Clinical investigations from the RACP

A child with jaundice: is this one for the family physician?

Edward O’Loughlin



An important principle in childhood liver disease is that some disorders are curable if diagnosed and treated early but can lead to end-stage liver disease if missed.

Key Points

  • The first step is to determine if the jaundice is due to haematological or hepatobiliary disorders, i.e. conjugated or unconjugated hyperbilirubinaemia.
  • Childhood liver disease resulting in jaundice can be due to either acute liver injury or an acute exacerbation or decompensation of chronic hepatobiliary disease.
  • Some hepatobiliary disorders presenting in childhood are potentially ‘curable’ if diagnosed early.
  • Physical or biochemical evidence of liver synthetic failure or encephalopathy is a life-threatening scenario and requires urgent referral to a paediatric tertiary centre.
  • Assessment of synthetic function is mandatory. Low serum albumin, or abnormal coagulation not responding to vitamin K, indicates liver synthetic failure.