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Brain tumors are the most common solid tumors in children and recognizing early symptoms is necessary for effective treatment. Vomiting, visual impairment, headaches, and seizures are common symptoms that could indicate the presence of a brain tumor.

Pediatric brain tumors: recognizing early symptoms and signs of brain tumors in children

Brain tumors are the most common solid tumors in children and account for 15-20% of malignant cancers in childhood. These occur in approximately 3 out of every 100,000 children, up until the age of 15 [1].

There are many different types of brain tumors, but they can generally be divided into two groups of tumors: 

  • infratentorial and
  • supratentorial.

Infratentorial tumors are tumors that form in the lower part of the brain and supratentorial tumors form in the upper part of the brain. Supratentorial tumors are common in children less than 2 years of age while infratentorial tumors are more common in children between the ages of 4 and 10. Both types of tumors are equally common after the age of 10 [2].

Brain tumors are particularly dangerous due to their proximity to very important structures that are required for the functioning of the human body. In fact, even a small increase in the size of the tumor can lead to a drastic effect on the patient’s condition. Therefore, early diagnosis is vital so that the growth of the tumor can be stopped [3].

New neuro-imaging techniques have helped shorten the time of diagnosis considerably. In fact, studies conducted in the 1950s show that there was a delay in diagnosis of up to 6 months in more than 50% of patients with pediatric brain tumors but more recently, the times has significantly shortened [4].

However, there are still many factors that can lead to a delay in diagnosis. One of the major issues in obtaining an early diagnosis for brain tumors is that the patients don’t display specific symptoms, which can often lead to a misdiagnosis of other, more common diseases.

Delays in diagnosis for pediatric brain tumors can be devastating as each day that passes leads to further tumor expansion and worsens the outlook for the child. There is also always the risk of brain damage due to the increasing tumor size, which in turn increases the pressure of the fluid that surrounds the brain and the spinal cord, also called intracranial pressure. Therefore, being able to identify the symptoms is necessary in order to prevent further damage [5].

Common Symptoms

Symptoms of pediatric brain tumors are extremely variable and tend to depend on a number of factors. Children of all ages present with early morning vomiting and increased fatigue. Patients also present in clinic with lethargy, nausea, headaches, decreased vision, and seizures. Children with pediatric brain tumors can also have cranial nerve palsies, which can cause a complete or partial weakness or paralysis of areas that are affected by a cranial nerve. This can include nerves that function to move the eye.

However, among all the symptoms, the most common ones are headaches and vomiting, which occur in more than 50% of the patients [6].

Location-specific Symptoms

Many of the symptoms of pediatric brain tumors are specific to the location of these tumors. In patients with infratentorial tumors, which are tumors that form in the lower part of the brain, symptoms can include loss of bodily movement control (ataxia), difficulty walking normally (gait abnormalities), morning vomiting and disturbed eye movement. Furthermore, infratentorial tumors are very close to one of the four fluid-filled cavities within the brain, which cause a more rapid development of intracranial pressure than in patients with supratentorial tumors. For patients with supratentorial tumors, seizures, motor dysfunction, paralysis on one side of the body (hemiplegia), hormonal deficits and visual impairment are all common symptoms [7]. 

Grade-specific Symptoms

Some symptoms are correlated with the severity of the tumor. Specifically, one study found that patients with early morning vomiting and ataxia or gait abnormality were much more likely to have a more severe tumor or a higher tumor grade. On the other hand, some symptoms, specifically vision impairment, are more likely to originate from less severe, or lower grade tumors [8].

Age-specific Symptoms

The presence of intracranial pressure in younger children can lead to an increase in the head circumference of children with brain tumors within the first year of their life. This can be detrimental to the children as it might prevent a fast development of symptoms, which can lead to a delay in diagnosis. While headaches are an extremely common and generic symptom that can be attributed to many diseases, ataxia or gait abnormalities in children are more specific symptoms of brain tumors. However, this can be difficult for parents to observe, especially in younger children that have not yet learned to walk. Therefore, brain tumors are particularly hard to diagnose in younger children as the children can’t describe their symptoms and the parents can’t observe gait abnormalities [9].

For older children, increased intracranial pressure, headaches and double-vision (diplopia) are the most common symptoms of brain tumors. Other common brain tumor symptoms can include a head tilt or neck stiffness, however, these symptoms are almost never attributed to brain tumors and are often misdiagnosed as orthopedic issues. In older children, mood changes or cognitive issues can develop as the tumor can press against vital areas of the brain, but these changes are likely to be attributed to puberty and therefore, are not usually linked to brain tumors [10].  

Conclusion

While uncommon, once diagnosed, pediatric brain tumors can be deadly. The most vital thing in the treatment of brain tumors in children is the ability to diagnose them early on, which can only be done by the recognition of these symptoms.

However, since symptoms are extremely variable and often indicate a mild issue, such as headaches, this can also be very difficult. If a child displays one of the symptoms mentioned above, there is no need to suspect a brain tumor. 

However, if a child displays a combination of symptoms such as vomiting, visual impairment, headaches, seizures, trouble walking or moving muscles, then it best to play it safe and relay the concerns to a doctor. With the current advances in CT and MRI imaging, a diagnosis of brain tumor can be done quickly and efficiently.

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