Sometimes it starts with something that doesn’t feel alarming at all. A child’s belly looks a little bigger than usual. Maybe relatives joke about “healthy weight gain.” Maybe parents think it’s just bloating, or that the child is eating well. After all, kids grow in spurts. Their bodies change. A slightly swollen tummy doesn’t immediately scream danger.But in some cases, that quiet swelling can be something far more serious.“A noticeable swelling of the abdomen in a young child can be subtle and easily misinterpreted. In early stages, it may simply look like a rounded belly without pain or obvious distress. In many cases, parents may assume it is related to diet or reduced physical activity. Yet, in some children, this outward change may be one of the earliest visible signs of neuroblastoma, a rare but serious cancer that primarily affects infants and young children,” says Dr. Ashwani Kumar Sharma, Vice Chairman – Manipal Comprehensive Cancer Centre & Onco Robotic Surgeries, Manipal hospitals, Gurugram and explains why the cancer occurs and how it remains hidden in plain sight in the initial stage.Neuroblastoma is one of the more common cancers seen in young children, especially under the age of five. And what makes it scary isn’t just the word cancer. It’s how easily it can blend into normal childhood changes. The tumour often grows in the abdomen, near the adrenal glands, which sit on top of the kidneys. So instead of a dramatic symptom, what parents may notice first is a firm or enlarged belly. Sometimes the child complains of vague stomach pain. Sometimes there’s loss of appetite. Or tiredness that feels a bit unusual but not extreme.“Neuroblastoma arises from immature nerve cells and most commonly develops in the adrenal glands or along nerve tissue in the abdomen. Because the tumour often grows deep within the body, it may not initially interfere with daily activity. Children can remain playful and energetic, even as the abdomen slowly becomes more prominent due to the growing mass.Over time, additional symptoms may appear, including reduced appetite, unexplained weight loss, persistent constipation, fatigue, or increased irritability. Some parents may notice that the abdomen feels unusually firm and appears uneven. In certain cases, discomfort may be evident when the child is lifted or during routine movement,” he warns and urges parents to pay attention to signs like swollen belly.And that’s the tricky part. These signs don’t always look urgent. Kids get tummy aches all the time. They skip meals. They seem cranky or low on energy after a long day. It’s easy to explain it away.But when the swelling doesn’t go down. When there’s persistent pain, unexplained fever, weight loss, or even bruising around the eyes, that’s when it deserves a closer look. Neuroblastoma can also cause symptoms like bone pain or limping if it spreads, which again can be mistaken for minor injuries from play.No parent wants to assume the worst. And most swollen bellies are not cancer. But awareness matters. Knowing that some childhood cancers don’t arrive with loud warning signs can make a real difference.Early detection is crucial in neuroblastoma, as treatment outcomes are significantly better when the disease is identified before it spreads. Timely diagnosis may allow for better treatment and improved long-term survival. Neuroblastoma treatment depends on risk level, age, and tumor location, often involving a combination of surgery, chemotherapy, radiation, and immunotherapy.“Most of the time, a swollen belly in a child turns out to be something simple. Gas. Constipation. A random tummy bug. And usually, it settles down on its own. But if the swelling keeps increasing, looks unusual, or just doesn’t feel right, it shouldn’t be brushed aside. Parents know their child best. If the tummy seems firmer than usual, if the size keeps changing, or if it’s coming along with pain, fever, low energy, or loss of appetite, that’s your cue to get it checked. Don’t wait it out for weeks hoping it’ll fix itself. Seeing a doctor early can make all the difference. Sometimes it’s nothing serious. But if it is something bigger, catching it early gives doctors more time and more options to treat it properly. A small doubt is always worth clarifying. It’s better to ask questions now than to regret waiting later.,” he urges.Medical experts consulted This article includes expert inputs shared with TOI Health by: Dr. Ashwani Kumar Sharma, Vice Chairman – Manipal Comprehensive Cancer Centre & Onco Robotic Surgeries, Manipal hospitals, GurugramInputs were used to explain what is neuroblastoma and how its early symptoms mimic childhood developmental milestones and the disease is not caught in the early stage.
