Lymphadenopathy is usually caused by an infection that occurs in one or more of the lymph nodes in the neck. This common childhood infection occurs in up to 45% of healthy children, and up to 90% of those aged four to eight years. The initial symptoms are swollen lymph nodes in the neck, which may or may not be tender depending on the cause.
Infection
Causes of cervical lymphadenopathy are usually viral or bacterial infection, which can include:
- Adenoid and tonsil infection
- Respiratory infections
- Rhinovirus
- Otitis media
- Epstein-Barr
- Infectious mononucleosis
- Streptococcus
- Staphylococcus
There are also other more serious infections that can cause swelling in the cervical lymph nodes. However they are uncommon. They include:
- Tuberculosis
- Fungal Infections
If your child is sick, the virus or bacteria can travel to the lymph nodes via the lymphatic system. The swelling and tenderness is the result of an inflammatory reaction that occurs when the body is trying to fight off an illness or infection.
Childhood lymphoma
Lymphomas, Hodgkin and non-Hodgkin lymphoma, are the third most common cancer in children, and NHL accounts for approximately 6-7% of cancers in children. Lymphomas are a group of malignancies in which the cancer cells originate from the lymphoid system.
The main difference between Hodgkin’s lymphoma and NHL is in the specific lymphocyte each involves. A doctor can tell the difference between Hodgkin’s lymphoma and NHL by examining the cancer cells under a microscope. Most lymphomas are NHL.
Overall, the risk of NHL in children increases with age. Childhood NHL can cause many different signs and symptoms, depending on where it is in the body. Common symptoms include:
- Enlarged lymph nodes – seen or felt as lumps under the skin
- Swollen abdomen
- Feeling full after only a small amount of food
- Shortness of breath or cough
- Fever
- Weight loss
- Night sweats
- Fatigue – feeling very tired
Duration of cervical lymphadenopathy
The swollen lymph nodes in your child’s neck may be classified based on how long the problem lasts. This may be acute, sub-acute or chronic. An acute condition can be defined by a short, often < 1 month duration. This usually responds well to therapy with return to normal health. Subacute is defined as within the interval between acute and chronic, so from one to three months time. A chronic condition is one that lasts 3 months or more.
Diagnosis
The diagnosis of lymphadenopathy requires a few different steps to determine the actual cause of the problem. You will need to provide a medical history for your child, as well as allow a physical exam of the head and neck area, and other areas as needed.
History
When you take your child to the doctor, you will need to be able to answer any questions concerning recent illnesses, ear nose or throat infections, insect bites, or tooth infections/abscesses. The doctor will also ask if your child is currently ill, or if they seem lethargic and fatigued. You should also tell the doctor if your child is taking any medications, or if they have recently had any immunisations.
Examination
The doctor will begin by palpating the swollen lymph nodes to see how large they are, whether they are tender to the touch, whether they move around, and whether they are soft or hard. He or she will also check for a fever or other signs of illness such as a rash or high temperature. The doctor will also assess the lungs and abdomen in the exam to make sure there is not an illness present that is affecting other organ systems. A neck ultrasound scan may also be needed.
Treatment
In most cases, acute cervical lymphadenopathy does not require immediate treatment, unless there are other signs or symptoms that a bacterial infection is present. If your child is suffering from a bacterial infection, he or she will be placed on antibiotics to treat the illness. If there are no other illnesses present, the doctor will simply keep an eye on the swollen lymph nodes to see if they change or go away on their own.
In cases where the swelling does not go away over time, the doctor may decide to run imaging tests or use a small needle to collect a sample of fluid from the node for further testing. As needed your doctor may recommend excision of the nodes for formal diagnosis by pathology.
Outcomes
In most cases, cervical lymphadenopathy in children is a benign condition. Those suffering from benign lymphadenopathy will generally see improvement within two weeks, depending on the cause. Uncommonly there are situations where the swelling may be due to cancer. In all situations the best course of action to ensure thorough assessment by your doctor, with specialist referral to an ENT surgeon or paediatrician. Follow your doctor’s advice, and make sure to keep all follow up appointments until the issue is resolved.