Signs are observed by parents or doctors (e.g., pale skin), but symptoms are experienced by patients (e.g., bone pain). The most common signs and symptoms of childhood ALL are:

• Fever
• Infection
• Night sweats
• Paleness
• Weakness or feeling tired
• Easy bruising or bleeding
• Small red spots on the skin (called petechiae) caused by bleeding
• Pain in the bones (children may limp or be unable to walk)
• Pain or feeling of fullness below the ribs from an enlarged spleen and/or liver
• Swollen lymph nodes in the neck, underarm, stomach, or groin

Some children with ALL have the disease in their CNS at diagnosis. These include:

• 10 to 15% of children with T-cell ALL
• 5% of children with B-cell ALL

Few of these children have signs or symptoms of CNS disease at diagnosis. However, if they do, the most common are headaches, nausea, vomiting, and abnormal response of the pupil in the eye to light.

Two-year-old Austin showed no typical signs and symptoms of childhood leukemia, so it was a unique and difficult situation. Two months before he was diagnosed with ALL, he developed a lump on the top of his head that was about the size of a quarter. We had two primary care doctors look at it and we were told to just keep an eye on it. Then my father-in-law noticed that Austin had large lymph nodes on one side of his neck. They hadn’t been there the day before, and so my stomach just flipped. Austin was still active, eating well, sleeping well, and no fevers. He just didn’t look sick. Our pediatrician diagnosed a possible ear infection and prescribed antibiotics. Three days later, the lump on his head was red and inflamed, and the hair had dropped out of the skin over the lump. We went back to the pediatrician, and even though Austin still didn’t look sick, she sent us to the emergency room. All of his initial blood results were normal and they were talking about surgically removing the lymph nodes. But, the WBC differential came back showing 7% blasts, so we were sent in an ambulance to the children’s hospital. After they did a bone marrow biopsy and spinal tap, they told us he had ALL with CNS disease. A week after chemo started, the lump was gone.