As the living standard of Chinese residents continues to improve, under the influence of coaxing food and drink, loving to eat more and “captive” lifestyle, the incidence of obesity among Chinese children is getting higher and higher. Obese children are also growing at an annual rate of about 9%, which has cultivated a sufficient “reserve army” for the ensuing NAFLD. What are the characteristics of clinical manifestations and treatment of NAFLD in children? What are the risks? This is briefly described below. Nonalcoholic fatty liver disease is a major concern in adults, and its treatment is becoming more and more important because it is closely related to abnormal liver function, abnormal lipid metabolism, elevated insulin levels, and elevated blood sugar. In contrast, the development of fatty liver in children has received less attention and has not received sufficient attention. The following is an overview of the clinical features of nonalcoholic fatty liver in children. The majority of children with fatty liver are NAFLD, and obesity is the most important factor in the development of NAFLD in children. Reports from Hangzhou suggest that the incidence of NAFLD in children with moderate to severe obesity is as high as 68%, and the prognosis of NAFLD in children is worse than that of adults. (up to 68%) and can progress to cirrhosis and end-stage liver disease requiring liver transplantation. Waist circumference is strongly correlated with childhood NASH, and one study reported that after analyzing the relationship between waist circumference and NASH fibrosis in 197 children with Caucasian nonalcoholic fatty liver disease (NAFLD), it was found that 60% of children with more than 90% of normal waist circumference had significant liver fibrosis. However, NAFLD in children is generally not easily detected because most children with NAFLD have no obvious signs and symptoms, and a few children may present with general malaise, right upper abdominal discomfort, hepatomegaly or even xanthogranuloma, ascites, edema, and acanthosis nigricans, etc. NAFLD is familially aggregated, so those with a family history of obesity, fatty liver, type 2 diabetes, or cardiovascular disease should be alerted to the occurrence of NAFLD. In addition, more and more studies have shown that fatty liver in children not only has a greater chance of liver injury, but also is closely related to type 2 diabetes and atherosclerosis. Recent studies have shown that the prevalence of hyperuricemia in children with fatty liver is as high as 29.3%, so the risk of gout, atherosclerosis, and cardiovascular disease is further increased. The pathology of NAFLD in children differs from that of adults, with periportal inflammation and fibrosis present in the majority of affected children. There are two main types: type I NASH presents with intralobular steatosis, ballooning degeneration, and perisinusoidal hepatic fibrosis, and type 2 HASH presents with inflammation and fibrosis prominent in and around the hepatic hilum, while ballooning degeneration of hepatocytes, Melloy’s vesicles, inflammation, and perisinusoidal fibrotic changes occur infrequently in the lobules. The different histologic staging correlates with the age, body mass index, gender, and race of the child. children with type 2 NASH are younger than those with type 1, but are more obese than those with type I. Boys are more likely to have type 2 NASH than girls. Boys are more likely to have type 2 NASH than girls, and type 2 is predominant in Asian, native American, and Spanish children. The diagnosis of NAFLD in children with suspected NAFLD is difficult to establish, and the presence of multiple liver diseases, the need for potentially hepatotoxic medications, and the need for a definitive diagnosis of NASH by liver biopsy prior to pharmacological treatment of NASH are essential. To understand the extent of fatty liver and fibrosis, liver biopsy, although recognized as the gold standard for the diagnosis of fatty liver in children, is difficult to perform in children because of its invasive nature, and the non-invasive Fibroscan and CAP combination diagnosis can be considered, which is easy to perform and has high accuracy. Therefore, it is very important to actively prevent the development of fatty liver in children, while reducing obesity is the focus of treatment. Non-pharmacological treatment with lifestyle changes can reduce serum transaminase levels and improve hepatic histological lesions in children with fatty liver, and is currently used as the first-line treatment for children with fatty liver, such as developing healthy dietary habits, avoiding the intake of high-calorie, high-fat and high-sugar foods, but adequate protein must be ensured; and promoting low-intensity aerobic exercise. Weight loss should not exceed 0.5 kg per week. medication needs to be considered for those who cannot receive formal intensive lifestyle interventions or when 6-month interventions are not effective. Such as vitamin E, metformin, polyenyl phosphatidylcholine, etc.