older children, manifestations of hemorrhagic syndrome are observed, and complications associated with the accumulation of bacterial infection often occur.

Congenital hepatitis B develops in the first days after birth or 2-3 months later in the form of a manifest or latent form with prolonged release of the hepatitis virus antigen. Manifest forms are difficult, with high mortality.

Viral hepatitis D. The disease occurs mainly in children over one year of age. The peculiarity of this infection is that it cannot exist without hepatitis B. Its implementation is possible only in an organism infected with the hepatitis B virus, since the delta agent uses the hepatitis B virus antigen as its outer shell.

The clinical picture of the initial period depends on the type of delta infection. When infected with hepatitis B and hepatitis D viruses at the same time, the disease manifests itself with the same symptoms as hepatitis B, but is more violent and severe. There is a tendency to develop malignant forms with acute hepatic encephalopathy. The disease has a high mortality rate.

Superinfection is characterized by a sharp exacerbation of latent or sluggish chronic hepatitis B.

Viral hepatitis C. The contagiousness of the blood and the likelihood of spreading the virus through sexual, transplacental and other routes is lower than with hepatitis B. The disease is characterized by a delayed appearance of antibodies - on average 15 weeks after the onset of hepatitis. The level of serum transaminases often does not change. Despite the favorable course of the acute period, the virus lingers in the liver for a long time and leads to the formation of chronic hepatitis with a high risk of developing cirrhosis and primary hepatoma. It occurs in the first 10 years of the disease and at a later date. Extrahepatic manifestations of infection are possible (vasculitis, glomerulonephritis, autoimmune thyroiditis).

Viral hepatitis F. The term “hepatitis F” was used to refer to etiologically unrecognized cases of hepatitis with a parenteral and enteral mechanism of infection. However, numerous studies have not detected the hepatitis F virus.

Viral hepatitis G. According to its clinical characteristics, hepatitis G resembles hepatitis C. However, it is not characterized by the development of chronic hepatitis and complications in the form of cirrhosis and hepatoma.

Outcomes viral hepatitis. Usually hepatitis A, E and G result in complete recovery. Residual effects of an incomplete process are possible in the form of an increase in liver size, dysproteinemia, an increase in the level of thymol test, and sometimes enzyme activity. In some cases, long-term consequences of viral hepatitis are observed in the form of hyperbilirubinemia, hepatomegaly (residual liver fibrosis), and damage to the biliary tract. With hepatitis B, D and C, chronic hepatitis often develops.

Laboratory diagnostics. The main specific markers of hepatitis are viral antigens (HAAg, HBsAg, HBeAg, etc.) and IgM and IgG antibodies to them (anti-HAAg, anti-HBs, anti-HBc (cor), etc.).

Nonspecific markers are transaminases (AST and ALT). They increase in the pre-icteric period (normally AST is 0.1 - 0.45 mmol/chl, ALT - 0.1-0.68 mmol/chl). At the end of the pre-icteric period, bile pigments and urobilin appear in the urine, and stercobilin disappears in the feces. During a biochemical blood test, an increase in bilirubin is observed, mainly in the direct fraction (normally 2.1-5.1 µmol/l).

Treatment. In case of viral hepatitis, the patient must be hospitalized. Separate placement of patients with enteral and parenteral mechanisms of infection is necessary. For hepatitis A and E, the filling of wards should be carried out taking into account the period of illness (the degree of contagiousness of patients).

Treatment of the disease includes a protective regimen, diet, antiviral and pathogenetic therapy.

In the acute period, for mild and moderate forms of hepatitis, semi-bed rest is indicated, for severe forms - bed rest. Food should be complete, easily digestible with a sufficient amount of protein (table No. 5). Spicy, salty, fried foods, pork, canned food, refractory fats, marinades, chocolate, and cakes are prohibited. For detoxification purposes, increase the amount of fluid consumed. For drinking, weak tea, fruit and berry juices, compotes, rosehip decoction, alkaline mineral waters, and 5% glucose solution are recommended. It is not advisable to use canned drinks.

Antiviral treatment is prescribed depending on the severity of the condition and the etiology of the disease. For hepatitis A and E, antiviral therapy is not indicated. It is carried out in severe and protracted cases of hepatitis B and D and in all cases of hepatitis C, taking into account the high probability of developing a chronic process. The main antiviral agent is os-interferon and its preparations - reaferon, realdin, intron A, roferon A, Viferon, human leukocyte interferon, wellferon. Etiotropic treatment also includes the use of synthetic nucleosides - famciclovir (fsshvira, lamivu-dina (epivir), zidovudine (retrovira, thymoside), didanosine (Videxa), ribavirin and other protease inhibitor drugs - saquinavir (invirases), indinavir (krssivana); interferon inducers - neovira (cycloferon), amiksina.

