Parents often get worried when their child has swollen glands or lymph nodes.
Much of that worry comes from their thoughts that swollen glands are a sign of cancer, and while they sometimes may be, they are much more commonly a sign that your child has some kind of a viral or bacterial infection.
Also keep in mind that it can be very normal to feel small glands in most infants and toddlers. This isn't true lymphadenopathy (enlarged lymph nodes), but are just normal sized glands - usually less than about 12mm in size.
If you are worried because your healthy child has swollen glands, keep in mind that by adult standards, almost all children have "lymphadenopathy," because palpable nodes, particularly in the cervical, axillary, and inguinal areas, are common in children of all ages, including babies
Glands in the Body
Glands are located throughout our bodies.
Some common glands can be found:
- in the back of the head - occipital
- in front of the ear - preauricular
- behind the ear - postauricular
- under the jaw - submandibular
- under the chin - submental
- in the cheek area - facial
- in the front of the neck - anteriorcervical
- in the back of the neck - posteriorcervical
- above the collar bone - supraclavicular
- behind the knee - popliteal
- in the armpit - axillary
- below the elbow - epitrochlear
- in the groin area - inguinal
Certain glands, especially the supraclavicular, epitrochlear, and popliteal glands, are rarely swollen, even in kids, and feeling them would likely prompt your pediatrician to look for a cause.
Other glands are deeper in the body and can't usually be felt. They include the mediastinal, hilar, pelvic, mesenteric, and celiac lymph nodes. They might be seen on an xray or CT scan though.
The cervical, axillary, and inguinal glands are the ones that are most commonly felt in normal children. In fact, about half of children between the ages of 3 to 5 years old will have swollen glands in these areas when they visit their pediatrician, whether it is for a sick visit or a well child check up.
What Are Glands?
These glands or lymph nodes are part of the body's lymphoid system, which include lymph vessels, the tonsils, the thymus, and the spleen.
As lymph, which includes white blood cells and other things that help us fight infections, moves from our blood to the lymph vessels, it gets filtered by our lymph glands.
That is why the lymph glands in your groin might become swollen if you have an insect bite or skin infection on your leg. It is just an immune response in the glands that are closest to the area. Similarly, a scalp infection, from head lice to ringworm, might cause swollen glands in your child's cervical or occipital glands.
Causes of Swollen Glands
Many young children have swollen glands because they have frequent infections, which lead to reactive lymph nodes - glands that become swollen as a reaction to an infection in their area of the body.
- lymphadenitis - a lymph node that itself becomes infected and becomes red, swollen, and tender
- viral upper respiratory infections - often cause swollen cervical glands
- strep throat - fever, sore throat, and swollen glands
- mono - infectious mononucleosis, caused by the Epstein-Barr virus, usually causing a high fever, sore throat, and swollen glands (bilateral cervical lymphadenopathy).
- Cat-scratch disease - often transmitted from a healthy appearing kitten who is infected with the Bartonella henselae bacteria and transmits it through a bite or scratch, where a small rash will develop in 7 to 12 days (a papule or pustule). One to two weeks later, nearby glands might become swollen, red, and tender.
- Scrofula - an infection of a lymph node caused by atypical mycobacteria or tuberculosis, which can cause painless, swollen glands, usually in neck
- Kawasaki disease - a single, swollen cervical lymph node is one of the features of Kawasaki disease, with others including fever, conjuctivitis without exudate, swelling of the hands and feet, a rash, and red mucous membranes in the mouth, with a strawberry tongue and cracked lips.
Many other infections, from tuberculosis to HIV, can also cause swollen glands and might be suspected based on a child's symptoms and risk factors.
Lymphoma, a type of cancer, seems to be what many parents worry about when a child has a swollen gland, even though it is much less common than other causes. One type, Hodgkin lymphoma is rare in younger children, being more common in teenagers, who, in addition to swollen glands, typically have unexplained fever, weight loss, and night sweats. Children with non-hodgkin lymphoma can have rapidly growing, painless lymph nodes, in addition to other symptoms like fever, weight loss, night sweats, coughing, and fatigue.
What You Need To Know About Swollen Glands
- In addition to having swollen glands, pediatricians look for other characteristics, such as the size, rate of growth, consistency (soft, firm, or rubbery), redness, tenderness, etc., to help figure out if they might be normal or not.
- Other associated symptoms, such as persistent or unexplained fever, weight loss, fatigue, and night sweats can be signs of a more serious condition causing swollen glands.
- Lymphadenopathy may be localized (in one area) or generalized (in more than two noncontiguous areas), with generalized lymphadenopathy more likely to be caused by a systemic disease.
- A stomach virus or other gastrointestinal infection might cause swelling and inflammation of the mesenteric glands, which can cause abdominal pain.
- There are about 600 lymph nodes in our body.
- In addition to your pediatrician, a pediatric ENT specialist can help evaluate your child with swollen glands.
In general, characteristics that swollen glands could be caused by a more serious condition that needs further evaluation include that they are found in more than one region of the body (generalized lymphadenopathy) and that they are firm, fixed (don't easily move around), larger than about 2.5 cm, are non-tender, and are rapidly growing, especially if the child has other symptoms, such as weight loss and daily fever.
Friedmann, A. Evaluation and Management of Lymphadenopathy in Children. Pediatrics in Review 2008;29;53.
Long: Principles and Practice of Pediatric Infectious Diseases Revised Reprint, 3rd ed.
Kliegman: Nelson Textbook of Pediatrics, 19th ed.;
Red Book. 2009 Report of the Committee on Infectious Disease. American Academy of Pediatrics. 29th Edition.