Lymph NodesWhat Is The Problem With This Bulge Behind The Ear & On...

What Is The Problem With This Bulge Behind The Ear & On The Neck In Children?

In everyday life, parents often unintentionally feel small bumps behind their child’s ears or at the back of the head near the neck, which kind of slide under the skin.

Some sizes are like soybeans, some are like peanuts, and all in all they are usually round and smooth. Look at the skin? No redness, and no other abnormalities. Parents are worried about touching it from time to time, but the child does not seem to be in pain or itchy. What in the end is this?

Some parents should have reacted here: is this a lymph node? That’s right! Today we will talk specifically about what is going on with the swollen Lymph nodes in the head and neck, and whether or not you need to worry about it.

1. Is Swollen Lymph Nodes in The Head & Neck Really That Common?

Swollen Lymph nodes in the neck can be found in more than 1/3 of healthy children and are often of a size that can be easily felt by parents. As shown in the picture, everyone has a number of lymph nodes hidden around the head and neck.

The areas marked by red circles are probably the areas where parents more often find enlarged lymph nodes.

2. Why are There Swollen Lymph Nodes in The Head & Neck?

The most common cause: viral upper respiratory tract infection.

Lymph nodes are like the command of immune cells, and when a child develops a respiratory infection, soldiers (lymphocytes) are first sent from the command to fight at the site of the infection.

However, since children’s immune system is often confronted with a completely new enemy (a virus that has not been encountered before), at the beginning of the battle the virus often prevails and not only knocks out all the soldiers at the infected site, but also chases them to the door and runs to the command to engage them, and at this time the lymph nodes become enlarged.

But don’t worry too much, for general viruses, as time advances, immune forces from other parts of the body will rush to join the battlefield and thus destroy the virus.

During an acute respiratory infection, the lymph nodes may feel a little swollen and painful to the touch, but this sensation usually disappears as the symptoms of the viral infection disappear.

However, it takes longer for an already swollen lymph node to return to its original state, often several weeks or even months. At this point, do not go to X degrees to scare yourself, because the water will boil at 100 degrees, people will die at 100 degrees ~

One of the common viral infections (HHV-6) – early childhood emergency rash, in the typical course of the disease when the fever subsides rash out, the back of the child’s head or behind the ear lymph nodes will be more obvious enlargement, but the pain is not obvious, with a certain diagnostic specificity.

Next common cause: bacterial infection

The enlarged lymph nodes are usually in the front of the neck and are mostly unilateral, often caused by staphylococcal and streptococcal infections.
The skin on the surface is often red, and the swollen and painful lymph nodes are more pronounced and may restrict the child’s neck rotation.
Sometimes the doctor can find other infections in related areas around the swollen and painful lymph nodes, such as tooth decay in the mouth or scalp infections.

Of course, there are some rare but alarming conditions that can present with swollen lymph nodes in the neck, such as Kawasaki disease, tuberculosis, and malignancy.

However, these diseases often have quite a few other more obvious symptoms that suggest swollen neck lymph nodes, and swollen neck lymph nodes are just one of the manifestations during a physical examination.

3. If a Child is Found to Have Swollen Lymph Nodes in The Head & Neck, Does He or She Need To See a Doctor Right Away?

It is recommended to see if the child is in pain first.

If the swollen lymph nodes are significantly painful to the touch, in most cases an acute infection has occurred and a doctor will need to come in for further evaluation.

If it is caused by a viral infection, there are usually swollen lymph nodes on both sides of the neck, and most of the time the surface skin is not red and the swelling and pain disappear more quickly. If the swollen lymph nodes last longer (more than 6 weeks), it may be some specific viral infection, such as EBV, cytomegalovirus, etc.

If it is caused by a bacterial infection, most of the surface skin will be red and the swelling and pain will be more pronounced. At this time it is more important for the doctor to check if other primary infections are also present.

For example, if you have tooth decay or swollen gums, the lymph nodes on the same side of your neck or jaw may also be swollen, and the swollen lymph nodes will not completely heal unless you get help from your dentist to address the tooth or gum problem first.

If the swollen lymph nodes do not cause pain, the situation is a little more complicated. It is recommended that a physician be consulted promptly if any of the following occurs.

  • the lymph nodes are more than 2 cm in diameter
  • the lymph nodes become significantly larger within 2 weeks
  • the lymph nodes do not become significantly smaller within 4-6 weeks
  • enlarged lymph nodes in the supraclavicular region
  • 2 or more enlarged lymph nodes throughout the body: head and neck, axillae, groin
  • the presence of other symptoms and manifestations: fever, weight loss, night sweats, unusual skin petechiae ecchymosis, the presence of teeth clenching or voice sound quality changes suggesting deep tissue infection in the head and neck.

If the above manifestations are present, they mostly suggest the presence of more serious local infections or systemic diseases, such as Kawasaki disease, rheumatic diseases, malignant tumors, etc.

If there is no such manifestation, the swollen lymph nodes after previous infection should be in the process of slow decreasing, parents can continue to observe at home.

4. If I Take My Child To The Doctor, What Kind of Tests & Treatment Will The Doctor Prescribe?

The doctor will first conduct a detailed consultation to learn the following information.

  • the length of time the enlarged lymph nodes have been found and the changes in the lymph nodes (epidermal color, presence of pain)
  • any recent acute infections: e.g. respiratory diseases, ear, nose and throat diseases, head, neck and facial skin diseases, oral diseases, etc.
  • history of animal contact: e.g. cat-scratch disease (Baltons disease)
  • history of BCG vaccination and contact with TB patients
  • history of other vaccinations: diphtheria, measles, mumps, rubella
  • any history of antibiotics and their efficacy.

The physical examination should first clarify the specific location, size, mobility, softness and hardness of the enlarged lymph nodes, and local epidermal changes.

It is necessary to determine whether the enlarged lymph nodes interfere with normal neck movement, whether there are infected lesions in other parts of the head and neck (e.g., scalp, face, ear canal, nasal cavity, throat, and teeth), and whether there are enlarged lymph nodes other than those in the head and neck.

The abdomen should be free of hepatosplenomegaly, and the skin should be free of unexplained rashes or bleeding in the mucous membrane.
If, through the above questioning and physical examination, the doctor assesses that the lymph nodes are benignly enlarged, then no further examination or treatment is needed and the parents can continue to observe the changes in lymph node size at home.

If there is any suspicious history or abnormal physical examination that worries the doctor, a venous blood test, sometimes a pharyngeal swab, or supplemental imaging (e.g., ultrasound of the neck, chest radiograph, or even CT), tuberculosis-related tests (e.g., tuberculin intradermal test), or even a lymph node biopsy are usually required.

Not all of these tests are necessarily needed, and doctors will often choose the test or tests that are most relevant to the diagnosis to help determine what is behind the swollen lymph nodes.

If the infection is bacterial, the doctor will choose to treat it with oral antibiotics and intravenous antibiotics. If this is not effective, sometimes a surgeon will need to help cut open the localized infected area to drain it. If it is a systemic disease, the doctor will issue a treatment plan for the primary cause based on the test results.

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