Pediatric Lymph Nodes: What Parents Should Know - Pediatrics

Dr. Pei Rensheng reply Pediatrics

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Hello: Regarding neck lumps, I previously published an article in the media, and the content is as follows for your reference! When bathing a baby, parents may notice one or several hard lumps on the neck or back of the head.
What should parents do? Most of these hard lumps are lymph nodes.
Lymphatic tissue is present in everyone, and as babies grow, they are exposed to various viruses and bacteria in the environment, causing this lymphatic tissue to proliferate steadily until puberty, after which it gradually shrinks.
Therefore, adult lymph nodes are less palpable, while normal children can often feel lymph nodes in the neck, back of the head, armpits, and groin.
When lymph nodes are enlarged, it could indicate inflammation or potentially be a sign of malignancy, so careful differentiation is necessary.
For example, skin infections, otitis media, and tonsillitis can cause nearby lymph nodes to become enlarged, soft, and painful, with redness and warmth on the skin surface, and even pus formation.
On the other hand, if the lymph nodes feel hard, elastic, non-tender, and are difficult to move, and if enlarged lymph nodes are found in two non-adjacent areas (such as the neck and groin), the likelihood of malignancy increases.
Table 1: Infectious causes of cervical lymphadenopathy (acute refers to lasting several days, chronic refers to lasting several weeks or more)
1.
Presentation: Acute and bilateral
Common causes: Rhinovirus, EBV (infectious mononucleosis), cytomegalovirus, herpes simplex virus, adenovirus, enterovirus, influenza virus, Group A Streptococcus, Mycoplasma pneumoniae
Uncommon causes: Roseola, Parvovirus B19 (fifth disease)
Rare causes: Diphtheria, measles, rubella, mumps
2.
Presentation: Acute and unilateral
Common causes: Staphylococcus aureus, Group A Streptococcus, anaerobes
Uncommon causes: Group B Streptococcus, plague, tularemia
Rare causes: Anthrax
3.
Presentation: Chronic and unilateral
Common causes: Cat scratch disease, non-tuberculous mycobacteria
Uncommon causes: Toxoplasmosis, tuberculosis, actinomycosis
Rare causes: Fungal infections
4.
Presentation: Chronic and bilateral
Common causes: EBV, cytomegalovirus
Uncommon causes: HIV, toxoplasmosis, tuberculosis, syphilis
Rare causes: Brucellosis
Table 2: Non-infectious causes of cervical lymphadenopathy (often chronic)
Malignant tumors: Leukemia, lymphoma, neuroblastoma, rhabdomyosarcoma, thyroid cancer
Collagen vascular diseases: Juvenile rheumatoid arthritis, systemic lupus erythematosus
Medications: Certain antiepileptic drugs (Phenytoin, Carbamazepine)
Others: Kawasaki disease, Kikuchi disease
From the above tables, it is clear that the causes of cervical lymphadenopathy are diverse; however, it is not always necessary to pursue a definitive diagnosis, as many cases of acute bilateral cervical lymphadenopathy are benign and will resolve on their own.
Nevertheless, considering the possibility of malignancy, parents should remain cautious.
Here are the key points for differentiating neck lumps:
1.
Medical history: Including the duration of the neck lump; any associated symptoms (sore throat, weight loss, fever, joint pain); consumption of unpasteurized raw milk (possible brucellosis infection); dental caries or oral ulcers (possible enterovirus, herpes simplex virus, anaerobes, actinomycosis); skin wounds (possible Staphylococcus aureus, Group A Streptococcus, herpes simplex virus, cat scratch disease, plague, tularemia); animal contact (possible cat scratch disease, toxoplasmosis, brucellosis, tularemia, plague); flea or tick bites (possible plague, tularemia); medication use (especially antiepileptic drugs); family history of tuberculosis.
2.
Physical examination: The entire lymphatic system should be palpated, including lymph nodes in the liver, spleen, axilla, and groin; check the oral cavity for ulcers or purulent tonsils; look for strawberry tongue (Kawasaki disease); inspect the skin for wounds or animal scratches.
3.
Laboratory tests: Including peripheral blood smear and routine tests, throat and blood cultures, tuberculin skin test, cytomegalovirus and other viral serologies, syphilis serology, chest X-ray, etc.; if the above tests do not reveal a cause, more invasive tests should be considered, including lymph node aspiration and bacterial culture, bone marrow aspiration, etc.
Table 3: Management of cervical lymphadenopathy in children
Cervical lymphadenitis (swelling): Treatment.
Acute and bilateral lymphadenitis: Mostly viral infections, generally no treatment is needed.
Acute and unilateral lymphadenitis:
1.
If symptoms are mild: Observation is sufficient.
2.
If symptoms are moderate (fever, local pain, but no signs of softening): Lymph node aspiration and bacterial culture, followed by oral antibiotics.
3.
If symptoms are severe (fever, local pain, and signs of softening or cellulitis): Incision and drainage, followed by bacterial culture and intravenous antibiotics.
Chronic lymphadenitis: Investigate for less common infections such as cat scratch disease and tuberculosis, and rule out rheumatic autoimmune diseases and malignancies.
If you find a lump in your baby's neck, although most are benign lymphoproliferative responses, they can also be a sign of serious issues.
If the neck lump persists for more than a few weeks or is accompanied by fever and pain, parents should take the baby to see a pediatrician for evaluation!

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Reply Date: 2019/12/02