Lymphadenitis

Advice intended for parent/carers taking their child home after seeing a healthcare professional

Lymphadenitis is inflammation (swelling) of the lymph nodes (glands) caused by infection. The lymph nodes are an important part of the immune system and contain cells which help to fight infection. An inflamed lymph node may be painful. The skin overlying it may be red and warm to touch.

Symptoms

• Fever may be present
• Warm, tender enlarged lymph node on one side (usually in the neck, but can also be in the arm pit or groin)
• Skin redness over the lymph nodes

Causes

Lymphadenitis in children often occurs in the neck area because these lymph nodes are close to the ears and throat, which are frequent locations of infections in children.

A single enlarged, painful lymph node is likely to be caused by bacterial infection, which will need antibiotic treatment. If your child has multiple swollen lymph nodes, this is more suggestive of a viral infection which is unlikely to require antibiotics.

Treatment

Lymphadenitis usually responds well to antibiotics. Treatment with intravenous antibiotics (given into a vein) is usually only needed for more severe cases or those that have not responded to antibiotics given by mouth.

Some children who need intravenous antibiotics are admitted to hospital initially whilst others can be looked after at home. These children would come into hospital once a day for someone to look at them and for their antibiotics to be given.

The decision on when to change from intravenous to oral antibiotics (tablets or liquid) will be made by the medical team caring for your child. This will depend on how quickly your child responds to treatment (improvement in fever, pain and sometimes their blood tests) and whether your child has other health conditions. Antibiotics are usually given for a total of 7 days. You can give regular pain relief (Paracetamol or Ibuprofen) until any discomfort has improved.

Complications

Children usually recover from lymphadenitis within 3-4 days, when given antibiotics. If your child is not responding to the antibiotic given, then further investigations may be required. This can be due to several reasons;

• Occasionally an abscess can form and may require surgical drainage
• Your child may have an infection caused by a less common bacteria and may need to change their antibiotic
• Despite antibiotics, the infection may not improve or can become worse

Most children recover without any complications. However, If you are concerned that your child's condition is getting worse within 48 hours, you should contact your discharging ward or otherwise contact primary care.

Things to look out for include:

• Fever
• Fast heart rate
• Fast breathing
• Changes in behaviour, such as confusion or disorientation
• Increase in pain
• Worsening or spreading of the cellulitis (redness on the skin)

Call 999 for an ambulance if you have serious concerns for your child.

Prevention of future episodes

It is not possible to prevent lymphadenitis, however, prompt review by a doctor and appropriate treatment can speed up recovery. It is important that your child completes their course of antibiotics, to prevent it from recurring.