Pathogenetic therapy should be as gentle as possible, since almost all drugs are inactivated in the liver. It consists of prescribing a complex of vitamins ("Aerovit" " Vitalux", "Vitrum", "Centrum" and etc.); enterosorbents (polyphepane, bigignin, granulated carbon sorbents), enzyme preparations (pancreatin, Creon, me-zim-forte, festal, panzinorm and etc.).

In case of development of cholestatic syndrome, it is recommended fat-soluble vitamins A And E, bile acid adsorbents (cholestyramine, bilignin); bile acid derivatives (ursofalk, ursonane). When signs of bile discharge appear, choleretic agents are indicated (allohol, hofitil, ode-ston, holagol, nikodin).

In patients with moderate and severe disease, infusion detoxification therapy is performed 5% solution glucose With riboxin, ascorbic acid acid, solution Ringer, hemodesis etc. The introduction of amino acid mixtures is indicated (aminosteril, hepasteryl, hepatamine). For severe forms of hepatitis, glucocorticosteroids are prescribed. A course of hyperbaric oxygen therapy is carried out. Immunosuppressants are used according to indications - delagil, azathioprine (imuran). During the period of reverse development of the disease, hepatoprotectors are prescribed (LIV-52, legalol, karsil), During the period of convalescence, physiotherapy (electrotherapy), tubing according to Demyanov, and physical therapy are indicated.

Care. The nurse must ensure that patients comply with the protective regime, diet, and receive a sufficient amount of fluid. An essential component of care is monitoring bowel regularity. To prevent the accumulation of toxins in the intestines, it is necessary to have regular bowel movements. This is essential from the first days of the disease, but is especially important during the height of the disease, when the disruption of all functions of hepatocytes, including detoxification, reaches its greatest severity. In the absence of daily bowel movements, the nurse, as prescribed by the doctor, performs cleansing enemas. Children with severe forms of the disease require constant monitoring due to the possibility of developing hepatic coma. Any changes in the patient's condition should be reported to the doctor immediately. viral hepatitis children transmission

Prevention. To prevent hepatitis A and B, active immunization is carried out. The fight against hepatitis A, along with vaccination, includes early diagnosis and timely isolation of patients, interruption of transmission routes. Those who have had hepatitis A are admitted to the children's team after clinical recovery and normalization of biochemical parameters.

Measures to prevent hepatitis B include a thorough examination of donors, the organization of centralized sterilization facilities in medical institutions, and the provision of syringes and disposable instruments. All manipulations involving blood should be carried out wearing rubber gloves, oversleeves, and an apron. Mask and goggles required. When washing your hands, it is necessary to avoid hard brushes that cause maceration of the skin. Damage to the hands should be covered with adhesive tape or finger pads.

Medical workers in burn centers, surgical, intensive care units, hematology and oncology departments are at increased risk of infection.

Events V hearth. Before hospitalization of the patient, current disinfection is carried out, after hospitalization - final. Subsequently, routine disinfection is carried out daily. Used dishes are soaked in a disinfectant solution.

Children who have been in contact with the patient are separated for 35 days. School classes for contact persons are held in the same class. They dine last in the canteen and are not allowed to be on duty in the canteen. They are subject to medical supervision (thermometry, questioning, examination of skin and stool). Children of preschool institutions are observed daily, schoolchildren - weekly. Passive immunization with immunoglobulin is carried out in the outbreak: at the age of 6 months to 10 years, 1 ml of the drug is administered, for older children - 1.5 ml. If there are clinical indications, laboratory tests (ALT and AST) are performed.

Control questions

1. What diseases belong to the group of viral hepatitis? Name the mechanism of infection transmission. 2. What periods are distinguished during the course of the disease? Describe the features of the course of hepatitis A and B. 3. What laboratory tests are performed for VH? 4. Name the basic principles of treating patients. Tell us about the features of care. 5. What is the prevention of hepatitis diseases with fecal-oral and parenteral transmission mechanisms? 6. What activities are being carried out at the source of infection?”

