Adenopathy or lymphadenopathy in pediatrics: What you need to know

Adenopathy is inflammation of the glands that release sweat, tears or hormones. Typical adenopathy refers to the swelling of the lymph nodes, so-called lymphadenopathy.

In the human body, there are between 500 and 700 nodes, round or oval in shape, with a diameter between 3-6 mm, spread along the path of the lymphatic channels. They are part of the immune system, so their inflammation mainly occurs as a reaction of the body to viruses or bacteria, and less often they can be a reaction to more serious diseases.

Lymph nodes or nodes can be found on the surface of the body and can be palpated, or they can be located deeper and, in this case, can be highlighted by more thorough investigations.

What is adenopathy?

Adenopathy refers to lymph nodes that are abnormal in size, consistency, or number. Lymph nodes larger than 1.5 cm in diameter in the groin or 1 cm anywhere else on the body are considered suspicious. However, in practice, a lymph node up to 2 cm in diameter is unlikely to indicate severe pathology.

Lymphadenopathy is very common in children; it is estimated that approximately 50% of healthy children may develop this disease at some point.

In most cases, adenopathy is reactive, that is, a normal immune response to childhood infections such as colds or tonsillitis.

Localized swelling or fever may indicate bacterial lymphadenopathy, which requires antibiotics.

How adenopathy manifests itself in children

In the newborn, the lymph nodes are not palpable. They increase in size until puberty and regress in adulthood. Palpation of lymph nodes in the region in front of the ear, at the elbow or above the collarbone presents the risk of being pathological.

In children, ganglions with a diameter of up to 3 mm can be palpated in the occipital region or in the axilla, or 1 cm in the cervical and inguinal regions, without being pathological.

Adenopathies are not a disease in themselves, but are signs that suggest the presence of a disease:

• the presence of prolonged or recurrent fever, associated with inflammation of the ganglia: indicates the risk of infection or cancer;
• sore throat: indicates the presence of pharyngitis;
• bruising or epistaxis (nosebleeds): suggest leukemia;
• the presence of a generalized itching of the skin: this is a sign of Hodgkin’s disease.

Cervical adenopathy (in the neck region) is one of the most common causes of adenopathy. Most often, it occurs in infections of the pharynx and tonsils, mainly caused by viruses or bacteria. Children with Hodgkin’s disease present, in 80-90% of cases, inflamed nodes in the cervical region, compared to those with non-Hodgkin’s lymphoma, in which cervical adenopathies appear in only 40% of cases.

Axillary adenopathy consists of inflammation of the lymph nodes that drain the arm, lateral chest, abdominal wall, and lateral portion of the breast. One of the common causes of swollen lymph nodes at this level is cat scratch disease, local infections or irritations, recent vaccination in the arm, brucellosis and rheumatoid arthritis.

What are the causes of adenopathy?

In general, lymphadenopathy has infectious causes. This category includes measles, tonsillitis, ear infections, skin or tooth infections, which cause inflammation of the nearby ganglia. Once the infection is resolved, the lymph nodes return to their normal size.

Toxoplasmosis is an infectious-contagious disease, caused by Toxoplasma gondi, in which the increase in size of the nodes (laterocervical, supraclavicular, occipital, inguinal, axillary) is not so important, the lymph nodes are painless, soft or firm, mobile and do not suppurate never. Clinically, the disease manifests itself as a pseudo-influenza syndrome, with pain in the muscles, head and neck, fever, sometimes with the appearance of a skin rash.

Infectious mononucleosis or “kissing disease” is caused by the Epstein-Barr virus and is characterized by inflammation of the axillary, cervical or inguinal lymph nodes, hepato- and/or splenomegaly, fever, sore throat, jaundice or rash.

Tuberculosis is an infectious-contagious disease, caused by the Koch bacillus, with multiple localization, predominantly pulmonary. Nodular tuberculosis represents the location of the bacillary infection in the lymph nodes, which initially has an inflammatory character (periadenitis), then tumor. Subsequently, the ganglia may fistulae to the surface of the skin, leaving contractile scars.

Non-infectious causes, although rarer, are much more serious. This category includes cancers, rheumatoid arthritis, sarcoidosis, lupus, and reaction to certain medications.

When it is recommended to consult a specialist for your child

The emergency presentation to the pediatrician with the child suffering from adenopathy is done in the conditions where he has lost weight in the last period of time, has night sweats, is always tired or has a fever for a long time or bleeding or bruises, which even appear spontaneously.

The presence of inflamed lymph nodes signals an irregularity in the child’s body. Even if, most of the time, swelling of the ganglia means an infection, if it does not subside or is accompanied by other alarming symptoms, it is good to see a doctor.

Treatment for adenopathy

Normally, it is not the adenopathy that needs to be treated, but the cause that led to the swelling of the lymph nodes.

To reduce the local discomfort caused by the increase in volume of the lymph nodes, warm compresses can be applied at home and drugs that reduce pain and inflammation can be administered.

If there is a bacterial cause causing the lymphadenopathy, the doctor will prescribe antibiotics. However, they are not effective if the etiology of the inflammation is viral.

Serious causes of lymph node inflammation, such as autoimmune diseases or cancers, require an individualized treatment plan.

What you can do to prevent adenopathy in your child

The prevention of adenopathy in children coincides with the prevention of the causative disease. Therefore, the education of the whole family plays an important role in preventing diseases that could cause inflammation of the lymph nodes. The measures aim at:

• avoiding crowding;
• encouraging the child to wash his hands as often as possible;
• if the child is already sick, in order not to transmit the infection, he must not be taken to the community and must strictly follow the doctor’s recommendations;
• compliance with the vaccination schedule.