Cases corner – 5 year old with concerned parent

4th June 2019

A 5 year old girl named Jane presents with Mum who is very worried about Jane. For the past year she often gets tired, likes to sleep a lot and is a very fussy eater. Mum reports that since being a baby it has been very hard to get Jane to put any weight on. She reports no pain or weight loss. She was born at term and up to date with her immunisations with no relevant past medical history or family history.

You look at her growth charts and she has been on the 35th centile since she was born and has remained within that range. There is no evidence of weight loss and examination of all systems are unremarkable. She seems playful today and well kept.

There are no concerns regarding the social welfare of Jane. You scan the notes and see this is Mums third visit with Jane. Previous GPs have referred to the health visitor and dietician. Mum reports no improvement and is clearly very anxious. You probe her and she admits she is worried of underlying leukaemia.

  1. Reassure Mum that Jane has no signs for concern and give clear instructions for safety netting when to bring Jane back
  2. Organise a blood test for Jane
  3. Refer Jane for a routine paediatric referral
  4. Consider referring Jane along a suspected cancer referral pathway

This may not be your first choice, and may seem rash as there is no objective or quantifiable reason to account for a suspected cancer referral. There are no clinical concerns either after thorough assessment. However, NICE recommends that despite this, we should take into account the insight and knowledge of parents and carers when considering a referral for suspected cancer in a child or young person. If their parent or carer has persistent concern or anxiety about the child’s symptoms, even if the symptoms are most likely to have a benign cause we should still consider a referral.