HIV infection

* Definition * Etiology * Epidemiology * Pathogenesis * Clinical picture * Diagnostics * Treatment * Prevention ® Actions in the outbreak * Medical and psychological features of the work of a nurse with infectious patients

HIV infection is an infectious process characterized by a slow course, damage to the immune and nervous systems, and the development of progressive secondary infections and neoplasms, ending in death.

AIDS is the terminal phase of HIV infection, in most cases occurring after a long period of time from the moment of infection.

Etiology. The disease is caused by the human immunodeficiency retrovirus - HIV 1, 2, 3. The causative agent is heterogeneous and genetically has a high degree of variability. Stability in the external environment is relatively low. In its native state in the blood on environmental objects, the virus retains its infectious ability for up to 14 days, in dried form - up to 7 days. The pathogen quickly dies when boiled and exposed to disinfectants. Resistant to UV and y-radiation in doses usually used for sterilization.

Epidemiology. The reservoir and source of the pathogen is a sick or HIV-infected person. The highest concentrations of the virus are found in blood, semen, female genital secretions, and cerebrospinal fluid. HIV is found in lower concentrations in amniotic fluid, breast milk, saliva, sweat, tears, feces, and urine.

Infection of children with HIV can occur from an infected mother during pregnancy, childbirth, and breastfeeding. The probability of a child becoming infected from an HIV-infected mother is 25-50%. Infection is possible through blood transfusions containing the virus, when blood and biological fluids from HIV-infected people come into contact with unprotected skin and mucous membranes, in the case of using “contaminated” (insufficiently processed or reused) medical instruments, syringes, catheters. Infection can occur through sexual contact with someone infected or sick with HIV.

Homosexuals, drug addicts, people who are promiscuous, and patients with hemophilia are at risk of infection. The risk group also includes medical workers who, due to the nature of their work, are constantly in contact with the blood and biological fluids of patients.

Pathogenesis. The immunodeficiency virus enters the human body through damaged skin or blood. The virus shows particular selectivity for T-lymphocytes. Viral proteins are synthesized inside the infected cell, the virus penetrates the cell nucleus and integrates into the DNA, remaining latent for a long time. Rapid reproduction of the virus begins after immune stimulation of T-lymphocytes due to reinfection, under the influence of diseases, intoxication, and chemotherapy drugs. Disturbances in the system of cellular regulation of the immune response make an HIV patient vulnerable to infection and the development of tumors.

Clinical painting. The incubation period ranges from 3 days to 3 months. It often extends for up to 1-3 years. The body's primary reaction to the introduction of HIV is the production of antibodies. The clinical course of HIV infection is divided into three stages: / stage - asymptomatic. It includes periods of initial manifestations (acute infection), asymptomatic infection and persistent generalized lymphadenopathy.

Acute infection is detected in 50-90% of infected individuals. The duration of clinical manifestations varies from several days to several months. The clinical picture is manifested by sore throat, generalized enlargement of lymph nodes, enlargement of the liver and spleen, periodic fever, sometimes rash and diarrhea. Aseptic meningitis may develop.

Asymptomatic infection (virus carriage) is characterized by the absence of clinical manifestations of HIV infection. There may be a moderate enlargement of the lymph nodes. Diagnosis of this stage is based on epidemiological history and laboratory tests.

Persistent generalized lymphadenopathy is manifested by persistent, more than 3 months, enlargement of two groups of lymph nodes in the absence of objective reasons for their damage.

Lymph nodes are moderately enlarged (more than 0.5 cm in diameter), sometimes painful, not fused with the surrounding tissues and with each other, they can decrease and increase in size again. The duration of stage I can vary from 2-3 to 10-15 years. // stage -- pre-AIDS. Patients begin to exhibit clinical symptoms indicating deep damage to the immune system. Characterized by weight loss of more than 10%, unexplained fever for more than 3 months, unexplained diarrhea lasting more than 1 month, profuse night sweats, chronic fatigue syndrome. Bacterial, fungal and viral lesions of the mucous membranes and skin, inflammatory diseases of the respiratory tract, which acquire a protracted course, are typical. The nervous system and internal organs are affected. Kaposi's sarcoma may be detected.

/// stage - AIDS. It is characterized by the development of severe, life-threatening secondary diseases and their generalized nature. Damage to the central nervous system and other organs and systems is irreversible. The death of the patient occurs within a few months.

HIV infection is characterized by a long course. In some cases, the disease develops more quickly and after 2-3 years it enters the terminal stage.

