may precipitate a rapid change in ICP followed by herniation of the brain The pressure may be relieved using steroids such as dexamethasone at a dose of to mg every hours Mannitol or hypertonic (3%) saline may be useful in decreasing ICP In some situations, intubation may be needed for both airway protection and to allow for hyperventilation to lower PCO when signs of herniation are present Neurosurgical consultation can address the appropriateness of a ventriculostomy or debulking procedure The decision about where to admit a patient with a newly diagnosed brain tumor hinges primarily on the neurologic status Patients may have altered airway, breathing, or circulation due to the tumor compressing the brainstem Cranial nerve dysfunction may compromise a patient’s ability to eat normally The tumor may cause symptoms such as headache, nausea, or vomiting, which require inpatient management Functional deficits may make discharge problematic In any of these cases, patients should be admitted to the hospital with prompt consultation with pediatric oncology, pediatric neurology, and pediatric neurosurgery for definitive management TUMORS OF THE HEAD AND NECK Goals of Treatment Children with head and neck tumors should be rapidly assessed for airway impingement, breathing compromise, and cervical spinal cord compression CLINICAL PEARL AND PITFALLS Cervical lymphadenopathy is common in childhood and rarely due to cancer Characteristics that make malignancy more likely include nontender masses, very firm/hard texture, diameter more than cm, adherence to other structures, irregular margins, and absence of signs or symptoms of infection Retinoblastoma often presents with leukocoria (white pupil) first noticed by parents Current Evidence Head and neck tumors represent a diverse range of conditions and, with the exception of retinoblastoma and neuroblastoma, occur most commonly in older children and teenagers Aerodigestive tract malignancies include sarcomas, lymphoid tumors, and carcinomas While the latter are commonly seen in the adult population, carcinoma is rare in pediatrics Clinical Considerations