Lymph glands (or lymph nodes) are an important part of the body’s defense system against infection and illness. These glands normally contain groups of cells, called lymphocytes, which act as barriers to infection. The lymphocytes produce substances called antibodies that destroy or immobilize infecting cells or poisons. When lymph glands become enlarged or swollen, it usually means that the lymphocytes have increased in number due to an infection or other illness and that they are being called into action to produce extra antibodies. Rarely, swollen glands, particularly if long-lasting and without other signs of inflammation, such as redness or tenderness, may indicate a tumor.
If your child has swollen glands, you’ll be able to feel them or actually see the swelling. They also may be tender to the touch. Often, if you look near the gland, you can find the infection or injury that has caused it to swell. For example, a sore throat often will cause glands in the neck to swell, or an infection on the arm will produce swollen glands under the arm. Sometimes the illness may be a generalized one, such as those caused by a virus, in which case many glands might be slightly swollen. In general, because children have more viral infections than adults, lymph nodes, particularly in the neck, are more likely to be enlarged. Swollen glands at the base of the neck and just above the collarbone may be an infection or even a tumor within the chest, and should be examined by a physician as soon as possible.
In the vast majority of cases, swollen glands are not serious. Lymph node swelling usually disappears after the illness that caused it is gone. The glands gradually return to normal over a period of weeks. You should call the pediatrician if your child shows any of the following:
Lymph glands swollen and tender for more than five days
Fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius)
Glands that appear to be swollen throughout the body
Tiredness, lethargy, or loss of appetite
Glands that enlarge rapidly, or the skin overlying them turning red or purple
As with any infection, if your child has a fever or is in pain, you can give her acetaminophen in the appropriate dosage for her weight and age until you can see the pediatrician. When you call, your doctor probably will ask you some questions to try to determine the cause of the swelling, so it will help if you do a little investigating beforehand. For instance, if the swollen glands are in the jaw or neck area, check if your child’s teeth are tender or her gums are inflamed, and ask her if there is any soreness in her mouth or throat. Mention to your doctor any exposure your child has had to animals (especially cats) or wooded areas. Also check for any recent animal scratches, tick bites, or insect bites or stings that may have become infected.
The treatment for swollen glands will depend on the cause. If there’s a specific bacterial infection in nearby skin or tissue, antibiotics will clear it, allowing the glands gradually to return to their normal size. If the gland itself has an infection, it may require not only antibiotics but also warm compresses to localize the infection, followed by surgical drainage. If this is done, the material obtained from the wound will be cultured to determine the exact cause of the infection.
Doing this will help the doctor choose the most appropriate antibiotic. If your pediatrician cannot find the cause of the swelling, or if the swollen glands don’t improve after antibiotic treatment, further tests will be needed. For example, infectious mononucleosis might be the problem if your child has a fever and a bad sore throat (but not strep), is very weak, and has swollen (but not red, hot, or tender) glands, although mononucleosis occurs more often in older children. Special tests can confirm this diagnosis. In cases where the cause of a swollen gland is unclear, the pediatrician also may want to do a tuberculosis skin test.
If the cause of prolonged swelling of lymph nodes cannot be found in any other way, it may be necessary to perform a biopsy (remove a piece of tissue from the gland) and examine it under a microscope. In rare cases this may reveal a tumor or fungus infection, which would require special treatment.
The only swollen glands that are preventable are those that are caused by bacterial infections in the surrounding tissue. In cases of suspected infection, you can avoid involving the lymph nodes by properly cleaning all wounds and receiving early antibiotic treatment.