Enlarged Lymph Nodes

Dear Lisa,

My 2 year old son has had enlarged lymph nodes on his neck for over 6 months now. He has been to 3 different pediatricians who say they have no concerns as its not growing and he has had a normal blood test and a normal physical exam. For 3 months now, he has been following up each month for a re-check. They measure it and check his liver and spleen. The doctor just keeps telling us that it's most likely nothing and that it might not go away for quite sometime, he even noted it may take years for it to go back to a normal size. It still worries me every day. Why does this happen to some kids and mean nothing? At what point do we go to a specialist for further testing? We live close to a very respectful children's hospital, why would they not be sending us there? Is there a point that we should see a specialist even if there is no change?

Thank you,

“Anxious and Worried Mom”

Dear "Anxious and Worried Mom",

Each time a child develops un upper respiratory infection or virus the body‘s immune system is activated. The lymphatic system is the part of the immune system that works to fight infections. The immune system consists of a special network of vessels and lymph nodes that are located throughout the body. Some of these lymph nodes are located close to the surface and can be visualized by the human eye while others are located so deep in the body that they never can be seen or felt. The cervical lymph nodes or lymph nodes located in the neck area are ones that are located close to the surface and can be seen and felt.

Children’s cervical lymph nodes enlarge with each upper respiratory tract infection that they contract. Since children are normally expected to develop 5 to 10 upper respiratory infections or viruses per year it is common for the lymph nodes in their neck area to appear enlarged for a long period of time. This is especially prevalent during the winter months when most of the upper respiratory tract infections occur.

Some viruses cause very obvious symptoms such as a fever or a sore throat. Other viruses can cause mild or non-specific symptoms such as irritability or tiredness. When this is the case, a parent may not even know that their child is ill. Therefore a child’s cervical lymph nodes may be swollen due to an infection that a parent does not recall.

Enlarged cervical lymph nodes in children are referred to as “Shotty nodes”. (1) This is a very common finding in the pediatric population and is considered normal. Shotty nodes are typically less than 2 centimeters in diameter, mobile, and not painful. As long as a child with Shotty nodes is evaluated and followed by a health care professional there should not be any cause for alarm.

Lymph nodes that are larger than 2 cm, painful, red or non-mobile are not considered to be normal. These symptoms require medical attention. In addition, enlarged lymph nodes associated with fever, pain, limited motion, weight loss, chronic cough, decreased appetite, rash, difficulty swallowing , abnormal movement of the tongue or joint pain are also a cause for concern. Children with enlarged lymph nodes associated with these symptoms need an evaluation in order to rule out another condition.

Without knowing the location or size of the lumps in you son's neck, it is impossible to determine if his condition is normal or not. Only a health care professional who physically examines your child and knows his medical and family history can make this determination. Since your son was evaluated by three separate Physicians and they all reported that his condition is normal it is unlikely that his condition represents a more serious condition. You can also be assured because his bloodwork was normal and he is not experiencing any other symptoms.

In regards to your question about seeing a specialist; usually the Primary Care Physician refers a patient to a specialist if he feels that it is necessary. Since you saw three Pediatricians and they all felt that your son’s condition is normal, I would be inclined to think that a specialist is not required.

Conditions that would lead me to think that your son may need further attention include the presence of the concerning symptoms mentioned above, swelling below the jaw line or bumps found in an area not consistent with the location of a lymph node. It is important to remember that not every bump or area of swelling in the neck is due to a lymph node. Swelling below the jaw line may be a sign of the Mumps. A mass in the center of the neck, near the Adam’s apple may represent a problem with the thyroid gland. A small round hard nodule located in the upper neck area that moves when a child swallows may be indicative of a Thyroglossal duct cyst. Thyroglossal duct cysts happen to be the most common cause of midline neck mass in children. (3)

If your son’s bumps are not consistent with the characteristics of normal lymph nodes, if they are located in an area not typical of the location of lymph nodes, or if you are still worried you may consider seeing a Pediatric Ear, Nose and Throat specialist or Otolaryngologist. This type of doctor will be able tell you if your son's bumps are normal lymph nodes and confirm your Pediatrician’s previous findings.

I wish you and your son well.

If you are interested in reading other Pediatric Advice Stories about this subject:

Lump in the Neck

Enlarged Lymph Nodes

Lump in the Groin

Inguinal Lymph Nodes

Mumps

References:
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:475.
(2)Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company. 1991:588.
(3)Dedivitis RA, Camargo DI, Peixoto GL. Thyroglossal duct; a review of 55 cases. J Am Coll Surg. 2002. 194:274-277.


Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice For Parents