Chronic hepatitis B in children is mostly due to mother-to child transmission and risk of chronicity is highest when exposed in early infancy. The infection passes through different phases depending upon the degree of activation of immune system and status of HBeAg. Accurate assessment of each phase requires measurement of HBeAg, HBV-DBA and ALT. Treatment is indicated in those who are in HBeAg positive or negative hepatitis, in those with cirrhosis and extra-hepatic manifestations. Peg IFN and nucleos(t)ide analogues (NA) are the mainstay of treatment. Peg IFN though has a finite duration of treatment has many side effects. NA therapy with high barrier against resistance have fewer side effects but duration of therapy should ideally be until loss of HBsAg as even after HBeAg seroconversion chances of seroreversal or HBeAg negative hepatitis are there. Children undergoing immunosuppression should be screened not only with HBsAg but also with AntiHBc and NA prophylaxis should be initiated in those cases with high risk of reactivation.
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