Evaluation and management of lymphadenopathy in children

Palpable lymph nodes are common in children and may be a normal finding or a sign of serious disease. Because parents frequently are concerned about lymphadenopathy, the role of the primary care practitioner is to provide reassurance when appropriate and carry out a systematic evaluation when warranted. The history and physical examination frequently can elucidate the cause of the lymphadenopathy. Infectious diseases are the most common underlying cause, and antibiotics frequently are indicated if there is lymphadenitis. Generalized lymphadenopathy is less common than localized lymphadenopathy and occurs in the setting of systemic disease. Worrisome features of lymphadenopathy that should lead to additional evaluation and possible biopsy include supraclavicular location; size greater than 2 cm in a cervical lymph node; a hard, firm, or matted consistency of an enlarged lymph node; lack of associated infectious symptoms; lack of improvement over a 4-week period; and accompanying constitutional symptoms. CBC, ESR, and chest radiographs are inexpensive, useful screening tests that can aid the clinician in determining whether a biopsy should be performed.