My 17 months old boy has a rubbery lump at the occipital region on both sides. He is taking orally well and active. He is also teething and likes to put his hands in the mouth. What can be the probable cause for the lump?
“Worried About Lump”
Dear “Worried About Lump”,
During an examination of a toddler, it is common to find pellet-like lumps under the jaw, on the neck and at the base of the skull posteriorly. These lumps are commonly referred to as “Shotty” lymph nodes which are a normal finding. (1) Lymph nodes are dispersed throughout the body and serve to filter out germs, foreign material and debris from the break down of old cells.(2) Normal lymph nodes are round or oval in shape and range from 1 to 25 mm (or 0.04 to 1 inch) in size. In children normal lymph nodes are usually less than 2 cm in diameter and should not be warm to touch, red or painful. If you feel a lymph node under your fingertip it should roll around and not cause any discomfort.(1) Lymph nodes are located just under the skin and the skin above the lymph node should not be discolored or oozing any discharge.
In children, lymph nodes enlarge or become more noticeable when the child’s immune system is working. Since the immune system filters the build up of old cells and germs the area around an enlarged lymph node should be checked for a break in skin integrity or an infection. (1) An enlarged lymph node in the child’s neck area could reflect that a child has a throat or ear infection. Enlargement of lymph nodes in the occipital region or at the nape of the neck could be due to a scratch on the child's scalp, Eczema, Seborrhea, Cradle Cap, a bug bite or Rubella ( German Measles). If your baby was immunized with the MMR vaccine("R" stands for Rubella) Rubella is not likely. Sometimes lymph nodes swell because there is a tick embedded under skin in that area. If you notice an enlarged lymph node at the nape of your child’s neck it is a good idea to inspect the head and scalp. Enlarged lymph nodes in a child should be evaluated and followed by your baby’s Doctor or Nurse Practitioner.
When babies are teething and put their hands in their mouth, they increase their risk of developing an infection. Repeatedly putting hands in your mouth introduces germs to the body from the environment. In some cases a baby can fight these germs on their own and in other cases the germs may be due to bacteria which would require medical intervention. Since your baby is putting his hands in his mouth he could have picked up a germ which is causing his lymph nodes to swell. Many times slight lymph node enlargement is a good sign that tells us that the baby’s immune system is working. It becomes a concern when the increased size persists, if it continues to enlarge or if a child develops other signs along with lymph node swelling. If your child develops fever, a stiff neck, pain, decreased activity level, decrease oral intake, vomiting, diarrhea, a red swollen lymph node, rash or fatigue you should bring him to the Doctor’s office for an evaluation.
In some cases rubbery nodules at the nape of the neck represent a Sebaceous Cyst. Sebaceous Cysts originate in the sebaceous glands which are attached to hair follicles. The purpose of the sebaceous gland is to secrete sebum which lubricates the skin.(1) Sebaceous Cysts feel like a soft mass and are usually found around the scalp area. They vary in size from 0.2 to 5 cm and should be non-tender and mobile.(3) They often show a central black dot which identifies the opening of the blocked sebaceous gland. (4) On occasion these cysts can become infected. An examination by your baby’s doctor should be able to tell you if the lumps you are seeing are Sebaceous Cysts.
Any nodule that is hard, not mobile, painful, enlarging, persisting, limiting motion or located on another part of the body may represent another condition and should be evaluated by your baby's Physician.
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:475.
(2)Tortora, G., Anagnostakos, N. Principles of Anatomy and Physiology. Harper & Row Publishers, New York. Fourth Edition;1984:520-521.
(3)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990: 562.
(4)Batz B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company. 1991:219.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice For Moms