Lymph node swelling in child: symptoms, cause and treatment

The function of the lymphatic system is to neutralize pathogens and remove waste products. The lymph nodes can swell as a natural response to an infection by bacteria, viruses or fungi. Any palpable enlargement of a lymph node is considered an enlargement. Usually several glands are enlarged at the same time on both sides. In young children, the most common cause of lymph node swelling in the neck is an upper respiratory infection.

  • What causes lymph node swelling in the neck in children?
  • Upper respiratory tract infection
  • Bacteria
  • Staphylococcus or streptococcus
  • Atypical mycobacterium
  • Systemic diseases and medication use
  • Without apparent cause
  • What is the treatment for a lymph node swelling in the neck in children?
  • Wait and see policy
  • Antibiotic
  • General practitioner’s policy for asymptomatic enlarged glands

 

Inflamed lymph nodes in the neck / Source: Artemida-psy/Shutterstock.com

What causes lymph node swelling in the neck in children?

In young children, the most common cause of lymph node swelling in the neck is a response to (recurrent) upper respiratory tract infections.¹ Four types of acute infections of the upper respiratory tract are distinguished:

  • cold: infection of the nose or throat;
  • acute sinusitis: infection of the paranasal sinus;
  • acute pharyngitis: a respiratory infection that usually follows a (nasal) cold;
  • acute tonsillitis: infection of the tonsils.

 

Upper respiratory tract infection

The upper respiratory tract can become inflamed by a virus or bacteria. In the vast majority of cases, it is a harmless viral infection. This often concerns the rhino, corona, adeno and respiratory syncytial (RS) viruses. Reovirus, parainfluenza, influenza (flu) and cytomegalovirus and Epstein-Barr virus (causing mononucleosis) are also quite common. Less common viruses include mumps virus, measles virus, rubella virus, varicella virus, herpes simplex virus, human herpes virus 6 (exanthema subitum), and coxsackie virus. Often in a viral pathogen, the glands are relatively small and there is no redness or warmth.

Bacteria

Staphylococcus or streptococcus

Bacterial pathogens can also cause lymph node swelling in the neck, often as a result of an infection of the upper respiratory tract. Acute bacterial lymphadenitis produces a unilaterally enlarged lymph node that is often larger than the viral variant and varies from 2 to 6 cm. With a bacterial pathogen, the skin is often red and warm and the glands are often painful due to rapid growth. The culprit is often a staphylococcus or streptococcus. This one-sided lymphadenitis colli (neck inflammation) often occurs in children between the ages of 1 and 4 years.

Atypical mycobacterium

In the case of a chronic or persistent enlarged gland in an otherwise unill child, the cause may be an infection with an atypical mycobacterium. Other possible pathogens include Bartonella henselae (cat scratch disease), parasites (toxoplasmosis) and fungi.

Systemic diseases and medication use

Furthermore, gland swelling can sometimes occur due to medication use and systemic diseases. In a young child, an enlarged gland in the neck is rarely malignant (due to cancer). In that case, other symptoms are in the foreground.

Without apparent cause

It is not always possible to determine the cause of lymph node swelling in the neck.

What is the treatment for a lymph node swelling in the neck in children?

Wait and see policy

If there are enlarged glands due to an infection in the head and neck area, the GP will advocate a wait-and-see policy. If necessary, the infection is treated. The lymph nodes will shrink in size when the infection disappears.

Antibiotic

A one-sided swelling with red, warm skin is normally treated with antibiotics. In case of serious general illness or additional general symptoms (recurrent fever, general malaise, night sweats, weight loss, general itching) or pus discharge, you will be referred to secondary care. A referral will also be made to the pediatrician if the swelling does not decrease after treatment with antibiotics.

General practitioner’s policy for asymptomatic enlarged glands

In the case of asymptomatic enlarged or swollen glands, the doctor’s policy depends on the size and duration of the swelling:²

  • with a diameter of up to 1 cm, a wait-and-see policy is adopted;
  • if the gland is between 1-3 cm in size, laboratory tests will be carried out and the gland will be checked every other week for growth and changes;
  • in case of persistent gland swelling without further complaints that lasts longer than six weeks, the child will probably be referred to the pediatrician for diagnosis and treatment;
  • In the case of an asymptomatic (unexplained) gland of 3 cm or larger, the pediatrician is always consulted in all cases;
  • In case of progressive or rapid growth of the gland, you should immediately be referred to the pediatrician.

Notes:

  1. Okkes IM, Oskam SK, Lamberts H. From complaint to diagnosis. Bussum: Coutinho, 1998.
  2. Dr. JAH Eekhof, Dr. A. Knuistingh Neven, Dr. W. Opstelten: Minor ailments in children. Elsevier Healthcare, Maarssen, second edition 2009.

 

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