Lymph Nodes / Glands
Lymph nodes or "glands" are lumps of tissue that are part of the immune system. We have them all over the body, and there are many of them in the neck.
Have a look at neck infections and non-tuberculous mycobacteria pages as well.
Why do lymph nodes enlarge?
Lymph nodes store the body’s immune cells and filter and trap bacteria, viruses and other agents that cause disease. However, when a child develops an infection somewhere in the body, the lymph nodes may respond by enlarging. For example, when a child develops tonsillitis the lymph nodes in the neck may swell in order to help the body fight off infection. This inflammation of the lymph nodes is known as lymphadenitis.
Whilst most enlarged lymph nodes are caused by infection, they can also increase in size for other reasons. Serious causes, such as certain types of cancer i.e. lymphoma are rare and in these cases the lymph nodes usually rapidly increase in size.
Chronic lymph node enlargement
Chronic lymph node enlargement means that the nodes have been present for several weeks without going down. The question then arises is why they are there. Although majority of the time it is simply the result of infection, they could also be much more serious, so it is important that you seek medical attention if you find that your child has developed a lump in the neck.
A lymph node that is enlarged simply as a result of coughs and colds is called a reactive lymph node, because it has developed as a reaction to underlying infection. These reactive lymph nodes are common, and not serious.
A reactive lymph node would have the following features
-size fluctuates, gets bigger during a cold then goes back down
-less than 1 cm in size
-located in the upper part of the neck
A swollen lymph gland could also indicate the presence of cancer. This is rare though. A worrying lymph node would have the following features
-size is increasing, lump keeps growing
-size larger than 2 cm
-located just low in the neck, next to the collar bones
-your child may also have weight loss, drenching night sweats, fevers, poor appetite, abdominal or chest pain, lumps under the armpits or in the groins, itching, or breathlessness
A lot of the time your doctor will be happy that the lymph node is reactive, and no tests will be needed. But if there are concerns, then further investigations, blood tests, X rays / scans or a biopsy may be required.
When should I take my child to the doctor?
Make sure you go and see your GP if your child develops a neck lump. If your lump initially looks like a reactive one, but your child then develops some of the worrying features, make sure that you go back to your doctor and tell them that things have changed.
In particular, you should consult your GP if you have any of the following concerns alongside a swelling in your child’s neck:
-Ongoing fever or temperature
-The swelling is over 1 cm and/or continuing to increase in size
-The skin over the swelling is red and painful to touch
-Your child is acting or looking very poorly and sick
-Any difficulty in moving the neck
-Any difficulty with breathing, drinking or swallowing
-Any other symptoms such as weight loss
Section contributor:
Rachael Lawrence MBBS BSc MRCS
ENT registrar