Persistent Neck Swelling in Children: Causes and Concerns

Left-sided swelling in the neck below the ear?

Hello, my son is 7 years old.
After receiving the COVID-19 vaccine on June 1, he experienced swelling in his neck and cheek within four hours.
The swollen area was painful and hard to the touch.
That evening, we consulted a doctor who diagnosed him with lymphadenopathy and prescribed antibiotics.
The swelling subsided and the pain resolved after three days.

However, about ten days later, the swelling returned.
The doctor suggested that the bacteria might not have been completely eradicated, so he prescribed more antibiotics along with anti-inflammatory and analgesic medications.
After taking the second course, the pain and swelling significantly decreased, so he completed the 7-day treatment.
We thought he was better, but on the afternoon of the first day off the medication, the swelling returned.
Upon returning to the doctor, it was suggested that he might have a salivary gland stone or antibiotic resistance, so a stronger antibiotic was prescribed.
Today marks the 8th day of this new course, and my son mentioned that there is still some pain when pressing on his neck before bed.
We are scheduled for an ultrasound and fine needle aspiration tomorrow, and I am very worried about why the swelling keeps recurring.
Could it be a salivary gland stone, a tumor, or possibly related to the vaccine?

Miss Lin, 40~49 year old female. Ask Date: 2022/07/04

Dr. Li Jiaxuan reply Otolaryngology

It is recommended to undergo an examination and have a biopsy for cellular analysis to ensure peace of mind.
Wishing you safety and good health.

Reply Date: 2022/07/04

More Info

Persistent neck swelling in children, particularly after vaccination, can be concerning for parents. In your son's case, the swelling began shortly after receiving the COVID-19 vaccine, which raises questions about the underlying cause. While it is essential to consider various possibilities, it is crucial to approach this situation with a clear understanding of the potential causes and the necessary steps for evaluation and management.

Firstly, lymphadenopathy, or swollen lymph nodes, is a common response to infections and vaccinations. The immune system reacts to vaccines by producing antibodies, which can lead to temporary swelling of lymph nodes as they filter out pathogens and produce immune cells. This response is generally benign and resolves on its own. However, in your son's case, the swelling has persisted and recurred, which warrants further investigation.

The fact that your son experienced pain and hardness in the swollen area suggests that there may be an ongoing inflammatory process. The initial treatment with antibiotics was appropriate, as bacterial infections can cause lymphadenopathy. However, the recurrence of swelling after stopping antibiotics raises the possibility of several conditions:
1. Infection: If the initial infection was not fully resolved, it could lead to recurrent swelling. This could be due to a resistant bacterial strain or an underlying viral infection that antibiotics cannot treat.

2. Salivary Gland Issues: The mention of possible salivary gland stones (sialolithiasis) is relevant. These can cause swelling and pain in the neck area, particularly if they obstruct the flow of saliva. This condition can lead to secondary infections, which may explain the recurrent nature of your son's symptoms.

3. Non-Infectious Causes: Other causes of neck swelling include autoimmune conditions, such as juvenile idiopathic arthritis, or even benign tumors like lymphangiomas. While malignancies are less common in children, they cannot be entirely ruled out without further investigation.

4. Vaccine Reaction: While vaccines can cause localized swelling and tenderness, significant or prolonged reactions are rare. However, it is essential to report any unusual or persistent symptoms to your healthcare provider.

Given that your son is scheduled for an ultrasound and fine-needle aspiration, these are excellent steps to clarify the nature of the swelling. An ultrasound can help visualize the lymph nodes and any potential salivary gland issues, while fine-needle aspiration can provide cytological analysis to rule out malignancy or identify infectious agents.

In the meantime, it is crucial to monitor your son's symptoms closely. Keep track of any changes in the swelling, pain levels, or associated symptoms such as fever, difficulty swallowing, or changes in appetite. If the swelling worsens or new symptoms arise, seek immediate medical attention.

In conclusion, while the persistent neck swelling in your son is understandably concerning, the combination of appropriate medical evaluations and treatments can help identify the underlying cause. It is essential to maintain open communication with your healthcare provider and follow through with the recommended diagnostic tests. With careful monitoring and appropriate management, most cases of recurrent lymphadenopathy in children can be effectively addressed.

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