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Lymph nodes in children

March 5, 2014 Robert L. Weinsheimer, MD

One of the most common referrals to my pediatric surgery practice is (in the parents’ words) “to check out this lump and make sure it’s nothing to worry about.”  Lymph nodes are part of the less publicized part of the circulatory system: the lymphatics.  Lymphatics play a key role in our body’s immune system, and lymph nodes grow in response to an infection in the “neighborhood” to produce cells necessary to hopefully resolve the infection. 

About half of all children will develop enlarged lymph nodes (cervical lymphadenitis) in the neck for example, and the vast majority of these are in response to a minor infection in the area (sore throat, sinus infection, ear infection, etc.).  Often the infection is quite subtle and might not be identified.  These nodes typically go through a pattern of growing and then receding in size once the infection resolves.  This process can take several weeks to months.  The nodes may become tender, warm, and there may be some redness of the overlying skin.  Your child might complain of pain in the area, be fussier, have fever, and/or have decreased appetite.  If the node itself becomes infected, it can turn into an abscess and would require antibiotics and a drainage procedure.  Any possibly infected lymph node should be evaluated by your doctor.
 
Some enlarged lymph nodes seem to stick around for a long time (longer than about 6 weeks), and this is a different category that should be brought to the attention of your physician.  These could be due to longer lasting (chronic) infections caused by certain organisms.  On the other hand, lymph nodes that persist can be the result of lymphoma or another cancerous process.  Red flags that should raise suspicion of a worrisome lymph node are: size (increasing in size, overall size more than 2.5 cm), the feel (firm, non-tender, feels stuck to surrounding tissues), its location (some sites are more likely related to a cancer), rapid increase in the number of nodes in various locations.  In the setting of a possible cancer, removing one of the lymph nodes (excisional biopsy) for evaluation is the appropriate next step.  Sometimes a biopsy is the only way to distinguish an infection-related lymph node from cancer.
 
Thankfully, the vast majority of lymph nodes in children come and go (with a little patience!) and do not need any specific treatment.  If a lymph nodes seems infected (red, swollen, tender, fever); or is accompanied by the above red flags, don’t hesitate to have the node evaluated.

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