There are features of the course of HIV infection in young children. The disease is characterized by faster progression of the process compared to adults. The course of the disease is determined by the properties of the virus strain and the timing of perinatal infection of the child. The most common clinical signs are encephalopathy and delayed psychomotor and physical development. Thrombocytopenia is common, clinically manifested by hemorrhagic syndrome, which can cause death in children. More often than in adults, recurrent bacterial infections, enlarged pulmonary lymph nodes, and interstitial lymphoid pneumonitis occur. Kaposi's sarcoma is rare.

Laboratory diagnostics. Methods used to diagnose the disease are divided into three groups: 1) methods aimed at identifying specific viral antibodies - enzyme-linked immunosorbent assay (ELISA) and immunoblotting (IB) reactions. In children born to seropositive mothers, maternal antibodies circulate in the blood during the first year of life. Therefore, detection of HIV antibodies is not sufficient to diagnose HIV infection; 2) methods that detect viral particles and other components of HIV in blood cells, saliva, tear and seminal fluid, as well as those obtained from the study of biopsies of organs and tissues. They are determined by the molecular biological method using polymerase chain reaction (PCR), DNA hybridization and DNA amplification; 3) methods based on identifying an immunodeficiency state. In general and biochemical blood tests, lympho- and thrombocytopenia, dysproteinemia, changes in the number and ratio of T-helpers and T-suppressors are determined (normally 1.6-2.2; in patients - less than 1).

The diagnosis of HIV infection in children is considered confirmed if: 1) an HIV-seropositive child or a child born to an HIV-infected mother under 18 months has a positive HIV test result in two blood samples taken at different times; 2) a child over 18 months has repeatedly detected anti-HIV antibodies in ELISA and IB or immunofluorescence reactions; 3) the child has an AIDS-indicating disease (candida cytomegalovirus, herpes, pneumocystis infections, cerebral toxoplasmosis, etc.).

Treatment. Modern therapy helps delay the development of the disease at intermediate stages, delaying the terminal phase. Basic etiotropic therapy includes antiviral therapy (aimed at containing the multiplication of the virus in cells) and chemoprophylaxis of secondary diseases.

The main antiviral drug is azidoti-midine (timazide, retrovir, zidovudine). To slow down the progression of the disease, combination therapy is used. It includes the prescription of three drugs: invirase (kriksivan and etc.), azidothymidine, lamivudine (zalcitabine and etc.). Sulfonamide drugs are used to prevent secondary diseases (biseptol, septrin, dapsoi), antifungal drugs (nystatin, fluconazole, ketoconazole), antituberculosis drugs (isoniazid, rifampicin). According to indications (in case of contact with chickenpox, measles), multicomponent immunoglobulin drugs are administered intravenously or intramuscularly. Lymphocyte transfusions and bone marrow transplants are performed. Symptomatic and restorative therapy is carried out according to an individual program.

Prevention. The World Health Organization (WHO) identifies four main areas of prevention.

HIV infection: 1) prevention of perinatal transmission of HIV during family planning; 2) prevention of transmission of infection through blood; 3) prevention of sexual transmission of infection; 4) organization of medical care and social support for patients, their families and others.

Prevention of nosocomial infection includes the use of single-use medical instruments, conducting research to detect HIV in donated blood, its preparations and other biological materials, strict adherence to the requirements of the anti-epidemic regime, and rules for sterilization of medical instruments.

Professional infection health workers can be prevented by observing precautions when providing medical care and serving patients, transporting and working with blood and other biomaterials, and carrying out emergency measures in case of injuries.

When performing manipulations that violate the integrity of the skin and mucous membranes, conducting laboratory tests, processing instruments, linen, and cleaning, it is necessary to use personal protective equipment (surgical gown, cap, mask, goggles or shield, gloves, waterproof apron and oversleeves). Medical workers with injuries (wounds) on their hands, exudative skin lesions, and weeping dermatitis are excluded from medical care for patients and contact with items used to care for them for the duration of their illness. Medical instruments, equipment, linen, dishes contaminated with blood and biological fluids that come into contact with mucous membranes must be disinfected immediately after use. Disinfection regimes are similar to those used to prevent infection with hepatitis B, C, D.

Health care workers must take precautions when handling cutting and piercing instruments. To prevent injury from needles, they should not be reinserted into the sheath or removed from the syringe after injection. Used instruments, syringes with needles must be immediately placed in a container for disinfection (sterilizer, bin). Before immersing the syringe with a needle in the disinfectant solution, only the plunger is removed.

