Glands (Lymph nodes) are part of the immune system. They are located in certain parts of the body as part of the lymphatic system, and their purpose is to process and treat environmental stimuli, for example viruses, bacteria, allergens etc.
The body of an infant and a toddler over the years will come into contact with many viruses and bacteria for the first time. During preschool age, and in particular if the child goes nursery school, it is normal for a child to catch illnesses of the upper respiratory system (fever, runny nose, cough) up to 10-15 times per year. Each time, antibodies are produced, and certain lymph nodes in the lymphatic system become sensitized. This happens more frequently between the ages of 2-5 years, when the lymph nodes are more often palpable, while during school age, there is gradual remission.
Swollen lymph nodes occur most commonly in the child’s throat, as well as in the armpits and the groin. A swollen lymph node is clinically significant if it exceeds the size of one to two centimeters during palpation. Lymph nodes of a smaller size are common and have no clinical significance.
Causes of swollen lymph nodes
Swollen lymph nodes are most commonly found in the child’s throat, and the most usual causes of the swelling are viruses of the upper respiratory system (rhinitis, gingivostomatitis – swollen, painful gums, otitis, pharyngitis, tonsillitis). Inflammation of the lymph nodes caused by viruses usually causes swelling of not more than 2.5 centimeters, while, in the rarer case of a bacterial infection, lymph nodes may exceed 2.5 centimeters in size.
Lymph nodes in the armpits and the groin become swollen more rarely, and they are usually the result of injuries and skin lesions to the arms and the legs respectively, or of infections on the arms and the legs.
In some cases, the infection is related to contact with animals, or due to insect bites and wounds.
There are rare cases, in which swollen lymph nodes may be a sign of another underlying disease (infectious mononucleosis, hepatitis, Kawasaki disease, tuberculosis, AIDS, autoimmune diseases, generalized lymphadenopathy, lymphoma etc.). The doctor will decide if there is indication for further investigation.
Swollen lymph nodes without accompanying symptoms or signs of tonsillitis/rhinitis etc. are not contagious, and the child may go to school as usual. If swollen lymph nodes are a sign of an active infection or a cold, the child may return to school when he no longer has a fever, and feels well enough to get on with his normal activities.
Worrying signs! When to contact the doctor promptly.
Most episodes of swollen lymph nodes occur with viruses, and pass on their own, without paraclinical examinations or treatment. However, parents should remain vigilant, and promptly ask for medical advice if swollen lymph nodes are accompanied by one of the following:
- The child is an infant less than 3 months old
- The child seems ill, has decreased muscle tone (hypotonic)
- The lymph node in the throat causes difficulty in breathing or swallowing
- There is high fever, over 40 degrees Celsius, which does not subside after the administration of antipyretics
- The skin above the lymph node is red or infected, or the area hurts when touched
- The size of the lymph node increases quickly within a few hours
- The lymph node appears larger than 2.5 centimeters
- The lymph node causes torticollis (twisting of the head to one side) or difficulty in moving the neck or the arm
- Fever remains above 38 degrees Celsius for more than 3 days
- There is generalized lymphadenopathy of the lymph nodes on both sides of the body, in the throat and/or the armpit and/or the groin
- The lymph node is large, hard, painless or non-movable
- Swollen lymph node exactly above the clavicle (collar bone)
- A large lymph node, more than 2 centimeters, persists in size for more than a month
- Lymphadenopathy persists for weeks and is accompanied by fatigue, night sweats, weight loss
Treatment is not necessary in normal and simple cases of slightly swollen lymph nodes during viruses of the upper respiratory system in preschool age children. Stimulation of the lymph nodes helps the body fight the virus, and their size may double as a consequence. Painkillers, antipyretics, and anti-inflammatory medications may be administered. The return of lymph nodes to their normal size may take up to 4 weeks. Often during the preschool age, it is normal for a lymph node not to recede completely, but to be revived with each new virus, and then slowly return to a palpable size of under 2 centimeters. When the diagnosis is bacterial, antibiotics are administered for 7-10 days. In rare cases (appearance of an abscess) for diagnostic purposes etc., a surgical procedure may be needed (biopsy with a needle, removal, or drainage).
Stelios Papaventsis MBBS MRCPCH DCH IBCLC 2013