Nutrition Support of Children With Chronic Liver Diseases

Publication Date: October 1, 2019
Last Updated: March 14, 2022


Chronic cholestatic liver disease

1. Beyond weight and height measurements, clinicians should monitor mid-upper arm circumference (MUAC) and triceps skin folds (TSF) serially in patients with chronic liver disease. The frequency of the measurements depends on the nutritional status and can range from every 2 weeks to 3 months.
2. A careful, nutrition focused, physical examination is recommended in every clinic visit.
3. Clinicians should familiarize themselves with the limitations of nutritional biomarkers in the context of chronic liver disease.
Nutrition support of cholestatic infants should be optimized to prevent and treat nutritional deficiencies.

Cirrhosis/end-stage liver disease

5. Nutritional status, growth, and eating habits should be closely monitored. The frequency of monitoring depends on the severity of malnutrition and severity of liver disease and can range from every 2 weeks to every 3 months.
6. Increased feeding frequency, increased caloric density of consumed foods and use of modular supplements should be used as needed.
7. Nasogastric/nasojejunal feeding should be considered, when appropriate.
Parenteral nutrition can be used when enteral nutrition (oral, gastric, and jejunal) is not tolerated or fails to achieve growth targets.

Post Liver Transplantation (LTx)

9. A formal assessment of nutritional status is recommended for all children before and after liver transplantation, the frequency of which depends on the nutritional status and can range from every 2 weeks to every 3 months and should occur until adequate growth patterns (achieve at minimum body mass index (BMI)>-1 standard deviation (SD) and/or MUAC>-1 SD without deceleration in weight for length z-score) are established post-LTx.
10. Nutritional interventions (provision of appropriate calories to achieve MUAC and TSF> 10th percentile for age, correction of micronutrient deficiencies) to optimize nutritional status in the peritransplant period should be implemented, as they are associated with improved patient outcomes.
11. Liver transplant recipients should be screened for overweight/obesity and hypertension at every routine medical encounter. Patients should also be tested for other metabolic syndrome-related complications, such as dyslipidemia and insulin resistance at minimum annually.
Monitoring of bone health is advised in liver transplant recipients; particularly the first 2 years post LTx. Monitoring with laboratory investigations should occur every 3-6 months.

Recommendation Grading




Nutrition Support of Children With Chronic Liver Diseases

Authoring Organization

Publication Month/Year

October 1, 2019

Last Updated Month/Year

July 28, 2023

Document Type


External Publication Status


Country of Publication


Inclusion Criteria

Male, Female, Adolescent, Child, Infant

Health Care Settings

Ambulatory, Hospital

Intended Users

Nurse, nurse practitioner, physician, physician assistant


Diagnosis, Assessment and screening, Treatment, Management


frailty, cirrhosis, malnutrition, metabolic bone disease, nutrient deficiencies

Supplemental Methodology Resources

Data Supplement