Survival rates are often used by doctors as a standard way of discussing a person’s prognosis (outlook). Some parents may want to know the survival statistics for children in similar situations, while others may not find the numbers helpful, or may even not want to know them. If you do not want to read about the survival statistics for brain and spinal cord tumors given in the next few paragraphs, skip to the next section.

The 5-year survival rate refers to the percentage of children who live at least 5 years after their cancer is diagnosed. Of course, many children live much longer than 5 years (and many are cured).

To get 5-year survival rates, doctors have to look at children who were treated at least 5 years ago. Improvements in treatment since then might result in a better outlook for children now being diagnosed with brain tumors.

The numbers below come from the Central Brain Tumor Registry of the United States (CBTRUS) and are based on children aged 19 or younger who were treated between 1995 and 2010. There are some important points to note about these numbers:

• These numbers are for some of the more common types of tumors. Numbers are not readily available for all types of tumors that occur in children, often because they are rare or are hard to classify.
• In some cases, the numbers include a wide range of different types of tumors that can have different outlooks. For example, the survival rate for PNETs below includes medulloblastomas, pineoblastomas, and PNETs in other parts of the brain. Medulloblastomas tend to have a better outlook than the other PNETs. Therefore the actual survival rate for medulloblastomas would be expected to be higher than the number below, while the number for other PNETs would likely be lower.

Survival rates are often based on previous outcomes of large numbers of children who had the disease, but they can’t predict what will happen in any particular child’s case. Knowing the type of a child’s brain tumor is important in estimating their outlook. But many other factors can also affect a child’s outlook, such as the location and extent of the tumor and how well it responds to treatment. Even taking these other factors into account, survival rates are at best rough estimates. Your child’s doctor knows your child’s situation and is your best source of information on this topic.

There is always research going on in the area of brain and spinal cord tumors. Scientists are looking for causes and ways to prevent them, and doctors are working to improve treatments.

Understanding gene changes in tumors

Researchers continue to look for the gene changes inside cells that result in brain and spinal cord tumors. The hope is that learning more about these gene changes may lead to better ways to treat these tumors.

For example, researchers have found that medulloblastomas can be divided into 4 main types, based on the different gene changes in the tumor cells. Some of these tumor types have a better outlook than others. Doctors are now learning how to use this information to help decide which children might need more or less intensive treatment.

More recently, researchers have identified some of the specific gene changes found in each type of medulloblastoma that might help the tumor cells grow. Some of these gene changes can be targeted with new types of drugs, which are now being tested in clinical trials. In the future, doctors may be able to develop other drugs that specifically target these gene changes.

Imaging and surgery techniques

Recent advances have made surgery for brain tumors much safer and more successful. Some of these newer techniques include:

• Functional magnetic resonance imaging (fMRI, described in “How are brain and spinal cord tumors in children diagnosed?”), which can identify the site of important areas of the brain and how close they are to the tumor.
• Magnetic resonance spectroscopic imaging (MRSI, described in “How are brain and spinal cord tumors in children diagnosed?”). In this approach, specially processed MRS information is used to make a map of important chemicals involved in tumor metabolism. This is being developed to help surgeons direct their biopsies to the most abnormal areas in the tumor and to help doctors direct radiation and evaluate the effects of chemotherapy or targeted therapy.
• Fluorescence-guided surgery. For this approach, the patient drinks a special dye a few hours before surgery. The dye is taken up mainly by the tumor, which then glows when the surgeon looks at it under special lighting from the operating microscope. This lets the surgeon better separate tumor from normal brain tissue.
• Newer surgical approaches for some types of tumors. For example, a newer approach to treat some tumors in or near the pituitary (such as some craniopharyngiomas) is to use an endoscope, a thin tube with a tiny video camera lens at the tip. The endoscope is passed through a hole made in the back of the nose, which allows the surgeon to operate through the nasal passages and limits the potential damage to the brain. A similar technique can be used for some tumors in the ventricles, where a small opening in the skull near the hairline serves as the point of endoscope insertion. The use of this technique is limited by the tumor’s size, shape, position, and by how many blood vessels it contains.

Radiation therapy

Several newer types of radiation therapy now let doctors aim radiation more precisely at the tumor, which helps spare normal brain tissue from getting too much radiation. Newer techniques such as stereotactic radiosurgery, 3-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), and proton beam therapy are described in the section “Radiation therapy.”

