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This guidance refers to children and young people up to 16th birthday, or 18th birthday if the young person prefers to be seen in a paediatric setting.
Lymphadenopathy is very common in children, and is usually reactive. It may rarely be the presenting feature of haematological malignancy or other serious condition.
Lymphadenopathy is defined as lymph nodes greater than 1 cm in diameter in all areas except groin where it is defined as lymph nodes greater than 1.5 cm in diameter. In practice, cervical lymph nodes of less than 2 cm are very unlikely to be pathological.
This guidance does not cover other presentations of cancer.
History should include:
Most lymph nodes need no investigation – Full blood count is rarely helpful.
Most enlarged lymph nodes require no treatment or investigation and simple reassurance is all that is required. Regular review is unlikely to be helpful, but a single review after 2-3 weeks is useful if a node is still enlarging.
If the lymph node is red and/or tender, and/or there is a short history with signs of infection, give 10 days of oral co-amoxiclav and arrange review, If the swelling is particularly large or fluctuant, or the child is systemically unwell, consider referral acutely.
Refer as below referral section.
It is important to definitively tell the child and family that this is not cancer. It may be helpful to get the carers to self-examine as it is normal for everyone to have some palpable lymph nodes. Reassure the child and family that the lymph node may persist, and will get bigger and smaller with intercurrent infections, and that this is "the immune system doing its job".
Including those referred under the 2 Week Wait rule:
Refer urgently by telephone, direct to the Attending Paediatric Consultant available via Switchboard on Bleep 340 or out-of-hours to the Consultant Paediatrician on-call. They will then advise if admission or other course of action is needed.
If not to be admitted, the clinician taking the call will take details of the patient to ensure that an out-patient appointment is booked without delay.
These may include:
If suspected acute bacterial lymphadenitis refer to acute paediatrics via the on-call team if not responded to oral antibiotics, systemic symptoms, fluctuant mass or very large (more than 5cm) swelling.
This guideline has been signed off by the Northern Locality on behalf of NEW Devon CCG.
Publication date: February 2017