Metabolic dysfunction- associated steatotic liver disease (MASLD) is the most common paediatric liver disease, affecting 10% of children. Paediatric MASLD has specific perinatal influences that, along with genetic predisposition and early onset, can exacerbate disease severity, increasing the lifetime risk of major adverse liver outcomes such as liver cancer and end stage liver disease requiring liver transplantation. There are additional disease factors in the pathogenesis of steatotic liver disease, only 1 in 4 patients with obesity will develop MASLD. The approach to assessing Liver Function Tests in children with obesity will be discussed, including the role of the primary care physician and referral pathways.