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Swollen lymph nodes in child

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Hello!

We would like to ask about the condition related to our 3.5 year old daughter. Since mid of November she has had swollen lymphnodes under the jaw, the largest one being to 2.7 cm, one of 1.8 cm and some smaller ones as it was seen by the ultrasound. Yet the answer came that the nodes are just enlarged but they are without structural changes and without any abnormalities.

This all started with the bad cold but once the cold had passed, the nodes remained. In the end of December she got another cold and then we asked the nodes to be checked. Our pediatrician sais this is response to the colds, additionally she has very large tonsis which at some point were also very red.

To calm us down she referred us to haematologist. She did a bunch of blood tests and mostly these came back fine. Her CRP was mildly elevated but doctor said this is OK as it was only four days ago she had a bad cold and this was also when the antivbiotics were prescribed. Another tests showed Ebsten Barr Virus. Othwerwise the rest of the blood tests were all OK.

Now the node is still there, I mean the biggest one we can touch under the jaw. It is of an oval shape and perhaps has become a little smaller but not significantly, Now it is already 2.5 months since this all started.

Although the doctors say that these nodes are clearly reactive, we wanted to ask for a second opinion. Naturally we are scared to death of lymphoma and probably will remain nervous untill the node disappears. However, can this really last until spring once the weather returns back to normal and there is no viruses and colds going around...

With best regards
Kaido

Category: Oncologist

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Category: Hematologist
 23 Doctors Online

Dear Parent,

EBV infection is one of the commonest infections in children causing lymph node enlargement. Only a few cases of thousands affected with EBV changes to lymphoma and that too after a prolonged period of time. MOST OF THE VIRAL,INFECTIONS ARE VERY MUCH SELF LIMITING IN THIS AGE GROUP. PLEASE BE ASSURED THAT YOUR CHILD HAS A NORMAL INFECTION APPROPRIATE FOR THE AGE AND THE GLANDS ARE ENLARGED IN RESPONSE TO THE TONSILLAR ENLARGEMENT CONSISTENT WITH HER GOOD AND HEALTHY IMMUNE STATUS.

Mostly the child will be diagnosed to have adenotonsillitis in this age which is in response to her immune reactions against environmental infections. Many children will get this corrected by itself by 6 to 10 years without any treatment. Few may require antibiotics. Very minimal patients may require surgical removal of tonsils and adenoids after which the neck nodes will regress automatically.

SO PLEASE BE ASSURED THAT THIS NODE IS ENLARGED BECAUSE OF HER GOOD IMMUNITY LEVELS AND NOT BECAUSE OF LYMPHOMA. YOU CAN MEET YOUR ENT SURGEON AND GET HIS OPINION TOO

Happy to clear doubts if any.

Kind regards


Patient replied :

Thank you doctor! So to be clear to ourselves:

1) Does it mean the nodes can remain swollen untill the weather becomes normal and she picks up the daycare viruses or catches simple cold?

2) The fact in itself that one of them has been over 2.5 cm (was 2.7) and the have last for a longer period, it does not automatically indicate automatically cancer e.g. lymphoma? I just googled and these kind of seemed to be the red signs but I am surely no doctor.

On the other hand the oval shaped node seems to move nicely so it is not hard and stuck as it was also said...

With best regards,
Kaido


Hello Kaido,

You need to take consideration into the fact that lymph nodes are normal organ glands . They can be palpable at times, especially in the children. Sometimes it could be infection , sometimes inflammation or at times a normal phenomenon. There is nothing to worry about that. The child had a physical examination and blood tests. So there is no reason to be concerned . So it is possible that the node can remain enlarged until the winter is over / till the child grows up (as children and more prone to infection)

The enlarged node is not a red flag sign, if the general physical examination and the blood tests are normal. Persistent fever is a red flag sign. Bleeding spots is red flag sign, gum bleeding is a red flag sign. The only way to know for sure is a needle biopsy. But I feel it might be bit extreme approach. Prudent observation should be enough.

Hope this helps
Feel free to ask followups
Thank you


Patient replied :


I apologize, hope this would be one of the last questions. Today when brushing her teeth there was a very little bleeding from upper teeth. It looks more like an area where we have had some hygiene problems. It was not a massive bleeding, the brush picked ul some pink.

As you mentioned this would be a red flag, we wanted to check it out. I am sure i looki like a kind of not normal person, but this is truly freaking me out.

With kind regards
Kaido


Ok. To answer precisely, could you send me a picture of her mouth area where you suspect to have bleed ? Look for any abnormal area in mouth in the inner cheeks, behind the teeth and in between teeth and cheek.


Patient replied :

I could not really see anything abnormal but the bleed on the toothbrush came from the upper area we photographed.

The lymph node is still present under the jaw (but it is on the opposite side), oval shape and moves around pretty freely. Just the size i can not get when the chin is up, it feels bigger, when she faces downwards, it feels smaller.

not sure if you got the pictures?


Hello, thanks for the pics.

Everything looks normal to me.


Dr. Prasad Eswaran
Category: Hematologist
Experience: 
Doctorate in Medicine (Fellowship in Oncology), DM,  Madras Medical College & Govt. General Hospital, Chennai, India.

Doctor of Medicine (Residency in Radiation Oncology) , MD, Christian Medical College, Vellore, Tamilnadu, India, 2004-06.

Diploma in Medical Radiology & Therapy (Residency in Radiation Oncology), D.M.R.T, Madras Medical College & Govt. General Hospital, Chennai, India, 2004-06.

Bachelor of Medicine & Bachelor of Surgery - M.B.B.S, Govt. Stanley Medical College & Hospital, Chennai, India, 1998-2004.
Dr. Prasad Eswaran and 4 other Medical Specialists are ready to help you

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