Albumin helps to keep fluid within blood vessels. If the liver produces less albumin, its levels fall and fluid leaks out of blood vessels and collects in cavities and tissues in the body. When the fluid collects in the abdomen it is known as ascites. The fluid can also leak into the space between the lungs and the chest wall, which is known as pleural effusion.

Portal hypertension raises blood pressure in the veins around the abdominal organs, which leads to fluid leaking into the abdomen.

This can contribute to a build-up of fluid in the tissues and body cavities.

Fluid in the abdomen can make children feel full very easily. They may eat smaller portions and may vomit because there is less space in the abdomen. A dietitian will be able to advise and support you.

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The fluid in the abdomen can become infected by bacteria. This is called spontaneous bacterial peritonitis.

Any fever accompanied by pain or tenderness in the abdomen should be reported to the medical team immediately. This is usually treated with intravenous antibiotics.

The movement of small children and toddlers can be restricted due to their enlarged tummies. This means they may not develop as quickly as expected. A physiotherapist can advise you on exercises and activities to help support your child’s development and progress.

Ascites can sometimes make breathing difficult as there is less room for the lungs to expand. It’s important to inform the medical team if this is a problem. Sitting in a more upright position can help as well as using extra pillows when in bed.

A diuretic may be prescribed. This is a medication which helps the body get rid of extra fluid and will mean your child needs to urinate (wee) more often. A diuretic called spironolactone is commonly used.

Children taking diuretics have an increased risk of becoming dehydrated (not having enough fluid) if they have vomiting or diarrhoea. This should be reported to their doctor, as well as the fact that they are on diuretics and have liver disease.

A dietitian may recommend changes to your child’s diet to make sure they are getting enough nutrients and energy to support healthy growth. It is also important to reduce the amount of salt in their diet. Too much salt can make ascites worse. Try not to add salt to food and avoid foods that are high in salt, such as crisps.

Your child may be advised to drink less fluid. This should only be done if recommended by your child’s medical team. A doctor and dietitian will let you know if this is needed and will advise you on how much your child should drink.

If the level of albumin in the blood is very low it might be necessary to give your child albumin. This is done through a drip and it may need to be repeated on several occasions.

A thin needle is passed into the cavity in the abdomen. This is then attached either to a drain or to a syringe. A local anaesthetic is used to numb the area where the needle will be placed. This procedure is done using an ultrasound scan for guidance.