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Quick reference medical handouts used by Pediatric offices


Swollen glands a Common Occurrence


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 appear necessary."

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.

 

As a reminder, this information should not be relied on as medical advice and is not intended to replace the advice of your child’s pediatrician. Please read our full disclaimer.

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