Lymphadenopathy

Please remember there is a Paediatric Clinical Mailbox that can be used for any non-urgent queries: clinical_paediatrics_crosshousehospital@aapct.scot.nhs.uk

• Palpable lymph nodes are common in children.
• Acutely enlarged lymph nodes are usually reactive.
• Often nodes may be felt for months or years due to the anatomy of the neck and groin, and a relative lack of subcutaneous tissue in children.
• Children with chronic skin conditions eg eczema may have longstanding widespread lymphadenopathy.

• Systemically unwell child.
• ‘B’ symptoms of:
  • lethargy
  • weight loss
  • night sweats.
• Unexplained bruising or petechiae.

Referrals to General Paediatrics should be made via SCI Gateway.

Please note, these are vetted in a timely manner so the priority status of a referral may change upon review.

Refer:-

• If concerning features are present.
• Persistent node for >6 weeks AND >1.5cm in size.
• Additional lymph nodes present such as axillary or supraclavicular in the absence of other underlying cause e.g. widespread eczema.
• Other findings on examination such as hepatosplenomegaly.
• Progressively increasing in size.

• Reassure is all that is required if a node is <1.5cm, even if it has persisted for several months.
• Antibiotics for the node itself are rarely indicated unless there is a strong suspicion of lymphadenitis.

Ruffle, A., Beattie, G., Prasai, A., Jeanes, A., & Paddock, M. (2022). Fifteen-minute consultation: A structured approach to the child with palpable cervical lymph nodes. Archives of Disease in Childhood- Education and Practice.
King, D., Ramachandra, J., & Yeomanson, D. (2014). Lymphadenopathy in children: refer or reassure?. Archives of Disease in Childhood-Education and Practice, 99(3), 101-110.