Lymphadenopathy is very common in young children usually due to an intercurrent systemic viral infection or local infection.
Lymphadenopathy is more common in children under 5 years of age and generally less common in older/ teenage children.
More serious causes include: lymphoma , leukaemia, and chronic infections such as TB.
Key points in the history:
Presence of red flag symptom – see below
Age – higher degree of concern in older children > 5 years of age
Travel history
- Possible contact with infectious diseases eg TB – ask about living with / visits from relatives from a TB endemic area . Ask about recent travel to areas outside the UK especially to higher risk areas.
Possible reactive causes :
- Intercurrent or recent illness
- Dental hygiene problems
- Skin conditions
- Contact with pets eg cats / kittens
- For groin nodes – is the patient sexually active?
Red flag symptoms / clinical features: (?persistent = >4 weeks)
- Hepatosplenomegaly
- Persistent lethargy / malaise
- Persistent or unexplained bone pain
- Unexplained bruising, petechiae or unusual bleeding
- Persistent unexplained fever
- Unexplained weight loss
- Drenching night sweats
- Shortness of breath (in the absence of acute wheeze / asthma history)
- Persistent nocturnal/supine cough in the absence of coryzal symptoms
- Pruritis
We do not currently recommend any investigations in primary care in these children as these will be undertaken in secondary care if appropriate.
Who NOT to refer:
- Children with persistent small pea sized ( < 1 cm) lymph nodes , especially if infection is ongoing ( e.g. large tonsils, dental abscess , eczema or scalp dermatitis) in the absence of red flag symptoms.
- Reactive lymphadenopathy is common and normal. Small lymph nodes may persist indefinitely following viral illness and are not a cause for clinical concern, please reassure parents accordingly
Who to refer:
- Lymph node(s) persistent for more than 6 weeks and > 2 cms in size
- Lymph node(s) in an unusual site e.g. supraclavicular or axillary
- Lymph nodes which are increasing in size
- Presence of any red flag symptoms
Who to refer to:
Haematology/oncology service
- Presence of any red flag symptoms / clinical features, in addition to, enlarged lymph nodes should warrant urgent discussion with the haematology / oncology team via 0131 536 0000 – ask for haematology or oncology registrar: bleep 9290
- These patients will be triaged on the level of concern to either urgent haematology-oncology review or next day A&E review.
- A referral letter is required in either instance.
General paediatrics via SCI referral service
- Any well child with persistent lymphadenopathy > 2 cms in the absence of red flag symptoms
- Any child with persistent lymphadenopathy > 2 cm and a significant recent travel history ( any areas to specify ?)
- If you are uncertain about referral or need any further clinical advice then please contact the general paediatric consultant on call 0131 536 0000 bleep 9250 9 am to 5 pm
- Please do not send well children with persistent lymphadenopathy and no red flags to the Accident and Emergency Department
Investigations in primary care:
We do not currently recommend any investigations in primary care in these children as these will be undertaken in secondary care if appropriate.
