Because of its size, the liver is the most easily injured abdominal organ in children. Located in the right upper area of the abdomen, the liver is right below the diaphragm. Most liver injuries are caused by blunt trauma from a car crash, fall, bike wreck or any other activity that causes a hard blow to the abdomen. A penetrating liver injury may also result from a gunshot wound or sharp object that tears or cuts the liver.

Function of the Liver

The liver is the largest solid organ in the body and is necessary for survival. The liver has many jobs:

• It makes bile, which helps with digestion
• It filters and cleans the blood and helps remove bacteria
• It stores carbohydrates, vitamins and minerals
• It makes proteins, glucose and clotting factors
• It breaks down hormones and certain drugs

Diagnosis of Liver Injury

Most children with liver injuries will have abdominal pain after the trauma or injury.

If a liver injury is suspected, the trauma surgery providers will thoroughly and carefully examine your child. X-rays, a computed tomography (CT) scan, ultrasound or blood tests may be done to determine how badly your child's liver is damaged.

The American Association for the Surgery of Trauma (AAST) grades liver injuries on a scale of 1-5. The grade is determined by the size and location of the injury seen on CT scan. Grade 1 is the least severe and 5 is the most severe.

Treatment for Liver Injury

Children with grades 1 or 2 liver injuries may be discharged from the Emergency Department or admitted to the hospital. Children with grades 3 - 5 liver injuries will be admitted to the general care unit or to the intensive care unit (ICU) for pain management, blood test, and close monitoring. Fortunately, most liver injuries are treated without surgery. Depending on the grade of injury, treatment can include strict bed rest, nothing to eat or drink for a short period of time, pain control, lab work, and IV fluid hydration. Blood transfusions can sometimes also be necessary.

If bleeding from the liver does not stop on its own, surgery to fix the damage and stop the bleeding may be necessary, but this is rare.

If your child has surgery, they will not be allowed to eat after surgery for some time. However, they will be given an IV (a small tube in their vein) for fluid hydration. Your child may also have a nasogastric tube (a tube through the nose into the stomach) after surgery to keep their stomach empty. Your child will be closely watched for any bleeding in the ICU, then moved to the general care unit as healing continues.

Medications and Pain Management

Speak to your trauma surgery provider about medications your child was taking prior to their admission to the hospital and obtain approval to resume home medications. Your child may have some pain or soreness at home. Give acetaminophen (also known as “Tylenol) for pain.

Your child's trauma surgery provider may also write a prescription for stronger pain medication. Give the stronger medication if the pain does not go away one hour after giving acetaminophen. Follow the directions on the prescription.

Do not give your child NSAIDs or ibuprofen (also known as "Motrin", "Advil", "Aleve" etc.) until the trauma surgery provider says that it is okay. Your child may require a stool softener while taking prescription pain medication to prevent constipation and straining with bowel movements.

Wound and Skin Care

Your child may shower or take a bath, but they may need help for several days after going home.

If your child has had surgery, check with your trauma surgery provider about taking a shower or bath.

Follow instructions given by the trauma surgery provider regarding any other injuries or wounds.

If your child has cuts or scrapes on the skin from other injuries, wash the areas with warm, soapy water and pat dry.

Activity After Liver Injury

Your child does not need to stay in bed but should walk and play quietly. while they heal. Your child should not rough play with family, friends or pets for several weeks. They may return to school in one to two weeks but your child will be on strict activity restrictions for some time. Strict activity restrictions include no gym, running, activities with wheels, or any activity in which both feet leave the ground at the same time. Your child should also not participate in any competitive / contact sports until the activity restriction time period is complete. The length of activity restrictions will depend on the grade of the liver injury.

Returning to Daycare or School

Your child may require some time off school to be at home to rest. Your trauma surgery provider will give you recommendations regarding going back to school. If surgery was needed or your child has other injuries, they may be out of school longer. At school, your child should not be taking gym class until the activity restriction time period is complete.

When to Call Your Trauma Surgery Provider

Call the trauma clinic or seek medical attention if your child has:

• Increased or worsening abdominal pain
• Fever higher than 100.5
• Difficulty with bowel movements
• Shortness of breath
• Nausea / vomiting
• Dizziness
• A fast heart rate
• Concern for wound infection (redness, swelling, pus drainage, or increased wound pain).

Emotional Recovery

After the injury, your child may be tired and irritable. It takes time to heal. Use this time for rest and quiet activities. Have your child play board games, read, or do small craft projects for short periods of time. Infants and toddlers are harder to distract and will be more difficult to confine. Try putting your infant or toddler in a large crib or playpen. Ask family and friends to visit, but for short periods of time and not at the same time to minimize activity.

After any trauma, children may experience acute stress symptoms that may be reflective of post-traumatic stress disorder (PTSD). If you notice your child having nightmares, flashbacks, nervousness, irritability or any other concerning emotional symptoms, please speak with the trauma surgery provider. Short-term therapy can be provided to help children heal and recover emotionally after a trauma. If concerned, call the Trauma Clinic at 513-636-8556.

Follow-Up / Contact Us

Usually no follow-up tests are needed; however, all children with liver injuries will receive a follow-up call or be seen in the trauma clinic two weeks after discharge. If needed, an appointment will be made for you before you leave the hospital or you will be given a number to call to make an appointment. The trauma clinic number is 513-636-8556.

Once it is OK for your child to return to normal activity, no further follow-up will be needed. After your child has healed, they are not at risk to hurt the liver again.

Preventive Action

It is very important to teach your child about all types of safety. Make sure your child is secured in an age-appropriate child restraint every time they ride in a vehicle. Children under 13 years old are safer in the back seat in the correct child restraint. For questions or to schedule a car seat safety check please call 513-803-7433.

Make sure your child wears the correct type of helmet when riding a bike, using other wheeled toys, or taking part in other active sports.

For more injury prevention tips and resources visit our Comprehensive Children’s Injury Center.