The brain is very sensitive to radiation, which can lead to side effects if normal brain tissue receives a large dose, especially if the child is very young. Clinical trials have shown that in some situations, using chemotherapy can let doctors use lower doses of radiation therapy without lowering the chance that treatment will be effective. Doctors are now trying to determine if even lower doses of radiation can be used and still give the same results.

Chemotherapy

New approaches may help make chemotherapy (chemo) more useful against brain and spinal cord tumors.

Adjuvant chemotherapy

In some children and infants with brain tumors, chemo is given right after surgery to either delay radiation therapy (particularly in infants) or to decrease the radiation dose needed to treat the tumor. This is known as adjuvant chemotherapy. Some studies are looking at whether giving prolonged chemo can help avoid the need for radiation therapy at all in certain cases.

High-dose chemotherapy and stem cell transplant

One of the main factors that limits the doses of chemo that can be given safely is its effects on the bone marrow, where new blood cells are normally made. A stem cell transplant allows higher doses of chemo to be given than would normally be possible. First, blood stem cells are removed from either the child’s blood or the bone marrow and are stored in a deep freeze. The child is then treated with very high doses of chemo. The blood stem cells are then thawed and infused back into the body, where they settle in the bone marrow and start making new blood cells.

Although some children with certain brain or spinal cord tumors (such as medulloblastomas) have responded well to this very intensive treatment, it can have serious side effects, and it is not yet known if it is effective enough to become standard. For now, most doctors consider this treatment experimental for brain and spinal tumors. Clinical trials are being done to determine how useful it is.

Improving chemotherapy drugs

Many chemo drugs are limited in their effectiveness because the tightly controlled openings in the brain capillaries, sometimes referred to as the blood-brain barrier, prevents them from getting from the bloodstream to some parts of the brain tumor. Researchers are now trying to modify some of these drugs by coating them with tiny layers of fat (liposomes) or attaching them to molecules that normally cross the blood-brain barrier, to help them work better. This is an area of active research.

Getting chemotherapy directly to tumors

Some newer approaches might help doctors get chemo directly to brain and spinal cord tumors.

For example, in one method called convection enhanced delivery, small tubes are placed into the tumor in the brain through a small hole in the skull during surgery. The tubing extends through the scalp and is connected to an infusion pump, through which chemo drugs can be given. This can be done for hours or days and might be repeated more than once, depending on the drug used. This technique can also be used to get other, newer types of drugs into the tumor. This is still an investigational method, and studies are continuing.

Other new treatment strategies

Researchers are also testing some newer approaches to treatment that may help doctors target tumors more precisely. The hope is to develop more effective treatments that cause fewer side effects. Although these treatment approaches are promising, most are still experimental at this time and are only available through clinical trials.

Targeted drugs

As researchers have learned more about the gene changes in tumor cells that help them grow, they have developed newer drugs that target these changes. These targeted drugs work differently from standard chemo drugs.

One example of such a targeted drug is everolimus (Afinitor), which may shrink or slow the growth of subependymal giant cell astrocytomas (SEGAs) that can’t be removed with surgery (see “Targeted therapy for brain and spinal cord tumors in children”).

Some types of medulloblastomas tend to have mutations (changes) in genes that are part of a cell signaling route called the hedgehog pathway. The hedgehog pathway is crucial for the development of the embryo and fetus, but it can be overactive in some medulloblastoma cells. Drugs that target proteins in this pathway are now being tested against medulloblastoma in clinical trials.

Many other targeted drugs are already being used to treat other types of cancer, and some are being studied to see if they will work for brain tumors as well.

Angiogenesis inhibitors

Tumors have to create new blood vessels (a process called angiogenesis) to keep their cells nourished. New drugs that attack these blood vessels are used to help treat some cancers, including some brain tumors in adults. Several drugs that impair blood vessel growth are now being studied for use against brain tumors in children.

Hypoxic cell sensitizers

Some drugs increase the oxygen content in the tumor, which makes tumor cells more likely to be killed by radiation therapy if the drugs are given before treatment. Studies are now looking to see if this affects treatment outcomes.

Immunotherapy

The goal of immunotherapy is to make the body’s own immune system fight the tumor.

