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 and location.

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.

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