Today, there are more cases of childhood leukemia seen in pediatric hospitalizations and consultations than used to be in the past. This has come as a result of increased awareness of the threat posed by the disease.There are many signs and symptoms that may suggest a child to have leukemia. Not only leukemia, there are many malignant tumors seen in children than adults. Perhaps this has also encouraged physicians to focus on the specialty of pediatric oncology that deals with cancer treatment in children.However before all examination procedures are taken, it is very important to bear in mind about the family history of leukemia. Others factors to consider are likely risk factors and clinical presentation of the disease.Children with leukemia present with many signs and symptoms. One of the most common symptoms seen in children with leukemia especially in our societies is persistent or recurrent anemia. Patients will normally present with generalised body weakness, dizziness, paleness of the skin or mucosa, and shortness of breath.Children with leukemia usually suffer from infections that do not respond well to medications. These children tend to have persistent high grade fevers. This is largely due to lack of normal white blood cells that normally help fight the infection in the body. Although children with leukemia may have high white blood cell counts, this increase in such cells is abnormal or due to leukemia. This does not protect against infection in the way normal white blood cells do. Fever is also sometimes caused by the leukemia cells themselves releasing certain chemicals into the body.Children with leukemia tend to lose appetite and weight. These symptoms usually have underlying enlargement of the liver and spleen. The liver is so close to the stomach and likely compression to the stomach limits the urge and amount of food eaten. This makes patients lose appetite and weight progressively. Swelling of lymph nodes especially under the skin in certain areas of the body such as the neck, underarm areas, and in the groin is indicative of the disease spread like in many cancerous diseases as seen in adult disease metastasis. However enlargement of lymph nodes in a children is often a sign of infection than leukemia. Also not all leukemia’s spread to lymph nodes.Lymph nodes in the chest and abdomen occur but can only be detected by radio-imaging techniques such as the MRI or CT-Scan.Problems like headache, trouble of concentration, generalized weakness, seizures, vomiting, problems with balance, and blurred vision can be symptoms of the leukemia disease that has spread to the central nervous system.In acute myelogenous leukemia (AML) type, patients may present with swelling and bleeding of the gums. In another type of leukemia known as the acute lymphocytic leukemia (ALL), it often involves the thymus, a small organ in the chest behind the sternum and in front of the trachea. Enlargement of the thymus or of lymph nodes inside the chest can press on the trachea. This can lead to persistent dry cough or even trouble to breathe normally as a result of disruption of breathing airways.Enlargement of the thymus may also lead to the compression of the superior Vena Cava, a large vein that carries blood from the head and arms back to the heart. This vein passes near the thymus and enlargement of thymus as a result of leukemia leads to the superior vena cava syndrome.Patient with this syndrome presents with swelling in the face, neck, arms, and upper chest. This condition is normally treated as an emergency case. Children with leukemia tend to suffer from frequent nosebleeds and also bleed excessively from small cuts. This comes from lack of blood platelets that normally stop bleeding.   Dr Joseph Kamugisha is a resident oncologist in Jerusalem, Israel