Symptoms of childhood acute lymphoblastic leukaemia (ALL)

Childhood cancer is rare. Most children with one or more of these symptoms don't have leukaemia. But it's important to get your GP to check any of the symptoms out.

Many symptoms of ALL are vague and non specific. They are similar to the symptoms of many more minor childhood illness.

Symptoms of childhood ALL can include:

• looking pale
• feeling very tired
• bruising or bleeding easily or for no reason
• having a high temperature (fever)
• picking up infections easily and often
• swollen lymph nodes
• bone pain
• loss of appetite
• swollen tummy (abdomen)
• swelling of one or both testicles

Not every child with ALL has all of these symptoms before they are diagnosed.

At the beginning these symptoms might come and go. Your child might be exhausted one day, but brighter the next.

Most of these symptoms are due to the leukaemia cells having spread inside the bone marrow . And there not being as many normal blood cells as usual.

More information about the symptoms

Pale skin

Your child might look paler or more 'washed out' than normal. This is due to the low number of red blood cells .

Feeling tired (fatigue)

Your child might be very tired, even if they are getting a good night’s sleep. This is due to the low number of red blood cells.

Unexplained bruising or bleeding

Your child might have:

• nosebleeds

• bleeding gums

• small dark red, purple or brown spots on their skin that looks like a rash (petechiae). This rash doesn’t fade under pressure with a glass

• blood in their wee or poo

Girls that have started their periods might find that they are very heavy. You might find your child is bruising more easily than normal.

Abnormal bruising and bleeding happens because there isn’t enough platelets .

Frequent infections

Your child might pick up infections such as coughs and colds easily. Or you might find that the infections last a long time and are difficult to shake off. 

This is because they don’t have enough healthy white blood cells  to fight bacteria or viruses.

A high temperature (fever)

Your child might have a high temperature or feel feverish with no obvious cause.

Swollen lymph glands

This diagram shows the lymphatic system . There are lymph nodes throughout the body.

ALL can cause your child’s lymph nodes to feel swollen when you touch them. The ones near the surface of the skin are the ones that people notice most. They include the nodes in the:

• neck

• armpit

• groin

Bone pain

Your child might have bony pain. Children might limp or refuse to walk as they would normally. This pain is most common in the long bones in the body, like the arms or legs. But it can also affect the back and joints. 

Loss of appetite

Your child might go off their food. They might be eating smaller amounts or not wanting to eat even their favourite foods. This is very common in childhood. Remember, this does not necessarily mean your child has leukaemia.

Feeling full in the tummy (abdomen)

Your child might have a feeling of fullness or discomfort in their tummy (abdomen). Your child’s tummy might look bigger than normal, or you might notice they suddenly jump a nappy or trouser size.

This can happen if their liver or spleen are swollen.

Swollen testicles

Boys might have testicular swelling in one or both testes . This is because the leukaemia cells can collect there. This is usually painless.

Irritability

Your child might seem particularly fractious or irritable and you might be finding it difficult to get them to settle.

Symptoms if the leukaemia has spread to the fluid around the brain or spinal cord (CNS)

The brain and spinal cord make up the central nervous system (CNS). Cerebrospinal fluid (CSF) is the name of the fluid that surrounds the brain and spinal cord. Some children at diagnosis have leukaemia cells that have spread to the CSF. Symptoms of this spread might mean your child: 

• has headaches

• is having more difficulty with school work

• is feeling generally weak

• has had unexplained vomiting

• has blurred vision

• has seizures (fits)

Symptoms of T cell ALL

A type of leukaemia called T cell ALL can cause swollen lymph glands in the centre of the chest. It might make the thymus gland in the upper chest swell. The swollen glands or thymus gland may press on the windpipe, causing breathlessness and coughing. They can also press on the veins carrying blood from the head.

This causes pressure in the blood vessels and makes the face, neck and arms swell and go red. This is called superior vena cava obstruction (SVCO).

When to see your GP

Take your child to see their GP if you notice a change that isn't normal for them or if you have any of the possible signs and symptoms of leukaemia.

There are guidelines for GP’s to follow so they know when to refer a child to a specialist. The guidelines are clear that parent or carer concern about any changes should be taken into account.