Getting ahead of concerns about fatty liver disease in children

Growing up, I was very much a daddy’s girl. My dad had a lively personality that helped him make instant friends wherever he went, sometimes forming decades-long friendships from a single interaction. His charisma stood in contrast to my introverted mother, whose quiet grace offered me peace from the stresses of adolescence. She was a gentle listener who nudged me to make kind choices. My father was more brash, but caring in his own way. I like to think I inherited the best of both.

My daughter and I, however, are both happy extroverts. We’re often a little loud, but usually because we’re laughing at something ridiculous. We share a dry and weird sense of humor. A few years ago, we took a DNA test to explore our heritage, and the results reminded me that there are plenty of genetic traits I don’t share with her — ones she gets from her father. As someone living with metabolic dysfunction-associated steatohepatitis (MASH), I can’t help but wonder what health markers might be in her future.

At 14, my daughter has been a healthy kid. I try to keep her soda, fried food, and other teenage delicacies within reasonable limits. I cajole her into drinking milk for her bones. She still takes polite “no, thank you” bites of suspicious vegetables. My goal is to keep her diet balanced but not so strict that she feels deprived of childhood goodies. There is a fine line between helping and over-policing.

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Protecting our children against liver disease

If you’re managing your own MASH diagnosis and have children, you may have wondered if the disease could affect them. According to an article published last year in The Journal of Clinical Investigation, about 10% of children in the U.S. have metabolic dysfunction–associated steatotic liver disease (MASLD), the precursor to MASH. And the prevalence of pediatric fatty liver disease is rising.

MASH is marked by inflammation and tissue damage, which cause symptoms many of us adults know all too well. I wouldn’t wish them on any child.

How might a parent know if their child is affected by this often-silent condition? Some children show signs of lethargy or fatigue. Others may complain of abdominal pain on the right side, where the liver sits. Excessively dry skin can also be a sign, and some children present with no obvious symptoms at all. If you notice any changes, talk with your child’s pediatrician. Early detection means early intervention, which improves long-term outcomes.

For decades, public health officials have worried about childhood obesity — a concern that now makes more sense than ever. As a former fat kid who spent most of her childhood on diets, I never understood the deeper medical fears behind all that talk. Recent findings show that U.S. children now get about two-thirds of their calories from ultra-processed foods. Instead of grabbing an apple, kids often grab a soda and chips before settling into several hours of screen time.

As parents, we are charged with protecting our kids. Ideally, they’ll never encounter violence at school or lose their future to trauma, but too much sugar, salt, and saturated fat can quietly take them out, too.

I’ve been guilty of overindulgence myself. Part of it is simply letting my daughter be a kid; the other part is that celebrations often involve cake — and I refuse to be the adult who stands between a child and their cake. In our house, every indulgence gets paired with a healthy follow-up. If she eats a toaster pastry for breakfast, she drinks a tall glass of milk with it. We don’t label foods as “good” or “bad.” We prefer “healthy” and “less healthy.” It gets the point across without shaming or moralizing.

If your child is significantly overweight, consider asking for liver function labs at their next checkup. And talk to them — gently. Try not to comment on specific body parts. Even well-intended observations can hurt in ways parents don’t foresee. What I convey instead is that my daughter’s health — not her appearance — is what I care about. It reassures her that she is loved unconditionally and that what we’re working toward is resilience and longevity, not thinness.

One way my daughter and I stay active — especially on weekends when we’d rather stretch out like cats in a sunny patch — is by gamifying movement. We race timers while doing chores. We race each other to the corner of the block. We assign silly rewards like choosing the movie and dinner if she gets through a week without fast food. Fun matters. The more games you invent, the more likely kids are to say yes to movement.

If you have children, you likely want a better future for them. This is what I want for my daughter. I plan to live to at least 100, which gives me 44 more years to be her mother. I want us both to be healthy, but like most parents, I’m rooting for her life to be even better than mine. So far, I’ve got no complaints.

Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.

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