Guide — Pediatrics
Pediatric Solid Tumors Nursing Care
The childhood solid tumors are exam favorites because each has one signature finding and one nursing reflex attached to it — and for Wilms tumor, that reflex (don’t palpate the abdomen) can change the disease’s course. Learn the buzzword and the rule together.
9 min read · Pediatrics
Educational use only. Staging, surgical timing, and chemotherapy/radiation protocols belong to the pediatric oncology team — follow their orders and your facility’s protocols. Hazardous-drug handling requires specific training and PPE. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Overview
After leukemia and brain tumors, the embryonal solid tumors are the classic pediatric cancers — they arise from immature tissue and cluster in early childhood. The three the exam loves are Wilms tumor (kidney), neuroblastoma (sympathetic nervous system/adrenal), and retinoblastoma (eye), joined by the adolescent bone tumors (osteosarcoma and Ewing sarcoma). Several have hereditary forms, so a family history can matter.
Each is treated with a multimodal plan — surgery, chemotherapy, sometimes radiation — so the chemo nursing care (neutropenic and bleeding precautions, central lines, symptom management) overlaps heavily with leukemia. What differs is the presentation and the tumor-specific priority.
Key Concepts
Wilms tumor (nephroblastoma) — DO NOT PALPATE
A kidney tumor, usually in a child under ~5, often found as a firm, non-tender, one-sided abdominal mass that does NOT cross the midline, sometimes with hematuria and hypertension. The cardinal nursing rule: avoid palpating the abdomen and post a sign — pressure can rupture the encapsulated tumor and seed cancer cells. Surgery (nephrectomy) is often early; handle and bathe gently until then.
Neuroblastoma — the mass that crosses midline
Arises along the sympathetic chain, commonly the adrenal/abdomen, typically under age 5. The discriminator from Wilms: the irregular abdominal mass often CROSSES the midline. Frequently metastatic at diagnosis, with varied signs — periorbital bruising (“raccoon eyes”), bone pain, an unsteady gait or “dancing eyes” (opsoclonus-myoclonus), and catecholamine effects. Urine catecholamines (VMA/HVA) help diagnose it.
Retinoblastoma — the white reflex
An eye tumor of infancy/toddlerhood whose hallmark is leukocoria — a white pupillary reflex (often first noticed in a photograph as a white instead of red reflex), plus strabismus or a red painful eye. It can be hereditary and bilateral. The priority is vision and eye preservation when possible; advanced disease may require enucleation, and the nurse supports the family through that and prosthetic care.
Bone tumors — osteosarcoma vs Ewing
Adolescent osteosarcoma favors the metaphysis of long bones (around the knee — distal femur/proximal tibia) with pain and a mass; Ewing sarcoma favors the diaphysis and flat bones (pelvis, femur) and more often brings systemic signs (fever, weight loss). Both treat with chemo plus local control (limb-salvage surgery, amputation, or — for Ewing — radiation). Pain that wakes a teen at night and a persistent “injury” that doesn’t heal are red flags.
Assessment Findings
Tie each tumor to its finding: Wilms = a flank/abdominal mass not crossing midline, hematuria, hypertension; neuroblastoma = a firm mass crossing midline, raccoon eyes, bone pain, neuro signs; retinoblastoma = leukocoria and strabismus; bone tumors = localized pain (often night/rest pain), swelling, and a pathologic-fracture risk. Throughout chemotherapy, the assessment mirrors leukemia: ANC and fever (neutropenic fever is an emergency), platelets and bleeding, hemoglobin, mucositis, central line, nutrition, and pain. Post-op, add the procedure-specific checks (nephrectomy abdomen and renal function with a single kidney; amputation/limb-salvage neurovascular and stump care; enucleation socket care).
Nursing Priorities
Protect the Wilms abdomen
No abdominal palpation; sign at the bedside; gentle handling and bathing until the tumor is removed. After nephrectomy, protect the remaining single kidney lifelong (hydration, avoid nephrotoxins, contact-sport counseling), and monitor blood pressure and renal function.
Run the shared chemo safety plan
Neutropenic fever within ~1 hour to cultures and antibiotics; neutropenic and bleeding precautions; hazardous-drug PPE; antiemetics ahead of nausea; mucositis and constipation care; sterile central-line management. (See the chemotherapy reference for the full bundle.)
Support the surgery that changes the body
For amputation or enucleation: prepare the child and family honestly and developmentally, manage phantom limb sensation and grief, teach stump or socket/prosthetic care, and bring in child life, PT/OT, and psychology. These surgeries are losses as well as treatments.
Catch what screening catches
Teach and reinforce the value of the routine red-reflex check (retinoblastoma) and timely evaluation of an abdominal mass or persistent bone pain — early detection meaningfully changes outcomes in these tumors.
Therapeutic Communication Considerations
As with leukemia, pace the information and lead with realistic hope — many of these tumors are curable, especially when localized. Hereditary forms (retinoblastoma, some others) raise genetic-counseling and sibling-screening conversations handled with sensitivity. Body-altering surgery (amputation, eye removal) needs honest, developmentally appropriate preparation; children cope better knowing what will happen than being surprised. Support siblings and exhausted parents, and connect families to the long-haul team — social work, child life, school liaison, and survivorship for the late effects that follow childhood cancer treatment.
Patient & Family Education
Wilms families: the no-palpation rule until surgery, and lifelong single-kidney protection afterward. All chemo families: fever per the team’s threshold means come in now, plus central-line care, infection and bleeding precautions, no live vaccines during treatment, and oral care. Retinoblastoma families: red-reflex significance, eye/socket or prosthetic care, and genetic counseling where relevant. Bone-tumor families: pain management, mobility and safety with limb-salvage hardware or a prosthesis, and pathologic-fracture precautions. Across all: keep appointments and counts, plan school re-entry, and know that survivorship follow-up watches for late effects — but most of these children survive and thrive.
NCLEX Pearls
- ✦Wilms tumor: DO NOT PALPATE the abdomen (rupture/seeding risk) — post a sign; mass does NOT cross midline.
- ✦Neuroblastoma: irregular abdominal mass that CROSSES midline; raccoon eyes, bone pain, ↑urine catecholamines (VMA/HVA).
- ✦Retinoblastoma: leukocoria — a WHITE pupillary reflex (often spotted in photos) — plus strabismus; can be hereditary/bilateral.
- ✦Osteosarcoma = metaphysis, around the knee; Ewing sarcoma = diaphysis/flat bones with systemic signs. Night/rest bone pain is a red flag.
- ✦Chemo care mirrors leukemia: neutropenic fever within ~1 hour, bleeding precautions, central-line and symptom management.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with American Academy of Pediatrics (AAP) · CDC / ACIP (immunization schedule). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →