b'5 HypermobilityChildren with NF1 often have hypermobilityUsually obvious by age 5 years REFERRAL to Physiotherapist and flat feetand flat feet. This may cause them to beadvised if hypermobility iseasily tired and to complain of aches insuspected and to podiatrist for flatlimbs.feet Skin Skin neurofibromasusually start toSkin neurofibromas- are more commonlyREFER to an NF clinic, dermatologist develop in teenagers of young adults but canseen in adults with NF1.or plastic surgeon for advice be seen in younger children. Can presentPlexiform neurofibromas-Usually presentconcerning the skin.with itching.by mid-teens and if not there then willPlexiform neurofibromas- these develop inNOT develop. Doctors with a lot of NF1 around 25% NF1 children, Early signs may beexperience may pick up subtle signs very large areas of caf au lait which thenearlier become thickened, the area may have excessive hair growth.Eye checksMost NF1 eye problems present by age 8Most NF1 gliomas cause visual loss by ageOnce visual loss is detected the child years. The minimum recommendation is for7 yearsshould be referred to a regional NF1 children to have their vision checkedcentre for assessment by a once a year by a Paediatric OphthalmologistPaediatric Oncologist until age 8 years. Some centres off younger children (who wont complain about visual loss) 6 monthly checks until 4-5 years. From 8 years onwards an annual check with a High Street Optician is recommended but the chance of a problem is very low indeed. PCHR Insert for Neurofibromatosis Type 1 First Edition April 2017'