Liver Injuries

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 1-5. The grade is determined by the size and location of the injury in the liver seen on CT scan. Grade 1 is the least severe and 5 is the most severe.

Treatment for Liver Injury

Typically, children with grade 1 - 4 liver injuries are admitted to the general care unit. Children with grade 5 liver injuries may be admitted to the general care unit or to the intensive care unit (ICU). 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, he / she will not be allowed to eat after surgery for some time. However, he / she will be given an IV (a small tube in their vein) for fluid hydration. He / she 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 in the ICU after surgery for a few days to watch for any bleeding, 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 he / she may need help for several days after going home.

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

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

Activity After Liver Injury

Your child does not need to stay in bed but should walk and play quietly. 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, competitive/contact sports, activities with wheels, or any activity in which both feet leave the ground at the same time. After the initial strict activity time period, he / she should not participate in any competitive/contact sports until instructed by the trauma surgery provider. 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 your trauma surgery provider says it's okay. Your child should leave class five minutes before the other students, to avoid bumping into other children in the halls. Your child should not carry or lift more than one to two textbooks at a time, even if he / she carries a book bag or backpack.

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 >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.

Follow-up / Contact Us

All children with liver injuries will be seen in the trauma clinic two weeks after discharge.

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.

Usually, no follow-up testing is needed. Once it is OK for your child to return to normal activity, no further follow-up will be needed. After your child has healed, he / she is 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 restraint every time they ride in a vehicle. Children under 13 are safer in a backseat in the correct restraint.

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

Last Updated 04/2019

Who treats this.

The Trauma Clinic provides follow-up care to traumatically injured children.