Lymph Nodes

It comes out of nowhere. Usually it’s during bath time. That’s when you notice “the lump.”

Often it’s around the neck. Sometimes it may be under the arms or near the groin area. He doesn’t seem bothered by it. In fact, he doesn’t seem to even know it’s there. You wonder if it’s always been there, or if it’s something new.

Although you know it’s a bad idea, you decide to Google it  — don’t worry, everyone does it — and panic sets in as you read headlines about leukemia and mycobacterium.  You curse the very existence of Google, then call our after hours service to find out what in the world you’re dealing with.

The good news is that what you’ve found is most likely an enlarged lymph node. Lymph nodes are essentially filters throughout the body that help to fight infections and remove harmful substances from the body. They contain cells from your immune system (these are the guys that fight infections). They can become enlarged or inflamed with illness or injury.

It’s also true that lymph nodes can become enlarged in certain types of cancers (though in pediatrics, this is the least common cause).  They may be tender and change in size over time. You may also notice a change in skin color over the swollen area; it may be come red or hard when you touch it. Lymph nodes are most often noticed around the neck and ears, under the arms, and near the groin.

This example shows various lymph nodes of the head and neck. Note that some are deep below the surface of the skin and can’t be felt.

So We’ve Established it’s an Enlarged Lymph Node. What’s the Cause?

1. Most likely the enlarged lymph node is the result of a current or recent infection. Often your child will have a history of a recent fever, cold symptoms, ear pain, sore throat, stomach virus, etc. The area may be tender for a time and get bigger in size. As your child’s symptoms improve, the area is no longer painful and returns to normal size. You may still notice it’s there (most likely it’s always been there, you just never noticed it until it became enlarged). It can take up to 2 weeks for enlarged lymph nodes to return to normal — often after other symptoms have long resolved.

2. Sometimes these lymph nodes can become infected with bacteria. When this happens, the lymph node typically continues to increase in size (sometimes very large and visibly noticeable). The area may be warm or hard to touch, and the skin may start to turn red. The area is usually significantly tender. Your child may have fever and no other symptoms. This typically requires antibiotics to treat. Sometimes there can be a collection of infected fluid (abscess) that requires drainage and IV antibiotics in the hospital.

3. Google technically didn’t lie to you. It just assumed the worst case scenario. It’s true that enlarged lymph nodes can sometimes be a sign of cancer in pediatrics. However, this is the LEAST likely cause of enlarged lymph nodes in children. A warning sign for cancer is often a persistently enlarged lymph node (or nodes), in association with other concerning symptoms (weight loss, unexplained fevers, night sweats, enlarged liver/spleen, etc).

So I’ve Found a Lump.  What Now?

We recommend an office visit for any unexplained “lumps” or areas concerning enlarged lymph nodes. Following a complete history and physical examination, we can most often reassure families of it’s harmless nature, and instruct parents to monitor for any changes in size or other symptoms (pain, skin change, etc).

In the case of a suspected bacteria infection, we may recommend oral antibiotics or possibly ER evaluation for imaging to determine if there is fluid that needs to be drained, or if we feel IV antibiotics are necessary. If there is concern for a more serious cause, we would order further testing.

Hopefully this gives you a little more understanding about towhat may cause a child’s lump and how we approach the visit. As always, if you have any questions, please don’t hesitate to ask. That’s why we’re here!

Dr. Chris Deskins is a former Kids Plus provider.