When collecting blood and other biological fluids, the use of glass objects with broken edges is not allowed. You cannot draw blood from a vein through a needle directly into a test tube (unless this is stipulated by the research technology). Any containers with blood and other biological fluids, tissues, or pieces of organs must be closed with plastic stoppers immediately at the collection site.

Transportation of blood samples and other biomaterials should be carried out in racks placed in containers (boxes or pencil cases) that prevent the opening of the lids along the way. It is prohibited to use cardboard boxes, wooden boxes, plastic bags for this purpose, or to place forms, directions or other documentation inside the container. To disinfect leaked liquid in the event of overturning or breaking of dishes, a 4-layer dry napkin or one soaked in one of the disinfectant solutions is placed on the bottom of the container. When sending blood for HIV testing, it is unacceptable to soak a napkin with chlorine-containing drugs.

Workplaces are provided with first aid kits for emergency prevention in emergency situations. Any damage to the skin, mucous membranes, or contamination with biological fluids of patients is regarded as possible contact with materials containing HIV and requires immediate implementation of measures to prevent infection.

Events V hearth. Anti-epidemic work begins from the moment positive test results for HIV infection are detected in at least two blood samples. Information is anonymously transmitted to the district and Republican AIDS centers (f. 264/u-88, 60/u-88), as well as to the donor center with a prohibition on the collection of donor blood. The HIV-infected person and his parents are informed in writing about the presence of the immunodeficiency virus in the body.

Among contacts, persons who could be infected are identified. The following are subject to medical supervision: 1) children born from an HIV-infected mother. They are followed for 18 months. HIV testing is carried out at 12 and 18 months; 2) contact persons from the source of HIV infection. They are observed for 1 year after cessation of contact with the infected person; 3) medical and other workers in the event of an accident - within 6 months. The examination is carried out immediately after the accident and after 6 months.

The importance of treatment with antiviral drugs is explained to children and parents. The duration of the latent phase and the risk of developing secondary infections depend on the state of the immune system. That's why healthy image life, balanced nutrition, adherence to a daily routine, and timely vaccination play a significant role in preventing an immunodeficiency state. Vaccinations for children with suspected perinatal HIV infection and HIV-infected people in the latent stage of the disease are carried out according to general rules.

The HIV-infected person and his parents are introduced to the essence of the disease, routes of transmission of infection and prevention of infection when caring for the patient. The importance of regular primary care is emphasized, the need to keep a diary recording symptoms of the disease and taking medications.

HIV-infected women are advised to avoid or terminate pregnancy, and pregnant women are advised to take antiviral medications throughout pregnancy and during childbirth. Delivery is carried out by caesarean section. It is recommended to feed the newborn with adapted milk formulas.

Control questions

1. Characterize the causative agent of HIV disease. 2. How does HIV infection occur? 3. Describe the clinical picture of the disease, features of manifestation in young children. 4. List the methods for diagnosing HIV infection. 5. What medications form the basis of treatment? 6. How is HIV infection prevented?"

Medical and psychological features of a nurse’s work with infectious patients

The psychology of an infectious patient differs markedly from that of somatic patients. This is due to the contagiousness of the infectious disease, the need to isolate the patient from family members and a change in the usual environment. Children often develop fear, and adolescents develop shyness and a feeling of unreasonable guilt before loved ones and relatives. Children try to hide the disease, harming the health of themselves and those around them, since those who continue to communicate with them are at risk of infection.

Hospitalization in the infectious diseases department is accompanied by fear of children and their parents of becoming infected with other infectious diseases. All this obliges the nurse to conduct individual health-educational and psychotherapeutic conversations with the sick child and his parents; explain the essence of infectious diseases, routes of infection and preventive measures; explain that isolation is temporary and is not caused by the severity of the condition, but by a real danger to others. The patient's relatives should be sufficiently informed about the degree of contagiousness or sanitization of the ill child, which will ensure the establishment of correct relationships between the former patient in the family and with others.

Parents and children should be convinced of the reliability of the preventive measures carried out in the department to ensure the prevention of nosocomial infections. Strict adherence by the medical staff of the department to the sanitary-hygienic and anti-epidemic regime will have a great psychotherapeutic effect. The reliability and demonstrativeness of disinfection measures calm the psyche of the patient and parents, make them more contactable, and instill confidence in recovery.

