Delayed Cancer Diagnoses Leaves Infant Permanently Paralyzed

Case Overview

This case involves a 7-month-old male patient whose right leg was not moving with the same range of motion as the left. He was admitted for a workup, but X-rays and a skeletal survey came back negative. Although the nurse noted that the infant wasn’t moving his right leg with the appropriate intensity or range of motion, the infant was discharged without a diagnosis. The infant continued to experience issues moving his leg for 3 months before he was eventually referred for further investigation. Additional testing diagnosed the infant with a paraspinal tumor which was found to be a neuroblastoma. Because the tumor had compromised the infant’s nervous supply to the legs, he was rendered permanently paralyzed. An expert in pediatric care was sought to opine on whether there was a lapse in the standard of care for this infant.

Questions to the Life Care Planning expert and their responses

At 7-months of age, what is considered normal regarding the movement of lower extremities?

At 7 months of age, a baby should have symmetric legs movements.

What should be the workup when an infant presents with decreased movement in their extremities?

A thorough physical evaluation and radiographs of the legs, in addition to an MRI and CT of the abdomen and spine, should be performed.

How important are the nurse's notes for decision-making on a hospitalized patient?

The nurses and parents would be an important source of documenting such an abnormality.

About the expert

This expert has over 40 years of experience in the field of pediatrics and pediatric rehabilitation. He earned his BA from Northwestern University and his MD from the University of Illinois. He completed his residency in pediatrics at Yale University and his fellowship in pediatric infectious diseases at the University of Chicago. Today, this expert is board-certified in pediatrics and spinal cord injury medicine and is a certified life care planner. He formerly served as the American Spinal Injury Association president, the Chicago Pediatric Society, and the American Paraplegia Society. He has authored over 170 peer-reviewed articles and 26 book chapters. Throughout his accomplished career, he has served as the program director of pediatrics for Mercy Hospital and Medical Center, the chief of pediatrics at Shriners Hospitals for Children, and a pediatrics professor at the University of Chicago and Rush Medical College. Currently, he is the emeritus chief of pediatrics at a children's hospital, a pediatrics professor emeritus at a major university, and a rehabilitation consultant for a pediatric rehabilitation firm in Illinois.