Most parents know the drill. A fever, a complaint about aching legs, a day of looking a little pale. Most of the time it passes in a week, and the pediatrician never gets a call.
That is exactly why pediatric cancer doctors worry. The early warning signs of cancer in children look nearly identical to the everyday ailments parents see every month.
According to Banner Health, most cancer symptoms are also symptoms of more common diseases, which makes early recognition hard for parents and physicians alike.
"Kids can handle symptoms much better than we can as adults," said Dr. Laurel Truscott, a children's cancer specialist at Banner University Medicine. A child in the earliest stage of leukemia can still run around the yard and smile at dinner.
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The signs that most often get written off
The American Cancer Society says the most common signs of cancer in children can be hard to notice because they are also common in other illnesses or injuries.
For leukemia and lymphoma, the two most common blood cancers in children, the group lists low appetite, weight loss, easy bleeding or bruising and frequent infections.
Other signs are fevers, heavy night sweats, low energy, pale skin, bone pain and swollen lymph nodes in the neck, armpits or groin.
For solid tumors, parents are told to watch for a lump or mass on the arm, leg, chest, neck or belly, and pain that cannot be explained. Brain tumors can show up as persistent headaches, vision changes, nausea or vomiting, balance problems or seizures.
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Each item on its own looks like something else. A pale, tired child could just be short on sleep. Easy bruising could be rough play. A morning headache could be dehydration or a bad night.
Why the delay often comes from the doctor's office
The problem is not usually that parents wait too long. A review in American Family Physician from August 2013 found that the parental delay in seeking care was considerably shorter than the physician delay in making the diagnosis.
The review pulled numbers from studies of children with malignant tumors. The median delay was about nine weeks for brain tumors. Leukemia averaged around three weeks, and solid tumors stretched to nearly 12 weeks.
The authors note that symptoms in children tend to be nonspecific and resemble benign conditions. Bone pain gets attributed to growing pains. A swollen lymph node gets called a lingering infection. A morning headache gets called a migraine.
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That is why pediatric oncologists increasingly focus on patterns rather than single symptoms. A single bruise is a bruise. Three unexplained bruises, a child who is suddenly tired after mild activity and a lump that keeps growing is a cluster that deserves a doctor's eye.
What the big pediatric cancer centers tell parents
Together by St. Jude tells parents to watch for a fever that doesn't go away, unexplained weight loss, and headaches that come with early morning vomiting.
The children's hospital also lists persistent pain or swelling in the bones, joints, back or legs, and a lump or mass in the belly, neck, chest or armpits.
Other signs are excessive bruising or bleeding, frequent infections, a whitish color behind the pupil of the eye, and sudden vision changes that don't go away.
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The common thread is persistence. A fever that lasts. A bruise that doesn't fade. A headache that keeps coming back. The question is not what the symptom looks like in isolation, but whether it is still there a week later.
St. Jude's advice is to call the doctor right away if any of these signs show up in a child. The American Cancer Society puts it even more broadly, writing that any sign or symptom that doesn't get better or go away, even one not on the lists, is reason enough for a check.
Parents who have already seen a pediatrician without an answer are told to go back. The review in American Family Physician found that physicians, more often than parents, are the ones who miss the signal in time.
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This article is made and published by Aksel Kryhlmand, who may have used AI in the preparation.