Enlarged Lymph Nodes
My two and a half your old son developed a swelling on both sides of his neck or should I say enlarged lymph nodes in the neck as a result of pus filled sores on his scalp, which eventually healed, this took place in the care of a nanny. The Doc prescribed antibiotics and he completed the course, and he warned us that the lymph nodes would remain enlarged months after the infection has healed, it has been 6 months and they have slightly reduced in size but are still large, he is healthy, is gaining weight steadily, but I am still concerned. Should these lymph nodes be drained? They are not painful, and move around when you touch the swelling, excuse my English, hope you do understand my problem.
“Swollen Lymph Nodes”,
Dear “Swollen Lymph Nodes”,
Lymph nodes enlarge as a normal response to infection. Being that your child had a skin infection on the scalp, it would be expected that the lymph nodes at the nape of his neck or in his cervical area appear enlarged. Once lymph nodes increase in size due to an infection, it can take weeks for the size to return to normal.
The purpose of lymph nodes is to remove bacteria, foreign material and cell debris from the lymphatic system. Sometimes the number of microorganisms entering the lymph node is so great that the node cannot detoxify the germs the way that it should. When this occurs the node becomes infected.(1) The signs of a lymph node infection include warmth to touch, pink or red color, enlargement of the node, pain and fever. When this occurs in the neck or cervical area it is called Cervical Adenitis.
Cervical Adenitis can occur in children with a Streptococcal infection(strep throat), a Staphylococcus infection, Epstein-Bar Virus (mononucleosis), a Mycobacteria infection(Tuberculosis) or Cat Scratch Disease. The treatment for Cervical Adenitis is antibiotics and in some cases incision and drainage. (2)
From your description it doesn’t sound like there is an infection of your son’s lymph nodes. Of course, this can only be determined by a Physcian who performs a history and physical examination on your child. In response to your question about draining his lymph nodes, this is typically reserved for lymph nodes that are infected. Since your son doesn't have a fever, his scalp infection has cleared and his lymph node size has decreased after antibiotic therapy it does not seem that there is an indication for drainage of his lymph nodes. In addition, his lack of pain and the mobility of the lymph nodes are also normal findings. If you are concerned that your son’s lymph nodes are infected, you should discuss this with his Physician.
You reported that your son's lymph nodes are still enlarged, but slightly reduced in size since the infection. The best way to determine if the size of a lymph node is normal is to have it measured by his Physician. Lymph nodes in children are expected to be 2 cm in diameter or less.(2) It is important to have a healthcare professional measure the lymph node because sometimes what appears to be an enlarged lymph node to a parent may actually be normal for a child’s age.(2)
Some important questions to ask are; “Why did your son develop pus filled sores on his head in the first place?” "Does your child have a skin condition on the scalp such as Eczema, Seborrhea or Ringworm of the scalp that became secondarily infected from scratching? " "Has your son been ill or has he been scratching his head a lot?" "Did he have blood work to check his immune system? Since your son's lymph node enlargement seems to be persisting, it would be a good idea to discuss these questions with his Doctor. It is also a good idea to have the Doctor examine your son's scalp, checking for a skin condition that may be contributing to lymph node enlargement.
Children with a dry itchy scalp or scratching of the scalp can have Tinea Capitis or Ringworm of the scalp. Ringworm is a fungal skin infection that occurs on the face, body or scalp. The symptoms of Ringworm or Tinea Capitis include a dry itchy scalp, scaling, crusting, inflamed nodules, hair loss and tender enlarged lymph nodes on the neck. (3,4) Because of the scratching that is involved with the condition it can become secondarily infected with a bacterial infection.(4)
Many parents fear that enlarged lymph nodes could be a sign of Cancer. (2) Although this is commonly the case in the adult population, this is not necessarily the case for children. Most lymph nodes noticed in the neck of children are normal or can be due to local infection. (2) Common causes of cervical lymph node swelling in children include acute Tonsillitis, outer ear infection, and Mononucleosis.
On the other hand, an enlarged lymph node that is accompanied by fever of an unknown cause or weight loss can be a sign of a more serious condition, such as a malignancy. Children with these symptoms should be evaluated by a Physician without delay. (2)
All children with lymph node enlargement should be evaluated and followed by a Physician. A comprehensive history and physical examination needs to be performed in order to find the cause.
I hope your son remains feeling well and his lymph node enlargement resolves soon.
For more information about the topics discussed read the following Pediatric Advice Stories:
Lumps in the Neck
Lump in the Groin
(1)Tortora G, Anagnostakos N. Principles of Anatomy and Physiology. 4th ed. Sao Paulo, Sidney:Biological Sciences Textbooks, Inc. 1984:520-521.
(2) Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company.1991:592-593.
(3)Kaplan D. Tinea Capitis. Consultant for Pediatricians. 2006. August:521.
(4 ) Ringworm. Consultant for Pediatricians. 2006. Jan:44.
Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner
Pediatric Advice Website