Several types of vaccines are being developed against brain tumor cells. Unlike vaccines against infectious diseases, these vaccines are meant to help treat the disease instead of prevent it. The goal of the vaccines is to stimulate the body’s immune system to attack the brain tumor cells.

Early study results of some of these vaccines have shown promise, but more research is needed to determine how effective they are. At this time, brain tumor vaccines are available only through clinical trials.

Other types of drugs that affect the immune system, such as lenalidomide, are also being studied.

Therapeutic viruses

Researchers have done a great deal of lab work with viruses that reproduce only within brain tumor cells and then cause those cells to die, while leaving normal cells alone. Research using these viruses in humans with brain tumors is still in very early stages.

The stage of a cancer is a measure of how far it has spread. The extent of spread is based on the results of imaging tests (see How are brain and spinal cord tumors in children diagnosed?) and any other tests that have been done.

For most types of cancer, the stage is one of the most important factors in selecting treatment options and in determining the outlook (prognosis). But tumors of the brain and spinal cord differ in some important ways from cancers in other parts of the body. One of the main reasons other cancers are dangerous is that they can spread throughout the body. Tumors starting in the brain or spinal cord can spread to other parts of the central nervous system, but they almost never spread to other organs. These tumors are dangerous because when they grow, it can interfere with essential functions of the brain.

Because most tumors in the brain or spinal cord do not usually spread, they are not formally staged. Some of the most important factors that determine your child’s prognosis include:

• The type of tumor (such as astrocytoma, ependymoma, etc.)
• The grade of the tumor (how quickly the tumor is likely to grow, based on how the cells look under a microscope)
• The location and size of the tumor
• How much of the tumor can be removed by surgery (if it can be done)
• Your child’s age
• Your child’s functional level (whether the tumor is affecting normal brain functions and everyday activities)
• Whether or not the tumor has spread through the cerebrospinal fluid (CSF) to other parts of the brain or spinal cord
• Whether or not tumor cells have spread beyond the central nervous system

Medulloblastoma risk groups

A staging system is a standard way for the cancer care team to describe the extent of tumor spread. Formal staging systems have been proposed for some childhood brain tumors.

For example, many clinical trials for treating medulloblastoma use a system that places children into either standard-risk or high-risk groups. Children are placed in the high-risk group if any of these apply:

• The child is younger than 3
• A lot of the tumor can’t be removed during surgery
• Tumor cells are in the CSF or have spread to other parts of the brain or elsewhere

Doctors are still refining this system to make it as accurate as possible.

Recent research has shown that medulloblastomas can be divided into 4 types, based on the major gene changes found in the cancer cells. Each type of medulloblastoma has a different outlook, so doctors may be able to use this to better tailor the treatment each child gets (see What’s new in research and treatment for brain tumors in children?).

Signs and symptoms from brain and spinal cord tumors might occur gradually and become worse over time, or they can happen suddenly, such as with a seizure.

General symptoms

Tumors in any part of the brain might raise the pressure inside the skull (known as intracranial pressure). This can be caused by growth of the tumor, swelling in the brain, or blocked flow of cerebrospinal fluid. Increased pressure can lead to general symptoms such as:

• Headache
• Nausea
• Vomiting
• Crossed eyes or blurred vision
• Balance problems
• Behavior changes
• Seizures
• Drowsiness or even coma

Headaches that get worse over time are a common symptom of brain tumors. But not all brain tumors cause headaches, and most headaches are not caused by tumors.

In some children, seizures are the first symptom of a brain tumor. Most seizures in children are not caused by brain tumors, but if your child has a seizure, your child’s doctor may refer you to a neurologist (a doctor who specializes in brain and nervous system problems) to make sure it wasn’t caused by a brain tumor or other serious disease.

In the first few years of life, other symptoms of tumors can include irritability, loss of appetite, developmental delay, and a drop in intellectual and physical abilities. In very young children who can’t complain of symptoms, a parent may notice an increase in head size, sometimes along with bulging of the soft spots of the skull (fontanelles). This happens because the bones of the skull haven’t grown together yet, and increased pressure from a tumor can push them apart.

In the school-aged child, other general symptoms of tumors can include poor school performance, fatigue, and personality changes.

If the child can cooperate, the doctor can sometimes tell if pressure inside the skull is increased by looking inside the child’s eyes for swelling of the optic nerve (known as papilledema).

