Swollen lymph nodes in children

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In this article

• what are the lymph nodes
• because they swell, the causes
• when is the enlargement normal?
• when to go to the pediatrician?
• what are the exams to do?
• care
• lymphatic children

What are the lymph nodes

Lymph nodes are the defense stations of the human body and are located all over the place. When there is an infection to be eradicated they can swell and it is possible to notice the increase in volume especially in the neck and armpit area. But when a lymph node grows beyond certain limits, it begins to freak out the parents.

We asked Susanna Esposito, Director of the High Intensity Care Pediatrics Unit, IRCCS Ca 'Granda Foundation Ospedale Maggiore Policlinico, University of our city, and President of the Del Paesena Society of Pediatric Infectious Disease (SITIP), to explain us when an enlarged lymph node is normal and when not.

Why a lymph node becomes enlarged, the causes

The lymph nodes are the 'sentinels of health' of our body, as they intercept any infections or inflammations and produce antibodies to eradicate them. In these cases, it is normal for the lymph nodes to work and increase in volume, number and consistency.

Generally those that increase are the lymph nodes near the area where the infection occurs:

• if there is a pharyngitis, for example, the lymph nodes in the neck swell;
• if there is an intestinal infection, the inguinal lymph nodes become enlarged;
• if the problem is in the arms or chest, the axillary lymph nodes become enlarged.

Causes of swollen lymph nodes

In the vast majority of cases, swollen lymph nodes are caused by an infection, which may be due to:

•  bacteria such as group A β hemolytic streptococcus (the main cause of pharyngitis), scratching diseases of cats or dogs, insect bites;
• viruses, for example cytomegalovirus, mononucleosis, herpes simplex
• from the protozoan of toxoplasmosis.

In addition to swollen lymph nodes, children usually also have symptoms of the disease that caused the swelling, such as fever or rash.

Much more rarely, swollen lymph nodes can be a sign of a chronic disease such as immunodeficiencies, such as HIV, neoplasms, such as lymphomas or leukemia, autoimmune diseases, such as systemic lupus erythematosus, or tuberculosis.

When is lymph node enlargement considered normal?

The lymph nodes that most frequently swell and are noticed in children are those of the neck and submandibular area, both because they are more superficial and because children suffer from frequent throat and ear infections. Under normal conditions, the lymph nodes in the neck are the size of a pea and are barely noticeable on palpation.

An enlarged lymph node need not worry if:

•  it increases up to about 2 centimeters in diameter;
• the overlying skin is not red;
• is sore, that is, the child reports pain when touched or when he bends his head or moves his neck;
• the child has a current or recent airway infection, fever and cold, earache, or has received an insect bite or scratch from a pet.

When there is an infectious cause, viral or bacterial, the lymph nodes usually regress spontaneously within 4-6 weeks, to definitively return to their original size within 3 months. Therefore, there is no need to worry if the lymph nodes are still enlarged weeks after the infectious episode ended.

When should a lymph node be evaluated by the pediatrician?

• The overlying skin is very red. Even marked redness is not in itself a worrying sign, but it may be that pus has formed inside the lymph node which in some cases must be removed with a small surgical incision.

• The child is less than one year old;

• The lymph node exceeds 3 centimeters in diameter;

• The swelling does not subside after 4-6 weeks;

• The child has a persistent low-grade fever for over 2 weeks (any upper airway infection, such as pharyngotonsillitis, gives fever only for a few days);

• Within 1-2 months there is a weight loss of more than 10%;

• Generalized rash and widespread itching appear;

• The child has night sweats.

What are the diagnostic tests to do?

After examining the child, the pediatrician will assess whether the child needs to be examined. In particular:

• blood test (complete blood count, ESR, C reactive protein),
• intradermal reactions for the detection of tuberculous and non-tuberculous mycobacteria,
• protidogramma,
• LDH,
• throat swab,
• chest x-ray.

If necessary, a biopsy of the inflamed lymph node is also performed, i.e. a sampling of the related tissue.

What is the cure?

An enlarged lymph node does not need to be treated. What needs to be treated, if necessary, is the cause that led to the swelling of the lymph nodes:

• if there is a viral infection, no therapy is needed, because the infection heals spontaneously;
•  if the cause is a bacterial infection, antibiotic therapy is required. "The type of antibiotic varies according to the bacterium responsible" specifies Susanna Esposito.
• If the cause is more serious, the referring specialist will decide the most suitable therapy on a case-by-case basis.

Why are we talking about lymphatic babies?

There are children who have one predisposition to have greater sensitivity of the lymph nodes, so as soon as their organism encounters an infectious agent, the lymph nodes react by swelling, just like there are children predisposed to have more enlarged tonsils.

"Once there was talk of lymphatism, but today it is a term that is no longer used in medical language, because having lymph nodes a little bigger than usual is not in itself a disease "underlines the pediatrician. And for this reason it is a phenomenon that does not require any therapy , nor restorative treatments.

Finally, it should be borne in mind that in children the lymph nodes are on average larger than in adults, because physiologically the lymphatic tissue increases progressively from birth until it reaches a peak around the age of 8-11, and then begins to shrink from puberty onwards.

Updated on 27.02.2022

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• swollen lymph nodes in children
• swollen neck glands
• 3-5 children years