Most adults know that an unexplained lump is one
of the seven warning signs of cancer. So it is easy to understand why discovering an
enlarged lymph node in their child’s neck or under their arm strikes fear in a
parent’s heart. They suspect the worst and arrange a prompt visit with their
youngster’s physician. True, enlarged lymph nodes can be a symptom of a serious
disease, but in children that is rarely the case.
Made up of specialized blood cells, lymph nodes
are an important part of the body’s defense system. There are nearly 1,000 of them
stationed throughout the body, ranging in size from a pinhead to a small grape. Nodes act
as filtering plants for the lymph system, trapping and eliminating foreign particles and
infectious agents from the circulation. In addition, lymph nodes act to prevent the spread
of infection by producing white blood cells and antibodies to destroy infecting germs and
poisons. When lymph nodes enlarge, it usually means that the nodes are being called into
action to make extra antibody or are filtering out unfriendly germs. Any illness or wound,
even one as minor as an insect bite, can mobilize this response, which explains why
children’s nodes can be swollen even when the youngster does not seem sick.
The lymph node system is divided into different
districts with each part of the body being defended by its own network of nodes. Most of
the time, the location of the enlaged node indicates where the current or past infection
was located. For example, since most infections enter the child’s body through the
nose, mouth, and throat, the lymph nodes in the neck (especially the ones just under the
corner of the jaw bone) are most often swollen and tender. When a child has an infection
in the arm, the nodes under the arm will enlarge. Similarly, swollen nodes found in the
groin usually indicate an infection in the leg. Certain viral infections, like infectious
mononucleosis, can cause swelling of the lymph nodes all over the body. Occasionally, the
node itself can become infected causing skin redness, node tenderness, and in rare cases a
yellow discharge is seen oozing from the lump. When this occurs, parents should contact
the child’s physician since antibiotics will probably be needed.
Because less fat covers the lymph nodes in
children, they are very easy to feel, even when they are not busy filtering germs or
making antibody. Furthermore, a youngster’s nodes enlarge faster and get bigger in
response to an infection and stay swollen longer, "like a peace keeping force that
remains behind after the battles have all been fought," according to California
pediatrician Dr. Gilbert Simon. "They both seem to last a lot longer than would
When a child’s lymph nodes enlarge without an
obvious reason, infections such as mononucleosis, tuberculosis, and a number of viruses,
may be responsible. Another cause of lymph node swelling is a common condition called
"Cat-Scratch Disease" that follows weeks to months after a scratch from a cat
(most often a kitten).
Still, the major concern for most parents when
they feel a lymph node in their child is leukemia or Hodgkin's Disease. Physicians also
think about this possibility, and use child’s physical examination to help determine
whether an enlarged node is worrisome or not.
The first important finding is the gland’s
location - lymph nodes in the neck are less likely to be a problem than those found above
the collarbone, for example. A node that is growing rapidly is potentially more serious
than one that remains the same size for a period of time. Physicians are less concerned
about a swollen node when the cause is found, such as a past ear or throat infection.
Generally, a lymph gland that is easily movable and can be rolled around under the skin is
less likely to be caused by a serious disease. The size of the lymph node is usually a
poor indicator of its cause, but a node that is abnormally large should always be
carefully watched. While all nodes in children feel like firm rubber, an extremely hard
lymph node might be more cause for concern. The last sign doctors look for has more to do
with the child than node. Lymph node swelling that persists while the child begins
experiencing intermittent fevers, weight loss, night sweats, fatigue, or loss of appetite
requires a more intensive investigation.
Occasionally, a two-week trial of antibiotics will
help determine whether or not a swollen lymph node is worrisome. If the node responds to
medication by getting smaller, an infection is most likely the cause. Failure of the lymph
node to get smaller may mean followup observation perhaps additional studies.
Investigations might include a blood count, skin test for tuberculosis and cat-scratch
disease, throat culture, chest x-ray and a mononucleosis test.
A physician might consider a biopsy of the lymph
node if the swelling persists without an apparent diagnosis. Fortunately, most biopsies do
not reveal cancer but reassure both the family and physician that the condition is not
malignant. It can also help in making the diagnosis!
Doctors caring for kids frequently exam their
young patients after a parent discovers a swollen lymph node. Since young children are
more suscpetible to infections than older kids and adults, enlarged nodes are very common.
However, whenever a parent is worried after finding a lump in their child, they should
check with their pediatrician, just for safety sake.