Referral to a specialist for possible acute lymphoblastic leukaemia (ALL) in children

It is normal to worry if your child has symptoms of any illness. But cancer in children is rare. Having possible symptoms doesn’t mean your child has leukaemia. But it is important to contact your GP surgery so that your child can be checked.

Seeing your GP

It can be hard for GPs to decide who may have cancer and who might have a more minor condition. For some symptoms, your doctor may ask you to wait to see if your child’s symptoms get better or respond to treatment, such as antibiotics.

Guidelines are very clear that the GP should take the parent or carer’s concerns into account when deciding about a specialist referral.

Following a referral, the first professional your child might see is a specialist children’s doctor. These doctors are called paediatricians. They might then go on to see a specialist children and young person’s blood doctor. These doctors are called consultant paediatric haematologists.

UK referral guidelines

There are guidelines for GPs to help them decide who needs a referral to see a specialist or have tests. The GP will use these guidelines as well as their experience and judgement.

These guidelines vary slightly between the different UK nations.

England and Wales

These guidelines are for leukaemia. They apply to anyone from birth to 24 years of age.

Your GP should refer your child immediately (within a few hours or sooner) to a specialist if they have either:

• unexplained red, purple or dark spots on the skin (petechia), or
• an enlarged liver or spleen

Your GP should offer a full blood count within 48 hours if your child has any of the following:

• looks unusually pale
• extreme tiredness (fatigue)
• an unexplained high temperature (fever)
• an unexplained infection that won't go away
• swollen lymph nodes
• bone pain that won't go away and can't be explained
• bruising or bleeding for no reason

Northern Ireland and Scotland

There are separate detailed guidelines for Northern Ireland and Scotland. If you live in these nations, your GP will use these to guide their decision. You can find these on the following websites. Please note these are intended for health professionals. Your GP can explain whether or not they are going to refer your child and why this is.

• Scottish Referral Guidelines for Suspected Cancer
• Northern Ireland Referral Guidance for Suspected Cancer - Reg Flag Criteria

Other ways of being diagnosed

Some children are diagnosed with leukaemia during tests for another condition. Other children are diagnosed as a result of an Accident and Emergency (A&E) visit.

Seeing your child unwell and then learning about their cancer diagnosis in a short space of time can be very frightening. We have information on what happens when your child is diagnosed with cancer.

If you're still worried about your child

Sometimes you might feel that your GP is not concerned enough about your child’s symptoms. If you think they should be more concerned, print this page and the symptoms page. Ask your GP to explain why they don’t think your child needs a referral.

Contact your GP surgery again if your child’s symptoms don't get better or you notice any new or unusual symptoms. 

Children’s cancer specialist team

If your child is diagnosed with cancer, a specialist children’s cancer team plan their care. The team is used to supporting and treating children with cancer. They will explain everything to you and your family. There is practical, emotional and psychological support available for children with cancer and their families.