Lymphadenopathy in Children The child has lymph nodes

Lymphadenopathy in Children The child has lymph nodes that are abnormal in size, shape or character Is the lymphadenopathy localised to one anatomical region? Yes = Localised No = Generalised Has it started within the last 4 – 6 weeks? Yes = ACUTE LOCALISED No = CHRONIC LOCALISED Most likely to be caused by an infection and hence be selflimiting Still likely to be caused by an infection but may indicate a more serious pathogen, e. g. , TB, EBV Yes = ACUTE GENERALISED Likely to be the result of infection or medication • • • GREEN Lymphadenopathy secondary to • Viral infection – manage expectantly • Bacterial infection – consider po antibiotics • Systemic disease – treat the primary condition • Lymphadenitis – give po flucloxacillin AMBER Localised lymphadenopathy that persists for more than 6 weeks Refer to Paediatric Integrated Care Clinic for outpatient review and further investigation Acknowledgment to North Middlesex Hospital Paediatric Team; Version Draft April 2013 No = CHRONIC GENERALISED Usually indicates the presence of significant systemic disease Lymph nodes are non-tender, firm or hard Lymph nodes are >2 cm in size Lymph nodes are progressively enlarging Lymphadenopathy plus other features of general illhealth, fever or weight loss Involvement of axillary nodes without local infection or dermatitis Involvement of supraclavicular nodes Shortness of breath and lymphadenopathy, particularly if not responding to bronchodilators Generalised lymphadenopathy plus full blood count / blood film suggestive of a haematological malignancy An unexplained lump in the neck that has recently appeared / not been previously diagnosed and has changed over the past 3 – 6 weeks An unexplained persistent swelling in the parotid or submandibular gland RED If any of these are found Refer via 2 ww children’s cancer care pathway Or Discuss with Paediatric On-call Team AMBER If non of the above are found arrange urgent FBC, ESR, CRP and blood film Refer to Paediatric Integrated Care Clinic with results