Clinical Reference Systems: Pediatric Advisor 10.0
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Illustration

Description

• Normal, noninfected nodes are less than 1/2 inch across (often the size of a pea or baked bean).
• Nodes infected by a virus are usually 1/2 to 1 inch across. This slight enlargement and mild tenderness means the lymph node is fighting infection and succeeding.
• Nodes severely infected with bacteria are more than 1 inch across and usually exquisitely tender. If they are over 2 inches across or the overlying skin is pink, the nodes are not successfully controlling the infection and may contain pus.

Cause

The body contains more than 500 lymph nodes. Lymph glands help prevent the spread of infection and protect the bloodstream from viral and bacterial invasion (blood poisoning). Normal nodes are largest at age 10 to 12 years. At this age they can be twice the normal adult size.

Cuts, scrapes, scratches, splinters, burns, insect bites, rashes, impetigo, and any break in the skin will cause lymph glands to get larger. Try to locate and identify the cause of a swollen gland. If the nodes in the groin are swollen, look for an injury in the legs and lower abdomen. If the armpit nodes are swollen, examine the arms and upper chest. Swelling of the back-of-the-neck nodes suggests an injury on the scalp. The front-of-the-neck nodes drain the lower face, nose, and throat, so an injury or infection in these areas might cause the nodes to swell. Most enlarged nodes in the neck are due to colds or throat infections. A disease like chickenpox can cause all the nodes to swell.

Expected Course

Viral infections and minor skin infections and irritations can cause lymph nodes to double in size quickly over 2 or 3 days. They return slowly to normal size over the next 2 to 4 weeks. However, they won't disappear completely.

You will always be able to see and feel nodes in most normal, healthy children, especially in the neck and groin. Don't check for lymph nodes because you can always find some normal ones.

Home Care

1. Treat the cause of swelling.

   In general, no treatment is necessary for swollen nodes associated with viral infections (for example, colds). For bacterial infections, the underlying disease that's causing the node to react needs to be treated. For example, remove the splinter, treat the ingrown toenail, or have a dentist treat the tooth abscess. Many children with swollen lymph nodes due to a skin infection also need an oral antibiotic.

2. Pain or fever relief.

   For pain or fever above 102 degrees F, give the appropriate dose of acetaminophen or ibuprofen.

3. Don't squeeze the nodes.

   Poking and squeezing lymph nodes may keep them from shrinking back to normal size. Remember that it may take a month for the nodes to return to normal. They won't completely disappear. There's no need to check them more than once a month. If your child fidgets with them, discourage it if he's old enough to cooperate.

Call Your Child's Physician Immediately If:

• The node swells to 2 or more inches across.
• The overlying skin becomes red.
• Your child starts acting very sick.

Call Your Child's Physician Within 24 Hours If:

• The node swells to 1 to 2 inches across.
• Your child also develops sore throat.
• A fever persists more than 3 days.
• You have other questions or concerns.