DEAR DR.PAUL: My four-year-old daughter has some bumps
on her neck. I brought her to the doctor who told me they were
lymph nodes and it was normal. I am still worried. Can these bumps
or nodes be serious?
PEDIATRICIAN DR.PAUL Answers: This is one of the most
common questions I get, reflecting that many otherwise normal
children have enlarged or noticeable lymph nodes in the head
and neck region.
Lymph nodes are responsible for protecting the body against
infection, and, like all lymph tissue - including tonsils and
adenoids - they tend to increase in size during childhood and
then shrink and become less numerous as a child reaches adolescence.
The most common area where we see lymph nodes is the neck, usually
the region under the jaw and sometimes in the back of the neck.
Lymph nodes can also be felt or noticed at the back of the head,
(called the occipital area) especially in babies).
Although the most common site for lymph nodes is in the head
and neck area, we can also find lymph nodes in the groin and
armpit areas. Most of these lymph nodes feel like small peas,
but can get bigger. As a matter of fact, they get bigger during
an infection. For example, a child with a throat infection will
usually have enlarged nodes in the neck area. A child with a
skin infection around the thigh may have enlarged nodes on the
same side in the groin or inguinal area. This enlargement means
that the lymph nodes have "reacted" to a local infection to
help fend it off.
As a reflection of a local infection, nodes get bigger, then
shrink as the infection clears. This cycle can continue a few
times during childhood. In general, physicians can tell if the
nodes are following a normal pattern, based on their size, texture
Are these bumps or nodes related to serious problems? A possible
but infrequent complication of an enlarged lymph node is bacterial
infection of the node itself (known as "adenitis"). In this
case one can easily tell that there is an infection as the node
becomes very big, very tender, painful and quite red. In some
cases there may even be associated fever.
How are these treated? When the infection is small and detected
early enough, antibiotics taken by mouth are usually prescribed.
In other cases, the child may need to be admitted to hospital
for intravenous antibiotics and possibly to drain the infected
node (which usually contains pus).
Of course not all bumps are nodes, and while most noticeable
nodes are not worrisome, in rare cases the cause may be more
serious like cancer (lymphoma). This is why lymph nodes persisting
in an enlarged form or getting bigger beyond a six-week period
are usually removed (biopsy) and examined.
Happily, this is not what usually happens, as most noticeable
lymph nodes in children are not serious and shrink or go away
on their own.
The information provided in this site is
designed to be an educational aid only. It is not intended to
replace the advice and care of your child's physician, nor is
it intended to be used for medical diagnosis or treatment. If
you suspect that your child has a medical condition, always
consult a physician.