Symptoms of tumors in different parts of the central nervous system

Tumors in different parts of the brain or spinal cord can cause different symptoms. But these symptoms can be caused by any disease in that particular location – they don’t always mean a child has a brain or spinal cord tumor.

Brain and spinal cord tumors often cause problems with the specific functions of the region they develop in. For example:

• Tumors in the parts of the cerebrum (the large, outer part of the brain) that control movement or sensation can cause weakness or numbness in a part of the body, often on just one side.
• Tumors in or near the parts of the cerebrum responsible for language can cause problems with speech or even understanding words.
• Tumors in the front part of the cerebrum can sometimes affect thinking, personality, and language skills.
• Tumors in an area of the brain called the basal ganglia typically cause abnormal movements and body positions.
• Tumors in the cerebellum, which controls coordination, can cause trouble walking or with other normal functions, even eating.
• Tumors in the back part of the cerebrum, or around the pituitary gland, the optic nerves, or certain other cranial nerves can cause vision problems.
• Tumors in or near other cranial nerves might lead to loss of hearing, balance problems, weakness of some facial muscles, or trouble swallowing.
• Spinal cord tumors may cause numbness, weakness, or lack of coordination in the arms and/or legs (usually on both sides of the body), as well as bladder or bowel problems.

Having one or more of the symptoms above does not mean that your child definitely has a brain or spinal cord tumor. All of these symptoms can have other causes. Still, if your child has any of these symptoms, especially if they don’t go away or get worse over time, see your child’s doctor so that the cause can be found and treated, if needed.

As much as you might want to put the experience behind you once treatment is completed, it is very important to keep good records of your child’s medical care during this time. This can be very helpful later on as your child sees new doctors. Gathering the details soon after treatment may be easier than trying to get them at some point in the future. There are certain pieces of information that your child’s doctors should have, even after the child has become an adult. These include:

• A copy of the pathology report(s) from any biopsies or surgeries.
• Copies of imaging tests (CT or MRI scans, etc.), which can usually be stored digitally (on a DVD, etc.)
• If your child had surgery, a copy of the operative report(s).
• If your child stayed in the hospital, a copy of the discharge summaries that the doctors prepared when your child was sent home.
• If your child got chemotherapy or other medicines, a list of the final doses of each drug your child received.
• If your child had radiation therapy, a final summary of the dose and field.

It is also very important to keep your child’s health insurance. Tests and doctor visits cost a lot, and even though no one wants to think of the tumor coming back, this could happen.

Brain and spinal cord tumors are the second most common cancers in children (after leukemia). They account for about 1 out of 4 childhood cancers. More than 4,000 central nervous system tumors are diagnosed each year in children and teens. The incidence rate (number of tumors per 100,000 children) has not changed much in recent years.

Boys develop these tumors slightly more often than girls.

About 3 out of 4 children with brain tumors (all types combined) survive at least 5 years after being diagnosed. The outlook can vary a great deal based on the type of tumor, where it is, and other factors. For survival information on some particular tumor types, see “ Survival rates for selected brain and spinal cord tumors.”

Visit the American Cancer Society’s Cancer Statistics Center for more key statistics.

A risk factor is anything that affects a person’s chance of getting a disease such as a brain or spinal cord tumor. Different types of cancer have different risk factors.

Lifestyle-related risk factors such as diet, body weight, physical activity, and tobacco use play a major role in many adult cancers. But these factors usually take many years to influence cancer risk, and they are not thought to play much of a role in childhood cancers, including brain tumors.

Very few risk factors have been found for brain and spinal cord tumors. There is no clear cause for most of these tumors.

Radiation exposure

The only well-established environmental risk factor for brain tumors is radiation exposure to the head, which most often comes from the treatment of other conditions.

For example, before the risks of radiation were well known (more than 50 years ago), children with ringworm of the scalp (a fungal infection) often received low-dose radiation therapy. This was later found to increase their risk of brain tumors as they got older.

Today, most radiation-induced brain tumors are caused by radiation given to the head to treat other cancers, such as leukemia. These brain tumors usually develop around 10 to 15 years after the radiation.

Radiation-induced tumors are still fairly rare, but because of the increased risk (as well as the other side effects), radiation therapy is only given to the head after carefully weighing the possible benefits and risks. For most patients with cancer in or near the brain, the benefits of getting radiation therapy as part of their treatment far outweigh the small risk of developing a brain tumor years later.

