Lump in the Groin

Hi,

Hope you could send me some advice on what to do about a lump on my 5 year old son's right neck, and on the right groin. He says no pain when I touched them, but concern. Seems the one in the groin is slowly getting bigger. Is there any physical risk? Any treatment?

“My Beautiful Son!”

Dear “My Beautiful Son!”,

Many parents report seeing small lumps underneath the skin on the side of their child’s neck. This tends to become more noticeable when a child turns his head. Parents also notice bumps under the skin in the groin area when they change their child’s diaper. These are the same areas that normal lymph nodes are found. Typically lymph nodes are round or oval shaped, rubbery, non-tender, painless nodules located under the skin. The size depends upon the location, but in general normal lymph nodes in the pediatric population are less than 2 cm. (1)

The lumps you are seeing on your beautiful boy may be normal lymph nodes, but the only way to be sure is to have an examination by a Physician or Nurse Practitioner. They will be able to tell you if the lumps are lymph nodes and if they are within normal limits for your child’s age.

Basically, the lymphatic system is a vascular network that drains fluid from the body tissues. The fluid is filtered through lymph nodes which serve to rid the body of old cells and toxins and make antibodies. Lymph nodes are dispersed throughout the body and only the superficial ones can be seen or felt. Superficial lymph nodes can be found in the cervical area (neck), underneath the arms and in the arms and legs. (1)

Typically lymph nodes enlarge when a child is fighting an infection. Therefore the body around the area of an enlarging lymph node should be examined. An enlarging lymph node in the inguinal area could represent a rash or an infection around the penis, lower abdomen or buttock area, or a cut or injury below the site on the child’s leg. (1) A bug bite or a tick bite in this area, is one example why an inguinal node would enlarge. Ticks tend to embed under the skin in the warmer parts of the body such as on the scalp, underneath the arms and in the groin area.

Since you noticed that the lump on your son’s right groin area is enlarging it would be a good idea to get it checked by your physician. If the lump is a lymph node your Doctor may want to check your son for an infection. In some cases the lymph node itself can become infected when it can’t filter the dead cells and toxins quick enough.

Adenitis is the term used for lymph nodes that becomes infected (2) In the pediatric population, the cervical nodes or the nodes around the neck area are the ones that tend to become infected. The symptoms of Adenitis include a red, warm and enlarging lymph node, pain and limitation of movement of the area. (2) If a child has signs of Adenitis, he should be evaluated by his physician so that the condition can be diagnosed and treated accordingly. An enlarging lymph node becomes a particular concern if a child develops a fever, weight loss, or if the node becomes painful, or hard. (1) If these symptoms occur your child should have an evaluation by his Pediatrician without delay.

Not every lump noticed on a on a child is a normal lymph node. It depends where the lump is located, the child’s state of health and other associated symptoms or physical findings. That is why it is important to have a child checked by his doctor who can inspect and evaluate the child’s whole body. A lump in the inguinal area may represent many conditions, one of these conditions being an Inguinal Hernia.

An Inguinal Hernia is the protrusion of the intestines through a defect in the abdominal wall. It presents as a bulging or protrusion of the skin in the groin area. In children most inguinal hernias are due to a congenital defect in which the hernia is detected in the scrotum. (3) During normal neonatal development the testes descend from the abdomen down to the scrotal sac. After the descent of the testes the tube should naturally close. An inguinal hernia develops when this tube remains open and the abdominal contents slide down the tract into the scrotal area. (4)

The symptoms of an inguinal hernia include a bulge in the groin area, an enlarged testicle and a dull ache. (3) Most children with reducible hernias have little or no pain at all. There have been many occasions that I discovered an inguinal hernia during a physical examination of a child and the child and parent never noticed it.

Direct hernias usually occur in the older population and are due to a weakness in the abdominal wall. This type of hernia rarely enters the scrotum and appears as a bulge in the groin area. (3) Both types of hernias become more noticeable or enlarged when a person engages in activities that increase intra-abdominal pressure such as coughing, crying constipation, straining with stools and obesity. (3, 5) If your child has symptoms that are consistent with a hernia he should be evaluated by his Physician.

I would not be alarmed about your son’s lumps because they may be normal physical findings. It would be a good idea to check the area for a rash or signs of an infection and inform your doctor about his condition. This is especially important because the lump in your son’s groin area is enlarging. An examination by your doctor can diagnose the lumps and put your mind at ease.

I wish your beautiful little boy good health and speedy resolution of these physical findings.

References:
(1) Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company. 1991:438-439, 592.
(2)Tortora G, Anagnostakos N. Principles of Anatomy and Physiology. 4th ed. Sao Paulo, Sidney:Biological Sciences Textbooks, Inc. 1984: 538.
(3)Graham M, Uphold C. Clinical Guidelines in Child Health. Gainsville, Florida: Barmarrae Books. 1994:422.
(4)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1458.
(5)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:790.

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

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