When working with HIV patients, deontological aspects are especially important. Due to the predetermined fatal outcome of the disease, the attitude towards the patient, regardless of the route of infection, should be imbued not with condemnation and fear, but with pain and compassion. The patient must have complete confidence in maintaining medical confidentiality. Only with this indispensable condition can one count on the patient’s frankness, which is so important when making a diagnosis and for specifying preventive measures.

Hepatitis is a dangerous infectious disease that occurs acutely in children and can lead to the most tragic consequences. Along with this, hepatitis is successfully treated today; the main thing is to seek help in time and be attentive to the specialist’s instructions.

We will talk about how the 3 most common types of infection among children are manifested, diagnosed and treated: hepatitis A, B and C. Is hepatitis transmitted from mother to child? How important is it to follow a therapeutic diet? Is the disease always accompanied by jaundice? Let's answer all these questions.

All hepatitis viruses are resistant to environmental influences, which allows them to safely withstand long periods while outside the host’s body. For example, a virus hepatitis A is able to live for about six months in water, which is why it is so often infected in dirty reservoirs, or by eating aquatic inhabitants that have not undergone sufficient heat treatment. Although just 5 minutes of boiling is enough to kill the virus.

Hepatitis B exhibits resistance to many disinfectants. In a low temperature environment, such as your refrigerator, it can live for about 6 years. Even boiling kills the virus only after half an hour of exposure.

Hepatitis C – one of the most dangerous viruses – can live in a house at normal room temperature for up to 4 days. You can destroy it by boiling it for two minutes or, for example, by washing contaminated clothing for 30 minutes at a water temperature of 60 degrees.

Thus, a child can become infected with hepatitis by drinking water or fish from dirty reservoirs, contaminated food, or simply by being in a room where there is a virus. In addition, the infection can be found in vegetables, berries and fruits, especially those that are in direct contact with the ground (strawberries, zucchini, carrots).

The virus is also transmitted from a person who is sick or a carrier through blood (through contaminated medical instruments, through blood transfusions, using the patient’s hygiene items). As for transmission from mother to child, the greatest likelihood of such infection is present if the mother is sick with hepatitis B; the hepatitis C virus is transmitted in this way relatively rarely. It is important to know that the virus is not transmitted through breast milk, however, the child can become infected if the mother’s nipples have cracks and at least some blood is released through them.

Incubation periods:

• hepatitis A - 7-50 days;
• hepatitis B – 7-12 days;
• hepatitis C – 49-56 days.

Symptoms and course of the disease

Hepatitis A popularly called jaundice. However, traditional icteric symptoms are by no means necessary for this disease. Signs of hepatitis A in children depend on the form in which the disease occurs. The following types of illness are distinguished.

1. Typical icteric. In the first week, the child develops a high temperature, which stays at 38–39 degrees for several days. Pain occurs in the abdomen and head, often they do not have a specific localization, and the baby cannot show where exactly it hurts. There may be nausea, vomiting, weakness, loss of appetite. The urine darkens, and the feces, on the contrary, lose their normal color. The liver and spleen increase in size.

The second week brings with it the manifestation of icteric symptoms. They develop gradually and begin with yellowing of the sclera of the eyes, mucous membranes, ears and skin on other parts of the body. Then jaundice reaches a peak and declines. Other symptoms also become less pronounced, however, the urine remains dark and the liver becomes denser.

2. Icteric with cholestaticcomponent. In general, this form is characterized by the same symptoms as the previous one. However, the icteric period is more pronounced and longer + there is skin itching.

3. Atypical jaundice. It occurs rarely, mainly in teenage children. Symptoms of intoxication are practically absent, but icteric signs and skin itching are very pronounced.

4. Anicteric. Manifested by weakness, abdominal pain, lack of appetite, however, all these symptoms are mild. It also happens that parents do not attach importance to them at all, due to their dim manifestation, triggering the disease.

5. Hardwareand subclinical. This form is characterized by an absolute absence of external symptoms. The only thing that may raise suspicion is a slight increase in the size of the child’s liver.

The disease lasts from one week to 2 months and may end spontaneously. The recovery period for the body takes about six months.

Signs of hepatitis B in children are similar to those characteristic of the type A virus. These are weakness, nausea and vomiting, loss of appetite, bitterness in the mouth. This also includes pain and bloating, jaundice of the mucous membranes and skin. If the disease lasts for a long time, bleeding from the nose and gums may begin. The liver and spleen increase in size. Urine acquires dark color, feces, on the contrary, become lighter.