The possible risk from fetal or childhood exposure to imaging tests that use radiation, such as x-rays or CT scans, is not known for sure. These tests use much lower levels of radiation than those used in radiation treatments, so if there is any increase in risk, it is likely to be very small. But to be safe, most doctors recommend that pregnant women and children not get these tests unless they are absolutely needed.

Inherited and genetic conditions

In rare cases (less than 5% of brain tumors), children have inherited abnormal genes from a parent that put them at increased risk for certain types of brain tumors. In other cases, these abnormal genes are not inherited but occur as a result of changes (mutations) in the gene before birth.

People with inherited tumor syndromes often have many tumors that start when they are young. Some of the more well-known syndromes include:

Neurofibromatosis type 1 (von Recklinghausen disease)

This is the most common syndrome linked to brain or spinal cord tumors. It is often inherited from a parent, but it can also start in some children whose parents don’t have it. Children with this syndrome may have optic gliomas or other gliomas of the brain or spinal cord, or neurofibromas (benign tumors of peripheral nerves). Changes in the NF1 gene cause this disorder.

Neurofibromatosis type 2

Less common than von Recklinghausen disease, this condition can also either be inherited or may start in children without a family history. It is associated with cranial or spinal nerve schwannomas, especially vestibular schwannomas (acoustic neuromas), which almost always occur on both sides of the head. It is also linked to an increased risk of meningiomas, as well as spinal cord gliomas or ependymomas. Changes in the NF2 gene are responsible for neurofibromatosis type 2.

Tuberous sclerosis

Children with this condition may develop subependymal giant cell astrocytomas (SEGAs), as well as other benign tumors of the brain, skin, heart, kidneys, or other organs. This condition is caused by changes in either the TSC1 or the TSC2 gene.

Von Hippel-Lindau disease

Children with this disease tend to develop blood vessel tumors (hemangioblastomas) of the cerebellum, spinal cord, or retina, as well as tumors in the kidney, pancreas, and some other parts of the body. It is caused by changes in the VHL gene.

Li-Fraumeni syndrome

People with this syndrome have an increased risk of gliomas, as well as breast cancer, soft tissue sarcomas, leukemia, adrenal gland cancer, and some other types of cancer. It is caused by changes in the TP53 gene.

Other syndromes

Other inherited conditions linked with increased risks of certain types of brain and spinal cord tumors include:

• Gorlin syndrome (basal cell nevus syndrome)
• Turcot syndrome
• Cowden syndrome
• Hereditary retinoblastoma
• Rubinstein-Taybi syndrome

Some families may have genetic disorders that are not well recognized or that could even be unique to a particular family.

Factors with uncertain, controversial, or unproven effects on brain tumor risk

Cell phone use

Cell phones give off radiofrequency (RF) rays, a form of electromagnetic energy on the spectrum between FM radio waves and those used in microwave ovens, radar, and satellite stations. Cell phones do not give off ionizing radiation, the type that can cause cancer by damaging the DNA inside cells. Still, there have been concerns that the phones, whose antennae are built-in and therefore are placed close to the head when being used, might somehow raise the risk of brain tumors.

Some studies have suggested a possible increased risk of brain tumors or of vestibular schwannomas in adults with cell phone use, but most of the larger studies done so far have not found an increased risk, either overall or among specific types of tumors. Still, there are very few studies of long-term use (10 years or more), and cell phones haven’t been around long enough to determine the possible risks of lifetime use. The same is true of any possible higher risks in children, who are increasingly using cell phones. Cell phone technology also continues to change, and it’s not clear how this might affect any risk.

These risks are being studied, but it will likely be many years before firm conclusions can be made. In the meantime, for people concerned about the possible risks, there are ways to lower their (and their children’s) exposure, such as using the speaker function or an earpiece to move the phone itself away from the head when used. For more information, see our document Cellular Phones.

Other factors

Exposure to aspartame (a sugar substitute), exposure to electromagnetic fields from power lines and transformers, and infection with certain viruses have been suggested as possible risk factors, but most researchers agree that there is no convincing evidence to link these factors to brain tumors. Research on these and other potential risk factors continues.

The cause of most brain and spinal cord tumors is not fully understood. But researchers have found some of the changes that occur in normal brain cells that may lead them to form tumors.

