Symptoms & Causes of NAFLD & NASH in Children

What are the symptoms of NAFLD in children?

Usually, nonalcoholic fatty liver disease (NAFLD)—including nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH)—is a silent disease with few or no symptoms. Children may not have symptoms even if they develop cirrhosis due to NASH.

Once symptoms arise, however, a child may already have permanent liver damage. If children do have symptoms from NASH, they may feel tired, become tired easily, or have discomfort over the liver, in the upper right side of the abdomen.

What causes NAFLD in children?

Experts are still studying the causes of NAFLD. Research suggests that certain health problems, genes, and other factors may make some children more likely to develop NAFLD.

Health problems

Children with the following health problems are more likely to develop NAFLD

Doctors may not be able to diagnose metabolic syndrome in children younger than age 10. Children in this age group may still have traits of metabolic syndrome.

Experts do not know for sure why some children with NAFLD have NAFL while others have NASH. Research suggests that NASH is more common in children who have both NAFLD and type 2 diabetes.3


Certain genes may increase a child’s chance of developing NAFLD. These genes may explain why NAFLD is more common in Hispanic and Asian American children than in Black children. Genes may also explain why NAFLD sometimes runs in families.

Experts are still studying the genes that may play a role in NAFLD.

Other factors

Scientists are studying other factors that may play a role in causing or worsening NAFLD in children. These include

  • birthweight. Research suggests that children who had a high or low birthweight are more likely to develop NAFLD.
  • changes in the microbiome—the bacteria in the digestive tract that help with digestion. Studies have found differences between the microbiomes of children who have NAFLD and those who do not.
  • diets high in fructose—a sugar that is part of table sugar and is also commonly added to sweeten drinks and foods. Studies suggest that diets high in fructose may increase the risk of NAFLD.

Is NAFLD the only cause of fatty liver in children?

Fatty liver may have causes other than NAFLD. If medical tests suggest that a child has a buildup of fat in the liver, the doctor may ask questions and order tests for other causes.

Other causes of fatty liver in children include


Last Reviewed December 2021
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This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.