Autoimmune hepatitis in pediatric patients requires a carefully adapted approach. While management broadly mirrors adult guidance, children carry unique risk from long-term corticosteroid exposure — in particular the risk of growth failure — which must be explicitly addressed in the treatment plan.
This protocol applies to children and adolescents under 18 years of age diagnosed with autoimmune hepatitis. The cornerstone of treatment follows adult principles but requires specific adjustments to corticosteroid dosing and tapering targets to protect normal growth and development throughout treatment.
First-line management involves corticosteroid-based combination immunosuppression, with the corticosteroid component carefully weaned to a low pediatric maintenance level to limit growth-related side effects; initial workup also includes screening for an associated biliary condition that may further shape the full regimen.
The primary target is biochemical remission.
DOI: 10.1016/j.jhep.2025.03.017
Treatment of AIH in children should follow the same guidance as in adults except for tailored weaning of predniso(lo)ne to a maintenance dose of 2.5-5 mg/day to avoid corticosteroid-related side effects including growth failure (LoE 2, strong recommendation, strong consensus).
In children, it is recommended to screen for the presence of a cholangiopathy at diagnosis and if a diagnosis of AIH/PSC is made to add UDCA to the treatment regimen.
Biochemical remission on predniso(lo)ne, with or without azathioprine, has been reported in 75-95% within the first year after diagnosis.
View source ↗