Because the immune function of the body is not fully developed during infancy, the body is in a “peaceful coexistence” stage with the hepatitis B virus after infection. Although the blood of infants and young children contains hepatitis B virus surface antigen and e antigen, and the level of hepatitis B virus is high, the serum alanine aminotransferase level is normal, the liver histology has no obvious lesions, and the infected person does not feel any discomfort. Antiviral therapy is not required during this period and the available drugs do not work. This state can be maintained for years or even decades and is clinically referred to as the hepatitis B virus carrier state. However, for children with progressive liver disease or cirrhosis, they have liver damage and should be treated with antiviral therapy promptly, while long-term treatment safety and drug resistance issues need to be considered. Drugs currently approved by the U.S. Food and Drug Administration (FDA) for treatment of pediatric patients include generic IFN-α (2 to 17 years of age), lamivudine (2 to 17 years of age), adefovir (12 to 17 years of age), entecavir (2 to 17 years of age), and tenofovir (2 to 17 years of age). Clinical trials have shown that the efficacy of generic IFN-α in the treatment of pediatric patients is comparable to that of adult patients. the recommended dose of IFN-α for pediatric patients is 3-6 MU/m2 body surface area three times per week, with a maximum dose not exceeding 10 MU/m2. however, IFN-α should not be used in the treatment of children under 1 year of age. Based on full informed consent, entecavir therapy is also available for ages 2 to 11 years, and entecavir or tenofovir for ages 12 to 17 years. Hepatitis B with nephritis may occur in a small number of children. Nucleoside (acid) antiviral therapy is the key to the treatment of hepatitis B-associated glomerulonephritis, and potent, low resistance drugs are recommended. Most nucleoside (acid) analogs are cleared by the kidneys as prototypes; therefore, dosing intervals and/or dose adjustments should be made according to the patient’s degree of renal impairment, as prescribed by the physician. Adefovir or tenofovir, which may cause renal injury, should be avoided if possible in children with chronic hepatitis B who already have renal disease and are at high risk for it. Some studies suggest that telbivudine may have a role in improving glomerular filtration rate, but the mechanism is unknown. Treatment with either telbivudine or entecavir is recommended for children with chronic hepatitis B who are at risk for renal damage.