Lymphadenopathy in Children

Lymphadenopathy means swelling of the lymph nodes or glands. These are the bean-shaped glands in the neck, armpits, groin, chest, and abdomen. These glands act as filters for lymphatic fluid. This fluid contains white blood cells (lymphocytes) that help the body fight infection. Lymphadenopathy can occur in just one area of the body, such as the neck. Or it may affect lymph nodes throughout the body. The cervical lymph nodes, found in the neck, are the most common site of lymphadenopathy.

Nearly all children will get lymphadenopathy at some time. That is because enlarged glands often occur with viral or bacterial infections like colds, the flu, or strep throat.

The lymphatic system is part of the immune system. The immune system fights infection and other disease. Cells and fluid build up in the lymph nodes to help fight infection or disease. This causes the lymph nodes to get bigger.

Enlarged lymph nodes are often near the source of infection, so their location can help find out the cause. For example, a baby with a scalp infection may have enlarged lymph nodes at the back of the neck. Swollen lymph nodes around the jaw may be a sign of an infection in the teeth or mouth. Lymphadenopathy may also affect lymph nodes throughout the body. This is common in some viral illnesses such as mono (infectious mononucleosis) or chickenpox.

The causes include:

• Infections caused by viruses or bacteria
• Infection of a lymph node or small group of nodes
• Cancer, although other symptoms are often present
• Reactions to medicines, such as some antibiotics and seizure medicines
• Juvenile arthritis and many other joint conditions that affect children

In children, it's normal to be able to feel some lymph nodes as small, movable lumps under the skin. But if the nodes get bigger than usual, your child may have an infection or other problem. The most common symptoms include:

• Lumps under the jaw, down the sides or back of the neck, or in the armpits, groin, chest, or belly
• Pain or tenderness in the area
• Redness or warmth in the area

Depending on the cause, other symptoms may include:

• Fever
• Respiratory symptoms such as sore throat, congestion, and cough
• Poor appetite
• Body aches
• Headache
• Tiredness
• Weight loss
• Rash

The symptoms of lymphadenopathy can be like other health conditions. Make sure your child sees their healthcare provider for a diagnosis.

Your child’s healthcare provider will ask many questions about your child’s health history and current symptoms. For example, they will ask whether your child has been around others with infections like strep throat. They may ask if your child has been around a young cat. This is because a scratch may cause enlarged lymph nodes in a mild condition called cat scratch disease. They will check your child, looking closely at the areas where lymph nodes are enlarged. The provider will check the size and location of the nodes. The provider will also want to know how long they have been swollen and if they are painful. Your child may need to see a specialist. They may also need some diagnostic tests. They may include:

• Lab tests. A complete blood count called a CBC. A CBC checks the red blood cells, white blood cells, blood clotting cells, and sometimes young red blood cells. Urine and other blood tests may also be done.
• Imaging tests. These can include a chest X-ray to check for enlarged lymph nodes or other problems. Your child may also have other imaging tests such as a CT or MRI scan.
• Lymph node biopsy. Enlarged lymph nodes may be checked with biopsy. Samples of lymph node tissue are taken and looked at under a microscope. They are tested for different causes of enlargement.

Your child may need to see a surgeon for biopsy. Or they may be referred to specialists in blood disorders and cancer. These can include a pediatric hematologist and oncologist.

The treatment of enlarged lymph nodes depends on the cause. Enlarged lymph nodes are often harmless and go away without any treatment. Treatment may include:

• Antibiotic medicines to treat an underlying bacterial infection, such as strep throat, or ear or skin infections
• Antibiotic medicines and drainage of the lymph node for infection of a lymph node or small group of nodes
• A follow-up exam to recheck enlarged nodes after waiting for 3 to 4 weeks
• Other medicines or procedures to treat other conditions that caused the enlarged nodes
• Referral to specialists for incision or drainage or more exams, diagnostic tests, and treatment

Lymphadenopathy is the body’s normal response to infection and other disease. Ignoring the enlarged lymph nodes may delay treatment of a serious infection or other disease.

Call your child’s healthcare provider if:

• You notice lumps below your child’s jaw, down the sides of the neck, in the back of the neck, in the armpits, or in the groin.
• Your child’s lymph nodes continue to be larger than normal, become newly tender, or develop redness of the skin over them, even after your child sees their healthcare provider.
• Your child complains of any problems or pain when swallowing.
• You hear any abnormal breathing sounds or your child complains of having a hard time breathing.

• Lymphadenopathy is the term for swollen glands or swelling of the lymph nodes.
• The lymph glands are part of the immune system and help fight infections and other disease. They are enlarged when the body is fighting infection or other diseases.
• Since enlarged lymph nodes are often near the source of infection, their location can help find the cause.
• Diagnosis of lymphadenopathy is often based on the presence of other conditions, such as an infection.
• Treatment is usually based on the cause of the lymphadenopathy.
• Ignoring lymphadenopathy may delay treatment of a serious infection or other disease.

Tips to help you get the most from a visit to your child’s healthcare provider:

• Know the reason for the visit and what you want to happen.
• Before your visit, write down questions you want answered.
• At the visit, write down the name of a new diagnosis and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
• Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are and when they should be reported.
• Ask if your child’s condition can be treated in other ways.
• Know why a test or procedure is recommended and what the results could mean.
• Know what to expect if your child does not take the medicine or have the test or procedure.
• If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
• Know how you can contact your child’s provider after office hours, and on weekends and holidays. This is important if your child becomes ill and you have questions or need advice.