The Enhanced Liver Fibrosis (ELF) score was made up of 3 serum markers of extracellular matrix remodeling and fibrogenesis: hyaluronic acid (HA), collagen type III N-terminal propeptide (PIIINP), and tissue inhibitor of metalloproteinase-1 (TIMP-1). For a study, researchers sought to assess the ELF score’s clinical utility in children. About 343 liver-healthy children aged 6 to 17 years were used to establish a reference interval for the ELF score. In healthy youngsters, the median ELF score of 8.9 was much higher than in healthy adults. ELF scores rose significantly in both female and healthy male controls, peaking around puberty, owing to increasing levels of HA and PIIINP, which were likely explained by increased growth. However, only 6.4% of the group of liver-healthy children fell into the normal range when adult average values were applied. Next, investigators looked at ELF scores in patients with autosomal recessive polycystic kidney disease (ARPKD) with probable or definite liver fibrosis. All ELF scores in children with ARPKD fell within the reference intervals derived from a healthy control group. For the ELF score in adults, the typical diagnostic cut-off ranges were not applicable; instead, age and gender-appropriate cut-off values should be employed in children. The clinical use of ELF scores in children was debatable, as children throughout pubertal development had higher ELF scores than individuals with ARPKD and liver fibrosis.