Non-alcoholic fatty liver disease (NAFLD) and its more advanced stage, non-alcoholic steatohepatitis (NASH), are on the rise among children in the United States, with more than 7 million kids thought to have the condition. Recently, the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition issued its latest guidelines for children with NAFLD, which included recommendations for screening, diagnosis and treatment.


All children between 9 and 11 years old who are overweight, obese or have other risk factors (family history, hypopituitarism) should be screened for NAFLD. Siblings and parents of children with NAFLD should be screened.

The recommended screening test for NAFLD is measuring alanine aminotransferase (ALT). This is a blood test. The normal ranges of ALT should be based on sex-specific upper limits of normal in children and not individual laboratory limits. Routine ultrasound is not recommended for children.

If the initial ALT results are normal and NAFLD risk factors remain unchanged, screen for NAFLD every two to three years.

Diagnosis and assessment

When evaluating a child for NAFLD, the medical provider will need to rule out all similar liver diseases. If non-alcoholic steatohepatitis (NASH) is suspected, a liver biopsy may be performed. NASH is a more advanced condition that occurs when fat accumulation has caused inflammation or damage to liver cells. Over time, cirrhosis may develop, which can lead to liver cancer or liver failure. Ultrasound and CT are not recommended for measuring the amount of fat in the liver.


Currently, there are no medications or supplements to treat NAFLD or NASH, but these can be managed by lifestyle changes. Good nutrition, maintaining a healthy weight and regular exercise are important. Children with NAFLD/NASH should avoid sugary beverages. Physical activity needs to be increased. It’s best to limit sedentary activities to less than two hours per day.

Adolescents with NAFLD or NASH should be advised to avoid alcohol, smoking, vaping and exposure to secondhand smoke. A recent study reported that NAFLD may worsen in teens with sleep apnea.

Children with NAFLD should visit their medical providers yearly. In addition to monitoring kids for any progression of liver disease, doctors should monitor kids’ blood pressure, diabetes and other obesity-related medical conditions.

Last Reviewed: January 30, 2019