It is noteworthy that during periods of remission, these signs of hepatitis B are less pronounced, and some may be absent altogether.

For hepatitis C in children, as with other forms of the disease, weakness, nausea, vomiting and loss of appetite are characteristic. There is pain in the abdomen and the temperature rises to 38.5 degrees. With this form of the disease, icteric symptoms appear in only a third of affected children. First, the sclera of the eyes turn yellow, then the mucous membranes and skin. At the same time, other manifestations of the disease intensify. The urine darkens, and the stool, on the contrary, becomes discolored. The liver is enlarged and often painful.

Hepatitis C in a child can be acute, protracted or chronic and last, respectively, less than 3 months, from 3 to 6 or more than six months. In the chronic course of the disease, it practically does not manifest itself at all, but has a destructive effect on the liver. It is hepatitis C that leads to serious consequences, for example, to the development of cirrhosis of the liver in a child, severe kidney disorders, and so on.

Diagnostics

If a child is suspected of having viral hepatitis, parents should take the child to a pediatrician or infectious disease specialist. The specialist will examine the little patient and prescribe the following tests.

1. Biochemical blood test. If one of the hepatitis viruses is present in the blood, an increased concentration of bilirubin and the liver enzymes aspartate aminotransferase (AST) and alanine aminotransferase (ALAT) are detected in it. In addition, there is an increased thymol test.
2. Blood test for antibodies. The analysis allows the specialist to determine at what stage the disease is and how severe it is for the body.
3. PCR, or polymerase chain reaction. Shows whether there is a virus in the patient's blood.
4. ELISA, or enzyme immunoassay. Shows how actively the hepatitis virus develops in the child’s blood.

In addition to blood tests, the doctor may prescribe an ultrasound of the abdominal cavity. This method of diagnosing hepatitis in children allows you to obtain several indicators at once:

• the size of the liver, spleen, gallbladder and pancreas;
• the size of the vessels of the liver and spleen;
• pathological processes occurring in these organs, changes in their structure.

In addition, ultrasound helps determine the appropriate area for puncture of a liver biopsy, another research method. Biopsy today is one of the most informative methods for diagnosing hepatitis. It is carried out quickly, is safe and allows you to evaluate changes occurring in the structure of the liver at the microscopic level.

Treatment

After tests have been performed and the nature of hepatitis has been clarified, therapy is prescribed. In general, the treatment of viral hepatitis in children of types A, B and C follows the same principles.

Treatment can be carried out both at home and in a hospital. The first option is possible if the disease is sluggish and the child feels relatively normal. Otherwise, the baby will have to go to the hospital.

The treatment strategy depends on the degree of the disease and the condition of the little patient. As a rule, therapy is symptomatic and includes the following drugs:

• enterosorbents for removing toxins,
• antioxidants,
• drugs to improve blood circulation and metabolic processes,
• antiviral agents,
• glucocorticoid hormones,
• hepatoprotectors to protect liver cells.

All these treatments for hepatitis in children are prescribed by a doctor only on the basis of research. Under no circumstances should you self-medicate - this can lead to unpredictable negative consequences.

The child is discharged from the hospital only after all symptoms of the disease disappear and the liver returns to normal size. Then, every 3 months the little patient will have to undergo examinations, and so on for one year, unless the doctor prescribes a different period.

If the baby is at home, parents must follow strict recommendations for its treatment, especially at first.

Bed rest

Complete rest and bed rest are prescribed as long as the child suffering from viral hepatitis continues to have any symptoms of intoxication.

Drinking regime

The child needs to drink a lot to recover water balance in the body and remove toxins. So, with a moderate form of hepatitis A, children should drink 1.5–2 liters of water. Of course, it will be difficult for the baby to drink so much liquid in a day, so the norms are determined individually. You shouldn’t force your child to drink if he can no longer drink, but making sure he drinks fluids throughout the day is necessary.

Diet

This is one of the main points in the treatment of hepatitis in children. If a child has signs of intoxication, a fruit and sugar diet must be followed for 1–2 days. It should be accompanied by a sufficient amount of liquid: 5% glucose solution, sweetened tea, compote or rosehip decoction. Then you can include jelly, fruit, berry and vegetable juices, as well as vegetable decoctions in your diet. Then add pureed, liquid milk porridge. This diet is usually provided in a hospital setting.

