Swollen Glands in Children

What They Mean and When to See a Doctor

Hispanic boy getting a checkup at doctor's office
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Children can have abnormally enlarged lymph nodes (swollen glands), also known as lymphadenopathy, for many reasons. Most are related to an infection during which the glands will "trap" a circulating virus or bacteria and trigger an inflammatory response to kill it. The swelling of the lymph nodes is referred to as lymphadenopathy.

With that being said, just because you can feel a child's lymph nodes doesn't mean that the child has lymphadenopathy. It is not uncommon to feel some normal-sized lymph nodes in infants and toddlers, with the lymph nodes measuring less than about one cm (around 1/2 of an inch.)

Function

The lymph nodes are part of the body's lymphatic system, which includes lymph fluid, lymph vessels, the tonsils, the thymus, and the spleen. There are over 600 lymph nodes in the body, some of which are located near the surface of the skin and other that are located deep in the abdominal or chest cavity.

Lymph fluid includes white blood cells and other things that help us fight infections. As it moves through the lymph vessels (a venous network parallel the blood circulatory system), it gets filtered by our lymph glands. Anything abnormal, including infectious agents and cancer cells, will become trapped and targeted for neutralization.

The lymph nodes may also respond to an allergy that occurs either locally on the skin or near the ear, nose, and throat. This is why the lymph glands may become swollen if you have an insect bite or a severe case of hay fever. It is a normal response to an abnormal immune reaction.

In addition to your pediatrician, a pediatric surgeon or pediatric ear, nose, and throat specialist can help evaluate your child's swollen glands.

Locations

Lymph nodes are situated throughout the human body and are described by their location. Example include:

  • Occipital (back of the head)
  • Preauricular (front of the ear)
  • Postauricular (behind the ear)
  • Submandibular (under the jaw)
  • Submental (under the chin)
  • Facial (in the cheek area)
  • Anterior cervical (the front of the neck)
  • Posterior cervical (back of the neck)
  • Supraclavicular (above the collarbone)
  • Popliteal (behind the knee)
  • Axillary (in the armpit)
  • Epitrochlear (below the elbow)
  • Inguinal (in the groin area)

Along with their location, the distribution of swollen lymph nodes can tell a doctor a lot about what is going on.

Lymphadenopathy may be localized or generalized (widespread). Generalized lymphadenopathy is often more serious and may be related to a viral infection, autoimmune disorder, or disseminated diseases like cancer or tuberculosis.

Other glands are situated deeper in the body and usually can't be felt. They include the mediastinal, hilar, pelvic, mesenteric, and celiac lymph nodes. These nodes may only be seen on an imaging study such as an X-ray or CT scan.

Causes

Many young children have swollen glands because they have frequent infections, which lead to a reaction in the nodes closest to the site of infection. Example include:

  • Upper respiratory infections, including the cold and influenza
  • Strep throat, caused by streptococcal bacteria
  • Infectious mononucleosis, caused by the Epstein-Barr virus
  • Lymphadenitis, in which a lymph node itself becomes infected
  • HIV, in which lymphadenopathy is a common symptom of early infection
  • Pediatric lymphoma, a cancer of white blood cells called lymphocytes
  • Leukemia, a cancer of white blood cells called leukocytes
  • Cat scratch disease, caused by the bacteria Bartonella hensela
  • Scrofula, an infection of a lymph node caused by tuberculosis
  • Kawasaki disease, a rare childhood disease
  • Pediatric lupus, an inflammatory autoimmune disease

Diagnosis

In addition to having swollen glands, pediatricians will look for many other characteristics, such as the size of lymph nodes, their location, their rate of growth, their consistency (soft, firm, or rubbery), whether redness is present, and whether there is tenderness to help figure out if they might be normal or not.

The cervical, axillary, and inguinal nodes are the ones most readily felt during a physical exam. These lymph nodes will be swollen in around half of all children between the ages of three and five who are perfectly healthy.

Certain lymph nodes, especially the supraclavicular, epitrochlear and popliteal glands are rarely swollen, even in children. This would be considered a red flag to doctors that further investigations are needed.

Other associated symptoms, such as persistent or unexplained fever, unintentional weight loss, fatigue, and night sweats can be signs of a more serious condition.

Depending on the suspected cause, the doctor will typically a battery of tests. They may include blood tests or various cultures to confirm likely bacterial or viral causes. Certain imaging tests may be used, such as a PET-CT scan, if leukemia or lymphoma are suspected.

The doctor may also order a biopsy to extract cells from a swollen lymph node to examine under the microscope. This is often performed with a fine needle aspiration (FNA) in which a hollow core needle is inserted through the skin into the lymph node.

When Further Investigation Is Needed

  • If the lymphadenopathy if generalized
  • If the lymph nodes that are larger than one inch
  • If the lymphadenopathy persists despite treatment
  • If the lymphadenopathy spread to other parts of the body
  • If the lymph nodes are hard, painless, and fixed
  • If there is unexplained weight loss or night sweats

A Word From Verywell

Parents often get worried when their child has swollen glands or lymph nodes. Sometimes parents worry that swollen glands are a sign of cancer, and while they sometimes may be, they are more commonly a sign that your child has some kind of a viral or bacterial infection.

It's important to keep in mind that swollen lymph nodes can take weeks to months to return to their normal sizes. Moreover, since younger children have an average of six to eight upper respiratory tract infections per year, it may seem like your child's lymph nodes are always enlarged.

If you are worried because your healthy child has swollen glands, remember that by adult standards, almost all kids have "lymphadenopathy." If you remained concerned, it doesn't hurt to see your pediatrician and have them looked at.

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