Pediatric Lymphadenopathy

The lymphatic system is part of the immune system and functions to fight disease and infections. As infection-fighting cells and fluid accumulate, the lymph nodes enlarge to many times their normal size. Nearly all children will develop lymphadenopathy at some time, as the condition commonly occurs in response to an infection from a virus, such as an upper respiratory infection. Bacterial infections, such as strep throat caused by the streptococcus bacterium, can also cause lymphadenopathy.

Since enlarged lymph nodes are often near the source of infection, their location can help determine the cause. For example, an infant with a scalp infection may have enlarged lymph nodes at the back of the neck. Swollen lymph nodes around the jaw may be due to an infection in the teeth or mouth. However, the lymphadenopathy may be generalized, with lymph node enlargement in more than one area, which is typical of a viral illness.

Sometimes, the lymph nodes themselves can become inflamed and enlarged, a condition called lymphadenitis. Lymph nodes can also enlarge due to cancer in the lymphatic system, such as Hodgkin disease.

In children, it is normal to be able to feel some lymph nodes as small, movable lumps under the skin. However, if the nodes become more enlarged than usual, there may be an underlying problem. The following are the most common symptoms of lymphadenopathy. However, each child may experience symptoms differently. Symptoms may include:

• Swollen, enlarged lumps in the neck, back of the head, or other locations of lymph nodes
• Tenderness of the nodes, although the nodes may not be painful if the child is no longer ill
• Warmth or redness of the skin over the lymph nodes
• Fever
• History of illness

The symptoms of lymphadenopathy may resemble other neck masses or medical problems. Always consult your child's doctor for a diagnosis.

Diagnosis of lymphadenopathy is often based on the presence of other conditions, such as an infection. It is important to determine if the child has been exposed to any communicable diseases, such as varicella (chickenpox), or has been bitten by an animal that may transmit an illness called cat-scratch fever. The size and location of the nodes, how long ago the swelling began, and the presence of pain are helpful in determining the cause. In addition to a complete medical history and physical examination, diagnostic procedures for lymphadenopathy may include a lymph node biopsy in which a sample of tissue is removed from the lymph node and examined under a microscope. Further tests may be necessary for specific diseases or infections that may be related to the lymphadenopathy.

Specific treatment of lymphadenopathy will be determined by your child's doctor based on:

• Your child's age, overall health and medical history
• Extent of the condition
• Your child's tolerance for specific medications, procedures or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment may include:

• Antibiotic medications (to treat an underlying bacterial infection)
• Continued evaluation (to check the size and location of the enlarged nodes)
• Medications or procedures (to treat other conditions that may have caused the lymph node enlargement)