When the symptoms of toxicosis subside , and the child will feel better, he can be fed lean fish and meat. Dishes should be soft, steamed or boiled. Souffles, mashed potatoes, and meatballs are perfect. You can also serve cereals and vegetables in boiled and grated form. Dairy and vegetable soups are allowed. Fruits and berries are served in the form of juices.

In case of hepatitis in children, the further diet should correspond to Table No. 5a according to the nomenclature of the Institute of Nutrition of the Russian Academy of Medical Sciences. When the child’s condition stabilizes, he is transferred to Table No. 5. The menu for this diet is built on the same principles as Table No. 5a. It will be useful for the mother to become familiar with it, since dietary nutrition should be maintained from 6 months to a year after the child is discharged from the hospital. It is very important to follow a diet; the baby’s condition depends on it. This means that the mother needs to approach the issue with all responsibility. It would not be an exaggeration to say that now the child’s health is entirely in the hands of the one who organizes his nutrition.

Diet food Table No. 5

Product group	Name of recommended products	Permitted method of preparation	Prohibited Products
Bread	Wheat	Yesterday's baking	Fresh bread, puff pastries and butter dough, fried in oil
Meat	Low-fat; beef, rabbit, turkey and skinless chicken	Boiled, steamed. In the form of cutlets, quenelles, purees, soufflés and dishes with minced meat	Duck, goose. Kidneys, liver. Smoked meats, most types of sausages
Fish	Low-fat; pike, pike perch, cod, perch	Boiled, steamed. In the form of cutlets, quenelles, purees, soufflés, etc.	Salted, smoked, canned
Soups	Low-fat; with vegetable broth, dairy	Boiled, mashed
Cereals and pasta	Everything except the prohibited ones	Boiled. Mashed porridge	Legumes. Wheat, barley and pearl barley porridges are undesirable
Eggs	Omelette	For a couple	Hard boiled, fried
Fruits and berries	Non-acidic, non-astringent varieties, dried fruits	Baked, boiled pureed, jelly, jelly, mousses
Vegetables	Everything except the prohibited ones	Fresh, boiled, baked, stewed; rubbed	Spinach, radish, sorrel, fresh and green onions, radish, garlic, mushrooms, marinades
Dairy and fermented milk products	Whole milk, low-fat and half-fat cottage cheese, sour cream as a dressing for dishes, fresh yogurt, butter, mild cheese with a low fat content	Fresh; Cottage cheese can also be served in the form of casseroles, puddings, etc.	Cream, fermented baked milk and other products with a high percentage of fat content
Sweets	Honey, jam, marshmallow, marmalade. Snowballs, meringues. Kissels, compotes, mousses, sambucas		Cream products, ice cream, chocolate
Beverages	Tea, coffee with milk. Berry, fruit, vegetable juices. Decoctions of wheat bran and rose hips.	Warm	Black coffee, cocoa. Cold and hot drinks

All food and drinks must be warm. High or low temperature of food is under no circumstances allowed. Subsequently, the degree of food processing (softening, rubbing) can be reduced. The child should eat 5 times a day in small portions. This is very important so as not to put stress on the liver.

Sample menu for the day

1st breakfast: milk oatmeal + cottage cheese seasoned with sour cream and sugar + tea.

2nd breakfast: baked apple.

Lunch: vegetarian vegetable soup with vegetable oil+ boiled chicken meat in milk sauce with a side dish of rice + compote.

Afternoon snack: marmalade + rosehip decoction

Dinner: boiled fish in white sauce with a decoction of vegetables + mashed potatoes + cheesecake with cottage cheese + tea.

A mother should not worry about her child’s malnutrition after he has had viral hepatitis. Diet Table No. 5 includes all the substances that are necessary for the full development of a growing organism. It also allows mom to cook a wide variety of dishes.

Lifestyle during recovery

A child who has had viral hepatitis must refrain from intense physical activity for up to six months. During this time, schoolchildren are exempt from physical education lessons. You can't swim, ski, or run. In addition, you should not sunbathe in the sun.

However, small loads only contribute to a speedy recovery. You need to find out from your doctor what kind of physical therapy your child can do. The set of exercises is determined by the individual characteristics of the little patient’s condition and the severity of the disease.

Viral hepatitis is a serious disease, especially for children. But if you take care of your baby, pay attention to his condition and strictly follow all the doctor’s recommendations, very soon his life will return to normal, and you will no longer remember the disease that has receded.

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