Normal human cells grow and function based mainly on the information contained in each cell’s chromosomes. Chromosomes are long strands of DNA in each cell. Brain and spinal cord tumors, like other tumors, are usually caused by changes (mutations) in the DNA inside cells. DNA is the chemical that makes up our genes – the instructions for how our cells function. We usually look like our parents because they are the source of our DNA. But DNA affects more than how we look.

Some genes control when our cells grow, divide into new cells, and die. Certain genes that help cells grow, divide, and stay alive are called oncogenes. Others that slow down cell division, or cause cells to die at the right time, are called tumor suppressor genes. Cancers can be caused by DNA changes that turn on oncogenes or turn off tumor suppressor genes. These gene changes can be inherited from a parent (as is sometimes the case with childhood cancers), but more often they happen spontaneously during a person’s lifetime.

In recent years, researchers have found the gene changes that cause some rare inherited syndromes (like neurofibromatosis, tuberous sclerosis, Li-Fraumeni syndrome, and von Hippel-Lindau syndrome) and increase the risk of developing some brain and spinal cord tumors. For example, the Li-Fraumeni syndrome is caused by changes in the TP53 tumor suppressor gene. Normally, this gene prevents cells with damaged DNA from growing. Changes in this gene increase the risk of developing brain tumors (particularly gliomas), as well as some other cancers.

In most cases, it is not known why people without inherited syndromes develop brain or spinal cord tumors. Most risk factors for cancer somehow damage genes. For example, tobacco smoke is a risk factor for lung cancer and several other cancers because it contains chemicals that can damage genes. The brain is relatively protected from tobacco smoke and other cancer-causing chemicals that we might breathe in or eat, so these factors are not likely to play a major role in these cancers.

Several different gene changes must usually occur in normal cells before they become cancerous. There are many kinds of brain tumors, each of which may have different sets of gene changes. A number of gene or chromosome changes have been found in different brain tumor types, but there are probably many others that have not yet been found.

Researchers now understand some of the gene changes that occur in different types of brain tumors, but it’s still not clear what causes these changes. Some gene changes might be inherited, but most brain and spinal cord tumors in children are not the result of known inherited syndromes. Most gene changes are probably just random events that sometimes happen inside a cell, without having an outside cause.

Other than radiation, there are no known lifestyle-related or environmental causes of childhood brain tumors, so it is important to remember that there is nothing these children or their parents could have done to prevent these cancers.

Screening is testing for a disease (such as brain or spinal cord tumors) in people without any symptoms. At this time there are no widely recommended screening tests for most children to look for brain or spinal cord tumors before they start to cause symptoms. These tumors usually are found as a result of signs or symptoms the child is having.

Most often, the outlook for people with brain or spinal cord tumors depends on the type of tumor and its location, not how early it is detected. But as with any disease, earlier detection and treatment is likely to be helpful.

For children with certain inherited syndromes that put them at higher risk for brain tumors, such as neurofibromatosis or tuberous sclerosis, doctors often recommend frequent physical exams and other tests. These tests might find tumors when they are still small. Not all tumors related to these syndromes may need to be treated right away, but finding them early might help doctors monitor them so that they can be treated quickly if they begin to grow or cause problems.

After treatment, the main concerns for most families are the short- and long-term effects of the tumor and its treatment, and concerns about the tumor still being present or coming back.

It’s certainly normal to want to put the tumor and its treatment behind you, and to get back to a life that doesn’t revolve around the tumor. But it’s important to realize that follow-up care is a central part of this process that offers your child the best chance for recovery and long-term survival.

Looking for tumor progression or recurrence

In some cases, even with slow-growing tumors, some of the tumor may still remain after treatment. Even when childhood tumors are treated successfully, some might come back even many years later. (Your child’s doctor should be able to give you an idea of how likely this is.)

Imaging tests (CT or MRI scans), physical exams, and sometimes other tests will be done after treatment to help determine how successful it was. Whether the tumor was removed completely or not, your child’s health care team will want to watch your child closely, especially in the first few months and years after treatment to watch for tumor growth or recurrence. Depending on the type and location of the tumor and the extent of the treatment, the team will let you know which tests need to be done and how often.

During this time, report any new symptoms to your child’s doctor right away, so the cause can be determined and treated, if need be. Your child’s doctor can give you an idea of what to look for. If your child needs further treatment at some point, the doctor will go over the options with you.